Artificial intelligence in healthcare: why not apply the medico-legal method starting with the Collingridge dilemma?

Technology has greatly influenced and radically changed human life, from communication to creativity and from productivity to entertainment. The authors, starting from considerations concerning the implementation of new technologies with a strong impact on people's everyday lives, take up Collingridge's dilemma and relate it to the application of AI in healthcare. Collingridge's dilemma is an ethical and epistemological problem concerning the relationship between technology and society which involves two approaches. The proactive approach and socio-technological experimentation taken into account in the dilemma are discussed, the former taking health technology assessment (HTA) processes as a reference and the latter the AI studies conducted so far. As a possible prevention of the critical issues raised, the use of the medico-legal method is proposed, which classically lies between the prevention of possible adverse events and the reconstruction of how these occurred.The authors believe that this methodology, adopted as a European guideline in the medico-legal field for the assessment of medical liability, can be adapted to AI applied to the healthcare scenario and used for the assessment of liability issues. The topic deserves further investigation and will certainly be taken into consideration as a possible key to future scenarios.

A National Typology of Health Service Regulation in Assisted Living

BACKGROUND AND OBJECTIVES

State-regulating agencies use 350 different licenses and certifications to govern assisted living (AL), resulting in significant variation in regulations governing health services, the scope of practice, and capacity. This lack of standardization makes it difficult to compare and contrast AL operations and residents' outcomes across similarly regulated communities.

RESEARCH DESIGN AND METHODS

We used qualitative and quantitative methods to empirically develop and describe a typology of state AL regulations that captures inter- and intrastate variation. Based on the rules governing health services, we created regulatory specificity scores for 5 thematic dimensions: medication administration, third-party care, skilled nursing, medication review, and licensed nurse staffing. With these scores, we conducted a K-means cluster analysis to identify groups of AL license types. To differentiate the regulatory types, we calculated standardized mean differences across structure, process, outcome, and resident characteristics of the AL communities licensed under each type.

RESULTS

We identified 6 types of AL differentiated by the regulatory provisions governing health services: Housing, Holistic, Hybrid, Hospitality, Healthcare, and Health Support. The types align with previous work and reflect tangible differences in resident characteristics, health service structures, processes, and outcomes.

DISCUSSION AND IMPLICATIONS

This typology effectively captures differences across regulated dimensions and can inform and support quality of care. Researchers, policy-makers, and consumers may benefit from using this typology and acknowledging these differences in AL licensure when designing research studies, developing policies, and selecting an AL community.

Healthcare workers' perspectives on the availability and use of mobile health technologies for disease diagnosis and treatment support in the Ashanti Region of Ghana

INTRODUCTION

Considering the usefulness of mobile health (mHealth) technologies in healthcare delivery in low- and middle-income countries, including Ghana; there is a need to explore healthcare professionals' perspectives on the availability and use of mHealth for disease screening and treatment of patients' conditions. The study's main aim is to explore healthcare professionals' perspectives regarding the availability and use of mHealth applications for disease screening and management at point-of-care in Ghana's Ashanti Region.

MATERIALS AND METHODS

We conducted in-depth interviews with healthcare professionals who use mHealth applications daily between July and September 2020. A purposive sampling strategy was employed to select healthcare professionals who have been using mobile health application tools to support healthcare delivery. The researchers conducted 14 in-depth interviews with healthcare professionals on the availability and use of mHealth applications to support disease diagnosis and treatment of patients' conditions. Data were transcribed, coded, arranged, and analyzed to determine categories and themes.

RESULTS

The study results demonstrated that healthcare workers had positive perceptions towards mHealth applications. Healthcare professionals identified significant challenges concerning mHealth applications: the high cost of data; lack of education or limited awareness; poor mobile networks; unstable internet connectivity; erratic power supply; and unavailability of logistics. Healthcare professionals identified the following prerequisite strategies to strengthen the use and scale-up of mHealth applications: stable internet connectivity; creating awareness; supplying logistics; reducing the cost of data; and developing local mobile apps.

CONCLUSIONS

The study results revealed the availability of mHealth applications at the individual level for disease screening and treatment support of patients' conditions. The study also showed several significant challenges facing mHealth applications which need to be addressed to guarantee the successful implementation and scaling-up of mHealth activities at all levels of healthcare delivery. Hence, future research should incorporate healthcare professionals' perspectives to completely understand mHealth implementation and scaling-up challenges and measures to inform policy regulations.

Operationalizing the Consolidated Framework for Implementation Research to build and support the lived experience workforce in direct health service provision

BACKGROUND

The involvement of people with lived experience (LEX) workers in the development, design, and delivery of integrated health services seeks to improve service user engagement and health outcomes and reduce healthcare gaps. Yet, LEX workers report feeling undervalued and having limited influence on service delivery. There is a need for systematic improvements in how LEX workforces are engaged and supported to ensure the LEX workforce can fully contribute to integrated systems of care.

OBJECTIVE

This study aimed to operationalize the Consolidated Framework for Implementation Research (CFIR) using a rigorous scoping review methodology and co-creation process, so it could be used by health services seeking to build and strengthen their LEX workforce.

SEARCH STRATEGY

A systematic literature search of four databases was undertaken to identify peer-reviewed studies published between 2016 and 2022 providing evidence of the inclusion of LEX workers in direct health service provision.

DATA EXTRACTION AND SYNTHESIS

A descriptive-analytical method was used to map current evidence of LEX workers onto the CFIR. Then, co-creation sessions with LEX workers (n = 4) and their counterparts-nonpeer workers (n = 2)-further clarified the structural policies and strategies that allow people with LEX to actively participate in the provision and enhancement of integrated health service delivery.

MAIN RESULTS

Essential components underpinning the successful integration of LEX roles included: the capacity to engage in a co-creation process with individuals with LEX before the implementation of the role or intervention; and enhanced representation of LEX across organizational structures.

DISCUSSION AND CONCLUSION

The adapted CFIR for LEX workers (CFIR-LEX) that was developed as a result of this work clarifies contextual components that support the successful integration of LEX roles into the development, design, and delivery of integrated health services. Further work must be done to operationalize the framework in a local context and to better understand the ongoing application of the framework in a health setting.

PATIENT OR PUBLIC CONTRIBUTION

People with LEX were involved in the operationalization of the CFIR, including contributing their expertise to the domain adaptations that were relevant to the LEX workforce.

Using the consolidated Framework for Implementation Research to integrate innovation recipients' perspectives into the implementation of a digital version of the spinal cord injury health maintenance tool: a qualitative analysis

BACKGROUND

Despite advances in managing secondary health complications after spinal cord injury (SCI), challenges remain in developing targeted community health strategies. In response, the SCI Health Maintenance Tool (SCI-HMT) was developed between 2018 and 2023 in NSW, Australia to support people with SCI and their general practitioners (GPs) to promote better community self-management. Successful implementation of innovations such as the SCI-HMT are determined by a range of contextual factors, including the perspectives of the innovation recipients for whom the innovation is intended to benefit, who are rarely included in the implementation process. During the digitizing of the booklet version of the SCI-HMT into a website and App, we used the Consolidated Framework for Implementation Research (CFIR) as a tool to guide collection and analysis of qualitative data from a range of innovation recipients to promote equity and to inform actionable findings designed to improve the implementation of the SCI-HMT.

METHODS

Data from twenty-three innovation recipients in the development phase of the SCI-HMT were coded to the five CFIR domains to inform a semi-structured interview guide. This interview guide was used to prospectively explore the barriers and facilitators to planned implementation of the digital SCI-HMT with six health professionals and four people with SCI. A team including researchers and innovation recipients then interpreted these data to produce a reflective statement matched to each domain. Each reflective statement prefaced an actionable finding, defined as alterations that can be made to a program to improve its adoption into practice.

RESULTS

Five reflective statements synthesizing all participant data and linked to an actionable finding to improve the implementation plan were created. Using the CFIR to guide our research emphasized how partnership is the key theme connecting all implementation facilitators, for example ensuring that the tone, scope, content and presentation of the SCI-HMT balanced the needs of innovation recipients alongside the provision of evidence-based clinical information.

CONCLUSIONS

Understanding recipient perspectives is an essential contextual factor to consider when developing implementation strategies for healthcare innovations. The revised CFIR provided an effective, systematic method to understand, integrate and value recipient perspectives in the development of an implementation strategy for the SCI-HMT.

TRIAL REGISTRATION

N/A.

Health Care AI and Patient Privacy-Dinerstein v Google

This Viewpoint summarizes a recent lawsuit alleging that a hospital violated patients’ privacy by sharing electronic health record (EHR) data with Google for development of medical artificial intelligence (AI) and discusses how the federal court’s decision in the case provides key insights for hospitals planning to share EHR data with for-profit companies developing medical AI.

Strategies to improve delivery of equitable and evidence-informed care for pregnant and birthing people with a substance use disorder in acute care settings: A scoping review protocol

This protocol outlines a proposed scoping review to characterize evidence on implementation and quality improvement (QI) strategies that aim to improve equitable, evidence-informed care delivery for pregnant and birthing people with substance use disorder (SUD) in acute care. Untreated SUD during pregnancy is associated with an increased risk of overdose and severe maternal morbidity. Acute care settings are one important place to deliver equitable, evidence-informed clinical care. While clinical practice guidelines for substance use treatment and care of pregnant and birthing people with SUD exist, there are gaps in implementation. Our population of interest is pregnant and birthing people with SUD in an acute care setting. We will include US-based studies that describe or evaluate implementation or QI strategies, including experimental, observational, and descriptive studies published from 2016 to 2023. The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews and registered at OSF (registration number: BC4VZ). We will search MEDLINE (PubMed), CINAHL Complete (EBSCO), Scopus (Elsevier), and APA PsychInfo (Ovid) for published studies. Conference proceedings and Perinatal Quality Collaborative websites will be searched for grey literature. Two reviewers will independently screen then extract studies that meet inclusion criteria using a data extraction tool. The completion of this scoping review will help illuminate strengths and gaps in research and practice that aim to inform substance use treatment and care in acute care settings for pregnant and birthing people with SUD.

The lived experience of chronic pain for Māori: how can this inform service delivery and clinical practice? A systematic review and qualitative synthesis

AIM

To synthesise the literature describing experiences of chronic pain and pain management for Māori, and to understand how this experience could inform service delivery and clinical practice.

METHOD

We systematically searched for qualitative research on Māori chronic pain experiences (Scopus, Medline, APA PsycINFO, NZ Research, Research Square). Data extracted were coded and synthesised using thematic analysis.

RESULTS

Seven studies were included. Three themes encapsulated the data: 1) a multidimensional view of pain and pain management: Māori expressed a holistic and integrated understanding of the multiple factors that influence pain and its management, 2) a responsibility: respectful tikanga-informed care: the experiences of Māori participants with healthcare highlight a need for antiracist approaches, and a clinical responsibility to practice manaakitanga and tikanga, and 3) tino rangatiratanga: a desire for knowledge, choice and autonomy in pain management: Māori valued the empowering nature of knowledge about pain, and information and support to make decisions about treatment, including considerations regarding Western and traditional Māori medicine.

CONCLUSION

Health services need to understand and respect the multidimensional aspects of pain, minimise racism and discrimination, use whakawhanaungatanga, manaakitanga, and tikanga-informed practices, and provide appropriate information to support tino rangatiratanga for pain management.

Experiences and learnings from developing and implementing a co-designed value-based healthcare framework within Victorian public oral health sector

Objective This study aimed to describe the development and implementation of a co-designed value-based healthcare (VBHC) framework within the public dental sector in Victoria. Methods A mixed-method study was employed. Explorative qualitative design was used to examine patient, workforce and stakeholder perspectives of implementing VBHC. Participatory action research was used to bring together qualitative narrative-based research and service design methods. An experience-based co-design approach was used to enable staff and patients to co-design services. Quantitative data was sourced from Titanium (online patient management system). Results Building a case for VBHC implementation required intensive work. It included co-designing, collaborating, planning and designing services based on patient needs. Evidence reviews, value-stream mapping and development of patient reported outcomes (PROMs) and patient reported experience measures (PREMs) were fundamental to VBHC implementation. Following VBHC implementation, a 44% lower failure to attend rate and 60% increase in preventive interventions was reported. A higher proportion of clinicians worked across their top scope of practice within a multi-disciplinary team. Approximately 80% of services previously provided by dentists were shifted to oral health therapists and dental assistants, thereby releasing the capacity of dentists to undertake complex treatments. Patients completed baseline International Consortium for Health Outcomes Measurement PROMs (n  = 44,408), which have been used for social/clinical triaging, determining urgency of care based on risk, segmentation and tracking health outcomes. Following their care, patients completed a PREMs questionnaire (n  = 15,402). Patients agreed or strongly agreed that: the care they received met their needs (87%); they received clear answers to their questions (93%); they left their visit knowing what is next (91%); they felt taken care of during their visit (94%); and they felt involved in their treatment and care (94%). Conclusion The potential for health system transformation through implementation of VBHC is significant, however, its implementation needs to extend beyond organisational approaches and focus on sustaining the principles of VBHC across healthcare systems, policy and practice.

AI Developers Should Understand the Risks of Deploying Their Clinical Tools, MIT Expert Says

This Medical News article is an interview with Marzyeh Ghassemi, a machine learning expert at the Massachusetts Institute of Technology who focuses on health care applications, and JAMA Editor in Chief Kirsten Bibbins-Domingo.

The Comparative Effectiveness and Provider-induced Demand Collaboration Project: A Pioneering Military-Civilian Academic Partnership to Build Health Services Research Capacity for the Military Health System

INTRODUCTION

Like civilian health systems, the United States Military Health System (MHS) confronts challenges in achieving the aims of reducing cost, and improving quality, access, and safety, but historically has lacked coordinated health services research (HSR) capabilities that enabled knowledge translation and iterative learning from its wealth of data. A military-civilian academic partnership called the Comparative Effectiveness and Provider-Induced Demand Collaboration (EPIC), formed in 2011, demonstrated early proof-of-concept in using the MHS claims database for research focused on drivers of variation in health care. This existing partnership was reorganized in 2015 and its topics expanded to meet the need for HSR in support of emerging priorities and to develop current and HSR capacity within the MHS.

MATERIALS AND METHODS

A Donabedian framework of structure, process, and outcomes was applied to support the project, through a core of principal investigators, researchers, analysts, and administrators. Within this framework, new researchers and student trainees learn foundations of HSR while performing secondary analysis of claims data from the MHS Data Repository (MDR) focusing on Health and Readiness, Pediatrics, Policy, Surgery, Trauma, and Women's Health.

RESULTS

Since 2015, the project has trained 25 faculty, staff, and providers; 51 students and residents; 21 research fellows across multiple disciplines; and as of 2022, produced 107 peer-reviewed publications and 130 conference presentations, across all five themes and six cores. Research results have been incorporated into Federal and professional policy guidelines. Major research areas include opioid usage and prescribing, value-based care, and racial disparities. EPIC researchers provide direct support to MHS leaders and enabling expertise to clinical providers.

CONCLUSIONS

EPIC, through its Donabedian framework and utilization of the MHS Data Repository as a research tool, generates actionable findings and builds capacity for continued HSR across the MHS. Eight years after its reorganization in 2015, EPIC continues to provide a platform for capacity building and knowledge translation.

The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review

BACKGROUND

Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use.

METHODS

We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered.

RESULTS

Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies.

CONCLUSIONS

Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.

Towards integrated mental health services in low-income and middle-income countries: organisation of primary healthcare providers - a scoping review protocol

INTRODUCTION

Mental health conditions constitute a significant percentage of the global burden of disease. A shortfall of mental health specialists and a lack of integration of services in primary care in low-income and middle-income countries (LMICs) contribute towards a mental health treatment gap in excess of 70%. Organising and equipping non-specialist healthcare workers is, therefore, an important strategy for improving access to mental health services in LMICs. This scoping review aims to map literature that addresses the organisation of and support provided to health teams in primary care settings within the context of integrated mental healthcare and as it relates to detection, treatment and referral of mental health conditions. The review will be guided by the 'Innovative Care for Chronic Conditions' framework.

METHODS AND ANALYSIS

This review protocol will employ the methodological framework first developed by Arksey and O'Malley and later advanced by others and will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews guidelines. This process will entail identifying the research questions, locating relevant literature, choosing eligible reports and studies, extracting the data and summarising the results in English-language studies and reports from 2008 to 2023 will be sourced from PubMed, CINAHL, Cochrane Library, PsycARTICLES, Scopus, Web of Science, Academic Search Complete and the WHO website. A two-stage screening of titles and abstracts, followed by full-text literature will be done in duplicate with blinded authors. Data extraction will be based on predefined fields.

ETHICS AND DISSEMINATION

All literature accessed for this scoping review is in the public domain and thus, no approval from an ethics review board is required. The findings of the scoping review report will inform future mental health research in LMIC and will be disseminated to relevant stakeholders and published in a peer-reviewed journal.

Integrated palliative care in oncology: a protocol for a realist synthesis

INTRODUCTION

Emerging evidence suggests improved quality of life, reduced symptom burden and lower health services costs when integrated palliative care and cancer care are implemented. Integrated palliative care aims to achieve care continuity by integrating organisational, administrative and clinical services involved in patient care networks. However, integrated palliative care for cancer is not common practice. This project, therefore, aims to understand how integrated palliative care and cancer care works in different healthcare settings (inpatient/outpatient), and for which groups of people (at what stage of the cancer journey), so we can develop guidance for optimal delivery.

METHODS AND ANALYSIS

We will conduct a realist synthesis to develop a programme theory of how integrated palliative care in cancer works, for whom and in what contexts to achieve improved symptom management and quality of life for patients and their families.This realist synthesis will follow the five stages outlined by Pawson: (1) locating existing theories, (2) searching for evidence, (3) article selection, (4) extracting and organising data and (5) synthesising the evidence and drawing conclusions. We will work closely with our expert stakeholder group, which includes health and social care professionals providing palliative care and oncology; management and policy groups and members of the public and patients. We will adhere to RAMESES quality standards for undertaking a realist synthesis.

ETHICS AND DISSEMINATION

Ethics approval for this project is not required.The realist synthesis will develop a programme theory that provides clarity on the optimal delivery of palliative care for adults with cancer. We will use the programme theory to coproduce guidance and user-friendly outputs, working with stakeholders to inform delivery of best practice. Findings will inform further research in integrated palliative care and cancer. Stakeholder engagement will assist in the dissemination of our findings.

PROSPERO REGISTRATION NUMBER

CRD42023389791.

Research on the barriers to accessing sexual healthcare for sexually diverse Muslim men: protocol for a scoping review

INTRODUCTION

Sexually diverse Muslim men are seen to be at a higher risk for HIV and other sexually transmitted infections due to their limited access to sexual healthcare services. We outline a protocol to conduct a scoping review of research on the barriers that may impede these men's access to sexual healthcare.

METHODS AND ANALYSIS

To conduct this scoping review, we will follow the methodological framework developed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses' extension for scoping reviews. To classify the barriers to sexual healthcare, we will employ Bronfenbrenner's socioecological model as a conceptual framework. We will conduct a literature search via Medline, Embase and Global Health (OVID); Scopus; CINAHL on EBSCOhost along with several other EBSCOhost databases (Academic Search Complete, Canadian Reference Centre, Alternative Press Index, Family & Society Studies Worldwide, Social Work Abstracts) and Google Scholar, published until November 2023. Journal articles, published in the English language, describing quantitative and qualitative research on sexual healthcare access barriers for sexually diverse Muslim men will be included in the review. Commentaries and correspondences, along with grey literature including research reports and conference abstracts, as well as studies that do not include men with the Muslim faith, will be considered ineligible. Following screening of titles and abstracts, we will conduct a full-text screening to determine the final number of studies to be included in the review. A Microsoft Excel spreadsheet will be used to extract study characteristics, and information on sexual healthcare access barriers will be classified according to the socioecological model's core concepts.

ETHICS AND DISSEMINATION

Our review does not require ethics approval. We will disseminate the review findings through peer-reviewed academic journals, seminars and conference presentations.

PUFchain 3.0: Hardware-Assisted Distributed Ledger for Robust Authentication in Healthcare Cyber-Physical Systems

This article presents a novel hardware-assisted distributed ledger-based solution for simultaneous device and data security in smart healthcare. This article presents a novel architecture that integrates PUF, blockchain, and Tangle for Security-by-Design (SbD) of healthcare cyber-physical systems (H-CPSs). Healthcare systems around the world have undergone massive technological transformation and have seen growing adoption with the advancement of Internet-of-Medical Things (IoMT). The technological transformation of healthcare systems to telemedicine, e-health, connected health, and remote health is being made possible with the sophisticated integration of IoMT with machine learning, big data, artificial intelligence (AI), and other technologies. As healthcare systems are becoming more accessible and advanced, security and privacy have become pivotal for the smooth integration and functioning of various systems in H-CPSs. In this work, we present a novel approach that integrates PUF with IOTA Tangle and blockchain and works by storing the PUF keys of a patient's Body Area Network (BAN) inside blockchain to access, store, and share globally. Each patient has a network of smart wearables and a gateway to obtain the physiological sensor data securely. To facilitate communication among various stakeholders in healthcare systems, IOTA Tangle's Masked Authentication Messaging (MAM) communication protocol has been used, which securely enables patients to communicate, share, and store data on Tangle. The MAM channel works in the restricted mode in the proposed architecture, which can be accessed using the patient's gateway PUF key. Furthermore, the successful verification of PUF enables patients to securely send and share physiological sensor data from various wearable and implantable medical devices embedded with PUF. Finally, healthcare system entities like physicians, hospital admin networks, and remote monitoring systems can securely establish communication with patients using MAM and retrieve the patient's BAN PUF keys from the blockchain securely. Our experimental analysis shows that the proposed approach successfully integrates three security primitives, PUF, blockchain, and Tangle, providing decentralized access control and security in H-CPS with minimal energy requirements, data storage, and response time.

How to Navigate the Pitfalls of AI Hype in Health Care

In this Medical News article, Arvind Narayanan, PhD, a professor of computer science at Princeton University, discusses the benefits of using artificial intelligence in research and clinical settings while remaining cautious of hype, biases, and data privacy issues.

Will Generative Artificial Intelligence Deliver on Its Promise in Health Care?

Importance

Since the introduction of ChatGPT in late 2022, generative artificial intelligence (genAI) has elicited enormous enthusiasm and serious concerns.

Observations

History has shown that general purpose technologies often fail to deliver their promised benefits for many years ("the productivity paradox of information technology"). Health care has several attributes that make the successful deployment of new technologies even more difficult than in other industries; these have challenged prior efforts to implement AI and electronic health records. However, genAI has unique properties that may shorten the usual lag between implementation and productivity and/or quality gains in health care. Moreover, the health care ecosystem has evolved to make it more receptive to genAI, and many health care organizations are poised to implement the complementary innovations in culture, leadership, workforce, and workflow often needed for digital innovations to flourish.

Conclusions and Relevance

The ability of genAI to rapidly improve and the capacity of organizations to implement complementary innovations that allow IT tools to reach their potential are more advanced than in the past; thus, genAI is capable of delivering meaningful improvements in health care more rapidly than was the case with previous technologies.

And what about today? Burden and support needs of adolescent childhood cancer survivors in long-term follow-up care-A qualitative content analysis

PURPOSE

Childhood cancer affects approximately 2000 children annually in Germany, and there is an increasing number of long-term childhood cancer survivors. Due to developmental tasks, adolescent survivors in long-term follow-up (LTFU) care may face specific challenges and perceive different burden due to their disease. The current study explored (a) the impact of cancer and burden regarding survivorship and (b) supportive needs of adolescent childhood cancer survivors in LTFU care.

METHODS

Semistructured qualitative interviews were conducted with 18 adolescent childhood cancer survivors in LTFU care aged 14-18 years (average age 16.4 years). Interviews were transcribed verbatim and analysed using content analysis.

RESULTS

Based on the exploratory research questions, two key categories were generated: (1) The impact and burden on survivors' lives during LTFU care and (2) support needs of adolescent childhood cancer survivors in LTFU care. The four subcategories that emerged regarding the impact and burden on survivors' lives during LTFU care were (1) physical consequences, (2) cognitive impairments, (3) difficulties in social interactions, and (4) psychosocial burden. Additionally, two subcategories, (1) practical and (2) emotional support needs of adolescent childhood cancer survivors were identified.

CONCLUSIONS

Our results indicate that childhood cancer influences adolescent survivors' life in a negative way even many years after the end of treatment. Furthermore, parents seem to play a crucial role in the survivorship experience of childhood cancer survivors, as they remain keep responsible for most cancer-related concerns even during LTFU care, causing adolescents to persist in the child role. A family systemic approach to care is suggested to facilitate development-specific tasks and to enable adolescents to become autonomous adults. Still, the question remains as to who in the health care system could take over the family systemic tasks.

Use of Tokens to Unlock Greater Data Sharing in Health Care

This Viewpoint discusses the use of privacy-preserving record linkage, a token-based record linkage system, as a promising avenue for building a data infrastructure system that bridges isolated data.

Improving integrated depression and non-communicable disease care in Malawi through engaged leadership and supportive implementation climate

BACKGROUND

Low- and middle-income countries often lack access to mental health services, leading to calls for integration within other primary care systems. In sub-Saharan Africa, integration of depression treatment in non-communicable disease (NCD) settings is feasible, acceptable, and effective. However, leadership and implementation climate challenges often hinder effective integration and quality of services. The aim of this study was to identify discrete leadership strategies that facilitate overcoming barriers to the integration of depression care in NCD clinics in Malawi and to understand how clinic leadership shapes the implementation climate.

METHODS

We conducted 39 in-depth interviews with the District Medical Officer, the NCD coordinator, one NCD provider, and the research assistant from each of the ten Malawian NCD clinics (note one District Medical Officer served two clinics). Based on semi-structured interview guides, participants were asked their perspectives on the impact of leadership and implementation climate on overcoming barriers to integrating depression care into existing NCD services. Thematic analysis used both inductive and deductive approaches to identify emerging themes and compare among participant type.

RESULTS

The results revealed how engaged leadership can fuel a positive implementation climate where clinics had heightened capacity to overcome implementation barriers. Effective leaders were approachable and engaged in daily operations of the clinic and problem-solving. They held direct involvement with and mentorship during the intervention, providing assistance in patient screening and consultation with treatment plans. Different levels of leadership utilized their respective standings and power dynamics to influence provider attitudes and perceptions surrounding the intervention. Leaders acted by informing providers about the intervention source and educating them on the importance of mental healthcare, as it was often undervalued. Lastly, they prioritized teamwork and collective ownership for the intervention, increasing provider responsibility.

CONCLUSION

Training that prioritizes leadership visibility and open communication will facilitate ongoing Malawi Ministry of Health efforts to scale up evidence-based depression treatment within NCD clinics. This proves useful where extensive and external monitoring may be limited. Ultimately, these results can inform successful strategies to close implementation gaps to achieve integration of mental health services in low-resource settings through improved leadership and implementation climate.

TRIAL REGISTRATION

These findings are reported from ClinicalTrials.gov, NCT03711786. Registered on 18/10/2018. https://clinicaltrials.gov/ct2/show/NCT03711786 .

Exploring how members of the public access and use health research and information: a scoping review

BACKGROUND

Making high-quality health and care information available to members of the general public is crucial to support populations with self-care and improve health outcomes. While attention has been paid to how the public accesses and uses health information generally (including personal records, commercial product information or reviews on healthcare practitioners and organisations) and how practitioners and policy-makers access health research evidence, no overview exists of the way that the public accesses and uses high quality health and care information.

PURPOSE

This scoping review aimed to map research evidence on how the public accesses and uses a specific type of health information, namely health research and information that does not include personal, product and organisational information.

METHODS

Electronic database searches [CINAHL Plus, MEDLINE, PsycInfo, Social Sciences Full Text, Web of Science and SCOPUS] for English language studies of any research design published between 2010-2022 on the public's access and use of health research or information (as defined above). Data extraction and analysis was informed by the Joanna Briggs Institute protocol for scoping reviews, and reported in accordance with the PRISMA extension for scoping reviews.

RESULTS

The search identified 4410 records. Following screening of 234 full text studies, 130 studies were included. One-hundred-and-twenty-nine studies reported on the public's sources of health-research or information; 56 reported the reasons for accessing health research or information and 14 reported on the use of this research and information. The scoping exercise identified a substantial literature on the broader concept of 'health information' but a lack of reporting of the general public's access to and use of health research. It found that 'traditional' sources of information are still relevant alongside newer sources; knowledge of barriers to accessing information focused on personal barriers and on independent searching, while less attention had been paid to barriers to access through other people and settings, people's lived experiences, and the cultural knowledge required.

CONCLUSIONS

The review identified areas where future primary and secondary research would enhance current understanding of how the public accesses and utilises health research or information, and contribute to emerging areas of research.

Scoping review of African health histories: a protocol

INTRODUCTION

The history of African health is closely entwined with the history of the continent itself-from precolonial times to the present day. A study of African health histories is critical to understanding the complex interplay between social, economic, environmental and political factors that have shaped health outcomes on the continent. Furthermore, it can shed light on the successes and failures of past health interventions, inform current healthcare policies and practices, and guide future efforts to address the persistent health challenges faced by African populations. This scoping review aims to identify existing literature on African health histories.

METHODS AND ANALYSIS

The Arksey and O'Malley's framework for conducting scoping reviews will be utilised for the proposed review, which will be reported in compliance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The main review question is 'What literature exists on the history of health practices and healthcare delivery systems in Africa from the precolonial era through to the sustainable development goal era?' Keywords such as Africa, health and histories will be used to develop a search strategy to interrogate selected databases and grey literature repositories such as PubMed, Scopus, Web of Science and WHOLIS. Two authors will independently screen titles and abstracts of retrieved records. One author will extract data from articles that meet the inclusion criteria using a purposively designed data charting. The data would be coded and analysed thematically, and the findings presented narratively.

ETHICS AND DISSEMINATION

The scoping review is part of a larger project which has approval from the WHO AFRO Ethics Research Committee (Protocol ID: AFR/ERC/2022/11.3). The protocol and subsequent review will be submitted to the integrated African Health Observatory and published in a peer-reviewed journal.

REGISTRATION DETAILS

https://osf.io/xsaez/.

Training programmes for healthcare professionals in managing postoperative epidural analgesia: A scoping review protocol

BACKGROUND

Epidural analgesia is an effective technique advocated worldwide for postoperative analgesia after a wide range of surgical procedures. Despite the benefits of epidural analgesia for pain management, systematic education of ward nurses in managing epidural analgesia appears to be lacking.

METHODS

The aim of the proposed scoping review is to map the body of evidence and identify training programmes for healthcare professionals in the safe management of postoperative epidural analgesia. The methodology will follow the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). In addition, the five main steps set forth by Arksey and O'Malley and refined by Levac for guidance of the process will be used. The scoping review will include any study design of any date, design, setting and duration.

RESULTS

We will present results descriptively, accompanied with visual presentations as tables and graphs.

CONCLUSION

The outlined scoping review will provide an overview of existing training programmes for healthcare professionals in the safe management of postoperative epidural analgesia and map the body of available evidence on the topic. The study may support the development of a training programme for ward nurses caring for patients receiving postoperative epidural analgesia.

Use of Telemedicine for Children in Foster Care

Introduction: Telemedicine studies specific to children in foster care are needed, given unique health care needs and barriers. It is important to utilize lessons learned from telemedicine programs deployed by necessity during the COVID-19 emergency. Objectives: Describe telemedicine health assessments for children in foster care performed during the COVID-19 pandemic. Compare medical recommendations resulting from telemedicine and in-person assessments. Methods: After navigating barriers specific to children in foster care including consent issues, we implemented a telemedicine program at our specialty clinic for children in foster care when in-person visits were restricted. Outcomes of telemedicine referrals were tracked. After each visit, physicians were asked to rate ability to express themselves, hear and see patients from 1 (strongly disagree) to 5 (strongly agree) using items from the validated Telehealth Usability Questionnaire. Recommendations for laboratory work, medication, and health services referrals were recorded and compared with 205 patients seen in-person the year prior. Results: From 91 referrals, 83 (91%) children with a mean age of 9 years completed telemedicine visits. Physicians rated receptive and expressive communications more favorably than visual quality. Most telemedicine patients (77%) received a referral for health care services but had significantly lower rates of laboratory work completion, vision referrals, and prescriptions for new medications compared with 205 patients seen in-person. Conclusions: Results suggest that telemedicine was accessible to most patients and highlighted essential in-person components of comprehensive health assessments. Findings could inform ongoing telemedicine applications and advocacy for underserved populations.

Comparison of Different Telemedicine Services to Pre-Evaluate Their Use in a New "Computational Hospital"

Future healthcare is transitioning toward a decentralization of patient care, in which personal care is increasingly moved at the patient home and surrounding areas, while hospitals concentrate primarily on procedures that cannot be performed elsewhere, such as surgeries or outpatient examinations. The healthcare system in the Liguria region (Italy) is currently developing a new Center for Computational and Technological Medicine (CMCT), which is intended to facilitate and support this transition. As a component of the strategic planning and design process, this study examines the development and organization of telemedicine services across a range of chosen Italian and European institutions that share similarities with CMCT in terms of scope and scale. We specifically focus on telemedicine services - how they are governed, their main fields of application. The analysis confirmed the growing importance of telemedicine as part of the new vision of medicine, in which the patient is at the center.

The End of the X-waiver: Excitement, Apprehension, and Opportunity

With the passage of the MAT act (Mainstreaming Addiction Treatment) and the MATE Act (Medication Training and Expansion), the Drug Enforcement Agency "X-waiver" program governing the office-based prescription of buprenorphine for opioid use disorder has been immediately eliminated. The move was championed by vocal organizations with a rightful concern about buprenorphine access but was opposed by most physicians. Nonetheless, buprenorphine can now be prescribed like any schedule 3 medication. Studies show that despite rising opioid overdoses, buprenorphine prescription increases have been slow to rise and are particularly absent in rural communities. The elimination of the X-waiver may theoretically improve buprenorphine prescribing rates for opioid use disorder in rural areas, by nurse practitioners and physician assistants, and by resident physicians in teaching programs. It may also help decrease discrimination against individuals with opioid use disorder in postacute-care settings like nursing homes, physical rehabilitation centers, and in prisons and jails. Concerns include the elimination of the only focused opioid use disorder education many physicians receive (X-waiver courses) and a literature base showing that interest, rather than the X-waiver itself, remains the biggest barrier to recruiting more buprenorphine prescribers. Concerns also exist over the harms of precipitated withdrawal when buprenorphine is initiated inappropriately. The change of the elimination of the X-waiver brings about a new opportunity for Family Medicine and its parent organizations to champion the inclusion of opioid use disorder treatment within the chronic disease care models well-known to our integrated care settings.

Translating medical device innovations to market - a Ugandan perspective

There is a disparity between low and middle-income countries (LMICs) and high-income countries (HICs) in translating medical device innovations to the market, affecting health care service delivery. Whereas medical technologies developed in HICs face substantial challenges in getting to the bedside, there are at least clear pathways in most of the major markets, such as the UK, the EU, and the USA. Much less is known about the challenges that innovators of medical technologies face in LMICs. The aim of this study was to map out current bottlenecks in medical device innovation in Uganda, a LMIC in Sub-Saharan East Africa.A cross-sectional survey was carried out using a digital questionnaire. Twenty-one individuals completed the questionnaire, with the majority being medical device innovators (n = 12). Only one of these had undertaken all the innovation stages, up to clinical validation. Very few innovators had established companies, and/or acquired intellectual property. It is evident from similar studies that challenges in medical device translations are multidimensional, and hence interdisciplinary collaborations are key to accelerating translation processes, especially for LMICs.

A call for digital inclusion initiatives in mental health services: An integrative review

WHAT IS KNOWN ON THE SUBJECT?: Digital tools such as video calls or mobile phone applications (apps) are increasingly used in the provision of mental healthcare. There is evidence that people with mental health problems are more likely to face digital exclusion: that is, they do not have access to devices and/or skills to use technology. This leaves some people unable to use digital mental health services (e.g., apps or online appointments) or to benefit more generally from access to the digital world (e.g., online shopping or connecting with others virtually). People can be digitally included through initiatives that provide devices, Internet and digital mentoring to increase knowledge and confidence when using technology. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Some initiatives in academic studies and grey literature have been shown to increase access to and knowledge of technology, but this has been outside of mental health care settings. There are currently limited digital inclusion initiatives that take into consideration the specific needs of people with mental health problems, and how they can be equipped and familiarised with digital technologies to help their recovery journey and everyday life activities. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further work is needed to improve the provision of digital tools in mental health care, with more practical digital inclusion initiatives to ensure equal access for all. If digital exclusion is not addressed, the gap between people with and those without digital skills or access to technology will continue to grow, enlarging mental health inequalities.

ABSTRACT

INTRODUCTION: The rise in the provision of digital healthcare during the pandemic has called attention to digital exclusion: inequality in access and/or capacity to use digital technologies. Digital exclusion is more profound in people with mental health problems, leaving an implementation gap of digital practice in mental health services.

AIM

Identify the available evidence of (a) addressing digital exclusion in mental health care and (b) the practical solutions to enhance uptake of digital mental health.

METHOD

Digital inclusion initiatives were searched from both academic and grey literature available and published between the years 2007 and 2021.

RESULTS

A limited number of academic studies and initiatives were found that supported people with mental health difficulties who had limited skills and/or access to overcome digital exclusion.

DISCUSSION

Further work is needed to combat digital exclusion and establish ways to reduce the implementation gap in mental health services.

IMPLICATIONS FOR PRACTICE

Access to devices, Internet connectivity and digital mentoring for mental health service users is essential. More studies and programmes are needed to disseminate impact and results for digital inclusion initiatives for people with mental health problems and to inform best practice for digital inclusion within mental health services.

The COVID-19 Pandemic and the Private Health Sector: Profiting without Socially Contributing

The COVID-19 pandemic necessitated the mobilization of all available health care resources, including private, for-profit ones. The aim of this multiple methods study (combination of document and secondary data analysis) was to assess government regulations facilitating the private health sector's participation in the COVID-19 response in Greece. During the pandemic, the government made three successive increases in private providers' reimbursement fees, provided additional financial incentives to private providers, and allocated €280 million of emergency funding for the private sector's involvement in the national COVID-19 response. In response, private hospitals made available on average 2.2% of their total bed capacity per epidemic wave for the treatment of COVID-19 patients and 1.7% of their total bed capacity for the treatment of non-COVID-19 patients transferred from National Health System (NHS) hospitals. In 2020 the five largest health care corporate groups maintained their revenues, while in 2021 they increased them by 18.7%-a striking comparison with the 9% recession experienced by the Greek economy in 2020 and its 8.4% recovery in 2021. In a time of an acute public health crisis, private health care providers responded to society's pressing health care needs by insulating their facilities from COVID-19 patients and NHS patient transfers, minimizing their social contribution and safeguarding their revenues and profits.

Conceptualising relational care from an Indigenous Māori perspective: A scoping review

OBJECTIVE

To identify and describe the attributes of relational care from an Indigenous Māori healthcare consumer perspective.

DATA SOURCES

CINAHL Plus, Ovid MEDLINE, ProQuest Nursing & Allied Health, Scopus, New Zealand Index, the Ministry of Health Library, New Zealand Research and Google Scholar were searched between 23 and 30 May 2022.

METHODS

This scoping review used the Joanna Briggs Institute methodology for scoping reviews, thematic analysis and the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework for the synthesis of the findings.

RESULTS

A total of 1449 records were identified, and 10 sources were selected for final review. We identified five relational attributes that were most important to Māori: (1) the expressive behaviours and characteristics of healthcare professionals (HCPs), (2) communication to facilitate the healthcare partnership, (3) appreciating differing worldviews, (4) the context in which healthcare is delivered and (5) whanaungatanga (meaningful relationships).

CONCLUSION

The relational attributes identified are inextricably linked. Connecting with HCPs and developing a therapeutic relationship is fundamental to improving consumer experience and engagement with mainstream healthcare services. Whanaungatanga is fundamental to meaningful engagements with HCPs. Future research should explore how relational care is practiced in acute care settings when clinician-consumer interactions are time-limited, examine how the health system influences the capacity for relational care and how Indigenous and Western paradigms can co-exist in healthcare.

IMPLICATIONS

This scoping review can inform future projects addressing health equity for Indigenous communities by creating environments that prioritise culturally safe relational care and value Indigenous knowledge systems.

REPORTING METHOD

We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

NO PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Reasons for Not Pursuing Virtual Prenatal Care in 2020 Through 2021 and Policy Implications

Aim: To investigate patterns of virtual prenatal visits and examine reasons for not pursuing virtual visits for prenatal care. Methods: A pooled cross-sectional study used Pregnancy Risk Assessment Monitoring System from October 2020 through June 2021, a nationally representative surveillance system targeted at women who recently gave live birth. Individuals (n = 11,829) who reported their prenatal care experiences were included. A modified poison regression estimated prevalence ratios for virtual prenatal visits and reasons for not using virtual services. Results: One-third of participants used virtual prenatal care. Hispanics were more likely to use virtual prenatal care than whites. Compared with college graduates, those with high school graduation (Prevalence Ratios [PR] 0.87, 95% confidence interval [CI] 0.76-0.99; p = 0.033) or some college education (PR 0.86, 95% CI 0.77-0.96; p = 0.009) were less likely to use virtual visits. A preference for in-person was the most common reason for not pursuing virtual visits (77.1%), followed by no available virtual appointments (29.5%), technology barriers (6.1%), and no private space (1.7%). Individuals with less than or with high school graduation had 4.16 times (95% CI 2.32-7.46; p ≤ 0.001) and 2.72 times (95% CI 1.67-4.43; p ≤ 0.001) greater technology barriers, and 10.03 times (95% CI 3.42-29.46; p ≤ 0.001) and 4.29 times (95% CI 1.56-11.80; p = 0.005) greater likelihood of lacking private space, respectively, while they had a lesser in-person preference. Conclusions: In a disrupted health care landscape, barriers to accessing virtual prenatal care may have further exacerbated access to care and effective management of pregnancy among those underserved. The findings provide practical implications for safe and effective prenatal care.

Artificial intelligence in mental healthcare: an overview and future perspectives

Artificial intelligence is disrupting the field of mental healthcare through applications in computational psychiatry, which leverages quantitative techniques to inform our understanding, detection, and treatment of mental illnesses. This paper provides an overview of artificial intelligence technologies in modern mental healthcare and surveys recent advances made by researchers, focusing on the nascent field of digital psychiatry. We also consider the ethical implications of artificial intelligence playing a greater role in mental healthcare.

Coronavirus disease and home recovery: a Singapore perspective

Objective

At the beginning of the coronavirus disease (COVID-19) pandemic in Singapore, the strategy initially involved aggressive ring-fencing of infections, before pivoting towards managing recurrent local interspersed outbreaks of COVID-19. A key feature of Singapore's efforts to preserve health-care capacity was the implementation of the nationwide Home Recovery Programme (HRP), whereby patients were allowed to recover at home as long as they met certain criteria. The programme was centrally coordinated by Singapore's Ministry of Health and was supported by telemedicine providers, primary care physicians and government agencies. This report aims to highlight Singapore's experience in coordinating and implementing the HRP, the challenges faced and the outcomes.

Methods

Published and internal data from the Ministry of Health in Singapore, along with policy documents, were reviewed together with a brief literature review of similar programmes conducted globally.

Results

Implementation of the HRP led to the majority of patients (98%) recovering from COVID-19 in the outpatient setting, with similar mortality rates to inpatient settings. Hospitalization rates for COVID-19 cases were reduced as compared to previously, alleviating strain on the health-care system.

Discussion

The HRP was largely successful at preventing health-care capacities from being overwhelmed, while keeping fatalities to a minimum. Nonetheless, the risks of emergent variants of concern remain present, and heightened vigilance and potential modification of existing protocols based on fluctuations in virulence and infectivity are still needed.

Task shifting and task sharing in the health sector in sub-Saharan Africa: evidence, success indicators, challenges, and opportunities

This review explores task shifting and task sharing in sub-Saharan African healthcare to address workforce shortages and cost-effectiveness. Task shifting allocates tasks logically, while task sharing involves more workers taking on specific duties. Challenges include supply chain issues, pay inadequacy, and weak supervision. Guidelines and success measures are lacking. Initiating these practices requires evaluating factors and ensuring sustainability. Task shifting saves costs but needs training and support. Task sharing boosts efficiency, enabling skilled clinicians to contribute effectively. To advance task shifting and sharing in the region, further research is needed to scale up effective initiatives. Clear success indicators, monitoring, evaluation, and learning plans, along with exploration of sustainability and appropriateness dimensions, are crucial elements to consider.

Shared decision-making in healthcare in mainland China: a scoping review

Background

Shared decision-making (SDM) facilitates the participation of healthcare professionals and patients in treatment decisions. We conducted a scoping review to assess SDM's current status in mainland China, referencing the Ottawa Decision Support Framework (ODSF).

Methods

Our review encompassed extensive searches across six English and four Chinese databases, and various gray literature until April 30, 2021. Results were synthesized using thematic analysis.

Results

Out of the 60 included studies, we identified three key themes based on the ODSF framework: decisional needs, decision support, and decisional outcomes. However, there appears to be a lack of comprehensive understanding of concepts related to decisional needs in China. Only a few studies have delved into feasibility, preference, choice, and outcome factors in the SDM process. Another challenge emerges from an absence of uniform standards for developing patient decision aids (PDAs). Furthermore, regarding health outcome indicators, their predominant focus remains on physiological needs.

Conclusion

SDM is in its infancy in mainland China. It is important to explore the concept and expression of decisional needs in the context of Chinese culture. Subsequent studies should focus on constructing a scientifically rigorous and systematic approach for the development of PDAs, and considering the adaptation of SDM steps to the clinical context in China during SDM implementation. Concurrently, The focus on health outcomes in Chinese SDM studies, driven by the unique healthcare resource landscape, underscores the necessity of prioritizing basic needs within limited resources.

Systematic review registration

https://inplasy.com/?s=202130021.

Culturally Responsive Care Delivery in Oncology: The Example of Multiple Myeloma

Multiple myeloma (MM) represents ∼1% of all cancers and is the second most common hematologic malignancy worldwide. The incidence of MM is at least two times higher in Blacks/African Americans compared with their White counterparts, and Hispanics/Latinxs are among the youngest patients diagnosed with the disease. Recent advances in available treatments for MM have demonstrated significant improvement in survival outcomes; however, patients from non-White racial/ethnic groups clinically benefit less due to multiple factors including access to care, socioeconomic status, medical mistrust, underutilization of novel therapies, and exclusion from clinical trials. Health inequities in disease characteristics and risk factors based on race also contribute to inequities in outcomes. In this review, we highlight racial/ethnic factors as well as structural barriers attributed to variations in MM epidemiology and management. We focus on three populations-Black/African American, Hispanic/Latinx, and American Indian/Alaska Native-and review factors that healthcare professionals may consider when treating patients of color. We offer tangible advice for healthcare professionals on how to incorporate cultural humility into their practice by following the five key steps: establishing trust, respecting cultural diversity, undergoing cross-cultural training, counseling patients on appropriate available clinical trial options, and connecting patients to community resources. The outlined recommendations will help the medical community to better understand and apply the important concept of cultural humility into their practice to provide the best care for all their patients, regardless of race/ethnicity.

Integration of hospital and community care for paediatric ophthalmology: A mixed-methods study

BACKGROUND

To explore collaborative care models for paediatric eye care that integrate hospital and community-based care to address access blocks.

METHODS

Sequential referrals to a tertiary paediatric ophthalmology clinic between April and October 2019 and subsequent encounters up until July 2020 at a major metropolitan public children's hospital in Sydney, Australia, were reviewed to identify those cases suitable for community care. Semi-structured phone interviews were conducted with eye health service providers, including ophthalmologists, orthoptists and optometrists, as well as service users to explore their perspectives on potential changes to service delivery. Qualitative data were analysed deductively using the Levesque model for access to healthcare and Consolidated Framework for Implementation Research (CFIR) to inform implementation strategies for future models of care.

RESULTS

One-third of the 439 audited referrals (30.5%; 134/439) were identified as suitable for community management. Interviews revealed five themes relating to potential models of care, which would support and promote access: integrated health systems, standardised quality of care, interprofessional trust, multidisciplinary governance and patient-centred care. Key recommendations for future implementation included: (i) identifying and preparing clinical champions, (ii) conducting educational meetings, (iii) conducting local needs assessments and (iv) informing local opinion leaders.

CONCLUSIONS

This audit highlights access blocks and poor targeting of referrals to tertiary paediatric ophthalmology services in a metropolitan hospital. Integration with community practitioners was identified as an acceptable way to streamline services, and strategies that may support successful implementation in this setting were identified.

Improving Dementia-Specific Referrals From the Acute Care Setting: A Quality Improvement Project

PURPOSE OF STUDY

The purpose of this quality improvement project was to design and implement an education and referral protocol for care coordination staff to use when working with hospitalized patients with dementia and their families. The goal was to increase delivery of dementia resource education and dementia-specific referrals during the discharge planning process.

PRIMARY PRACTICE SETTING

The practice setting for this project was an acute care hospital in Northern California. The care coordination department collaborated with the Northern California Chapter of the Alzheimer's Association to improve the delivery of referrals and follow-up with patients and families who were interested in additional information and support related to dementia.

METHODOLOGY AND SAMPLE

Twenty-one members of the care coordination department received education on the dementia disease process as well as community resources available to the patient population. The registered nurse care coordinators (RNCCs) and social workers (SWs) within the department then implemented a referral protocol to connect patients with dementia and their families to the Alzheimer's Association. Referral volume was captured over a 60-day preimplementation period, a 60-day implementation period, and a 60-day postimplementation period. The Northern California Chapter of the Alzheimer's Association tracked referral volume. A paired-sample t test was used to examine pre/postimplementation Dementia Knowledge Assessment Scale (DKAS) scores to evaluate the impact of the education intervention. Care coordination staff completed a pre/postimplementation survey on knowledge of community resources for dementia and confidence in connecting patients to these resources. They also completed a postimplementation survey about the benefit of the project to their care coordination practice.

RESULTS

There was a modest, yet positive increase in referral volume over the 60-day implementation period ( n = 6) compared with the preimplementation period ( n = 1). An increase was sustained during the 60-day postimplementation period ( n = 4). Pre/posttimplementation DKAS scores significantly improved for care coordination staff postimplementation ( p < .001) by an average of 7 points. Fifty-three percent of RNCC and SW staff responded to the postimplementation survey, and results indicated they thought the project was beneficial ( n = 8) or somewhat beneficial ( n = 1) to practice. In addition, RNCC and SW staff reported an increase in awareness of available community resources and confidence in connecting patients and families to these resources.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Case management professionals have an important role in providing education and support to patients and families across the continuum of care. The complexity and trajectory of illness, shortage of qualified providers, and gaps in provider knowledge about resources place patients with dementia and their families in an increasingly vulnerable position within the health care system. This quality improvement project demonstrates that care coordination staff can improve referrals to resources when in contact with patients and families in the acute care setting. Case managers can ensure patients with dementia and their families have access to the resources in the community that may prevent return to the emergency department or rehospitalization.

The Academic Learning Health System: A Framework for Integrating the Multiple Missions of Academic Medical Centers

The learning health system (LHS) has emerged over the past 15 years as a concept for improving health care delivery. Core aspects of the LHS concept include: promoting improved patient care through organizational learning, innovation, and continuous quality improvement; identifying, critically assessing, and translating knowledge and evidence into improved practices; building new knowledge and evidence around how to improve health care and health outcomes; analyzing clinical data to support learning, knowledge generation, and improved patient care; and engaging clinicians, patients, and other stakeholders in processes of learning, knowledge generation, and translation. However, the literature has paid less attention to how these LHS aspects may integrate with the multiple missions of academic medical centers (AMCs). The authors define an academic learning health system (aLHS) as an LHS built around a robust academic community and central academic mission, and they propose 6 features that emphasize how an aLHS differs from an LHS. An aLHS capitalizes on embedded academic expertise in health system sciences; engages the full spectrum of translational investigation from mechanistic basic sciences to population health; builds pipelines of experts in LHS sciences and clinicians with fluency in practicing in an LHS; applies core LHS principles to the development of curricula and clinical rotations for medical students, housestaff, and other learners; disseminates knowledge more broadly to advance the evidence for clinical practice and health systems science methods; and addresses social determinants of health, creating community partnerships to mitigate disparities and improve health equity. As AMCs evolve, the authors expect that additional differentiating features and ways to operationalize the aLHS will be identified and hope this article stimulates further discussion around the intersection of the LHS concept and AMCs.