PP22 How Do Health System Leaders Use Evidence To Inform Action?

2018 ◽  
Vol 34 (S1) ◽  
pp. 74-75
Author(s):  
Matthew D Mitchell ◽  
C Michael White ◽  
Jeanne-Marie Guise ◽  
Lionel Bañez ◽  
Craig Umscheid ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Process Improvement ◽  
Systematic Reviews ◽  
Predictive Analytics ◽  
Structured Interview ◽  
Healthcare Research ◽  
System Quality ◽  
Study Results ◽  
System Leaders

Introduction:The US Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) program sponsors the development of systematic reviews to inform clinical policy and practice. The EPC program sought to better understand how health systems identify and use this evidence.Methods:Representatives from eleven EPCs, the EPC Scientific Resource Center, and AHRQ developed a semi-structured interview script to query a diverse group of nine Key Informants (KIs) involved in health system quality, safety and process improvement about how they identify and use evidence. Interviews were transcribed and qualitatively summarized into key themes.Results:All KIs reported that their organizations have either centralized quality, safety, and process improvement functions within their system, or they have partnerships with other organizations to conduct this work. There was variation in how evidence was identified, with larger health systems having medical librarians and central bureaus to gather and disseminate information and smaller systems having local chief medical officers or individual clinicians do this work. KIs generally prefer guidelines, especially those with treatment algorithms, because they are actionable. They like systematic reviews because they efficiently condense study results and reconcile conflicting data. They prefer information from systematic reviews to be presented as short digestible summaries with the full report available on demand. KIs preferred systematic reviews from reputable entities and those without commercial bias. Some of the challenges KIs reported include how to resolve conflicting evidence, the generalizability of evidence to local needs, determining whether the evidence is up-to-date, and the length of time required to generate reviews. The topics of greatest interest included predictive analytics, high-value care, advance care planning, and care coordination. To increase awareness of AHRQ EPC reviews, KIs suggest alerting people at multiple levels in a health-system when new evidence reports are available and making reports easier to find in common search engines.Conclusions:Systematic reviews are valued by health system leaders. To be most useful they should be easy to locate and available in different formats targeted to the needs of different audiences.

scholarly journals Quality in crisis: a systematic review of the quality of health systems in humanitarian settings

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Keely Jordan ◽  
Todd P. Lewis ◽  
Bayard Roberts
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Health Systems ◽  
Point Of Care ◽  
System Level ◽  
System Quality ◽  
High Quality ◽  
Humanitarian Settings ◽  
Quality Health

Abstract Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings.

scholarly journals Re-imagining Research: A Bold Call, but Bold Enough? Comment on "Experience of Health Leadership in Partnering with University-Based Researchers in Canada: A Call to ‘Re-Imagine’ Research"

2019 ◽  
Author(s):  
Bev J. Holmes
Keyword(s):  
Health System ◽  
Health Systems ◽  
Research Area ◽  
Evidence Use ◽  
Health System Change ◽  
Health Leadership ◽  
System Leaders ◽  
Change Projects ◽  
High Level ◽  
Partnership Models

Many articles over the last two decades have enumerated barriers to and facilitators for evidence use in health systems. Bowen et al’s article "Response to Experience of Health Leadership in Partnering with University-Based Researchers: A Call to ‘Re-imagine Research’" furthers the debate by focusing on an under-explored research area (health system design and health service organization) with an under-studied stakeholder group (health system leaders), by undertaking a broad program of research on partnerships, and, based on participant responses, by calling for re-imagining of research itself. In response to the claim that the research community is not providing expertise to this pressing issue in the health system, I provide four high level reasons: partnerships mean different things to different people, our language does not reflect the reality we want, our health systems have yet to fully embrace evidence use, and complexity is easier to talk about than act within. Bowen et al’s study, and their broader program of research, is well-placed to explore these issues further, helping identify appropriate researcher-health system leader partnership models for various health system change projects. Given the positive shifts identified in this study, and the knowledge that participants demonstrate about what needs to change, the time is right for bold action, re-imagining not only research, but healthcare, such that the production and use of evidence for better health is embraced and supported.

scholarly journals Digital health Systems in Kenyan Public Hospitals: a mixed-methods survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Naomi Muinga ◽  
Steve Magare ◽  
Jonathan Monda ◽  
Mike English ◽  
Hamish Fraser ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
New Technologies ◽  
Digital Health ◽  
Structured Interview ◽  
Public Hospitals ◽  
Adoption Process ◽  
Efficient System ◽  
Wide Range ◽  
The Government

Abstract Background As healthcare facilities in Low- and Middle-Income Countries adopt digital health systems to improve hospital administration and patient care, it is important to understand the adoption process and assess the systems’ capabilities. This survey aimed to provide decision-makers with information on the digital health systems landscape and to support the rapidly developing digital health community in Kenya and the region by sharing knowledge. Methods We conducted a survey of County Health Records Information Officers (CHRIOs) to determine the extent to which digital health systems in public hospitals that serve as internship training centres in Kenya are adopted. We conducted site visits and interviewed hospital administrators and end users who were at the facility on the day of the visit. We also interviewed digital health system vendors to understand the adoption process from their perspective. Semi-structured interview guides adapted from the literature were used. We identified emergent themes using a thematic analysis from the data. Results We obtained information from 39 CHRIOs, 58 hospital managers and system users, and 9 digital health system vendors through semi-structured interviews and completed questionnaires. From the survey, all facilities mentioned purchased a digital health system primarily for administrative purposes. Radiology and laboratory management systems were commonly standalone systems and there were varying levels of interoperability within facilities that had multiple systems. We only saw one in-patient clinical module in use. Users reported on issues such as system usability, inadequate training, infrastructure and system support. Vendors reported the availability of a wide range of modules, but implementation was constrained by funding, prioritisation of services, users’ lack of confidence in new technologies and lack of appropriate data sharing policies. Conclusion Public hospitals in Kenya are increasingly purchasing systems to support administrative functions and this study highlights challenges faced by hospital users and vendors. Significant work is required to ensure interoperability of systems within hospitals and with other government services. Additional studies on clinical usability and the workflow fit of digital health systems are required to ensure efficient system implementation. However, this requires support from key stakeholders including the government, international donors and regional health informatics organisations.

scholarly journals Two visions of clinical integration: perspectives from health system leaders

2014 ◽  
Vol 4 (1) ◽  
pp. 36 ◽  
Author(s):  
Wenke Hwang ◽  
Joseph Andrie ◽  
Michelle LaClair ◽  
Harold Paz
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Health Care Professionals ◽  
Success Factors ◽  
Leadership Roles ◽  
Health Care Environment ◽  
Clinical Integration ◽  
System Leaders ◽  
Patient Centric

Objective: Clinical Integration has been implicated as the key to achieving higher quality of care at a lower cost. However,ambiguity regarding the meaning of clinical integration poses challenges as health care professionals strive to adapt to the rapidlyevolving health care environment. This study aims to solicit insights from health system executives about what it means to beclinically integrated.Methods: The authors interviewed 13 health system executives from 11 different institutions in Pennsylvania ranging fromsmall community hospitals to large academic medical centers.Results: Two major viewpoints of clinical integration were identified from the interviews: patient-centric, which emphasized theimportance of the patient’s experience and strengthening patient involvement in their own healthcare, and provider-centric, whichfocused on leadership roles, organizational structure, and physician alignment. Participants with provider-centric viewpointswere associated with larger medical centers and were more likely to describe their health systems as highly clinically integrated.Conversely, patient-centric perspectives were affiliated with smaller health systems/hospitals and were more likely to describetheir health systems as less integrated. Participants also identified five key success factors of clinical integration: physicianalignment, shared data and analytics, culture, patient engagement, and an emphasis on primary care.Conclusions: Despite the central role of clinical integration in emerging health systems, there is not a shared understanding ofits definition. A better understanding of the varied perspectives regarding clinical integration can help current and future healthcare professionals to better communicate with one another about clinical integration and the practical steps necessary to achieveit.

scholarly journals Alternative service models for delivery of healthcare services in high-income countries: a scoping review of systematic reviews

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024385 ◽  
Author(s):  
Rebecca L Jessup ◽  
Denise A O’Connor ◽  
Polina Putrik ◽  
Kobi Rischin ◽  
Janet Nezon ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Systematic Reviews ◽  
Scoping Review ◽  
Healthcare Services ◽  
High Income ◽  
Primary Data ◽  
Delivery Of Healthcare ◽  
Service Models ◽  
Alternative Delivery

IntroductionCosts associated with the delivery of healthcare services are growing at an unsustainable rate. There is a need for health systems and healthcare providers to consider the economic impacts of the service models they deliver and to determine if alternative models may lead to improved efficiencies without compromising quality of care. The aim of this protocol is to describe a scoping review of the extent, range and nature of available synthesised research on alternative delivery arrangements for health systems relevant to high-income countries published in the last 5 years.DesignWe will perform a scoping review of systematic reviews of trials and economic studies of alternative delivery arrangements for health systems relevant to high-income countries published on ‘Pretty Darn Quick’ (PDQ)-Evidence between 1 January 2012 and 20 September 2017. All English language systematic reviews will be included. The Cochrane Effective Practice and Organisation of Care taxonomy of health system interventions will be used to categorise delivery arrangements according to: how and when care is delivered, where care is provided and changes to the healthcare environment, who provides care and how the healthcare workforce is managed, co-ordination of care and management of care processes and information and communication technology systems. This work is part of a 5-year Partnership Centre for Health System Sustainability aiming to investigate and create interventions to improve health-system-performance sustainability.Ethics and disseminationNo primary data will be collected, so ethical approval is not required. The study findings will be published and presented at relevant conferences.

Getting quality data back to frontline providers.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 196-196
Author(s):  
Anne Barry-Weers ◽  
Carol Huibregtse ◽  
Sue Ihde ◽  
Marija Bjegovich-Weidman ◽  
James L. Weese
Keyword(s):  
Health System ◽  
Process Improvement ◽  
Performance Metrics ◽  
Stage Iv ◽  
Quality Data ◽  
System Quality ◽  
Front Line ◽  
Regional Lymph Nodes ◽  
Course Of Action ◽  
Integrated Health

196 Background: Oncology quality performance metrics may be improved by establishing a coordinated process for getting data back to providers. However, establishing ownership of quality metric data can be a challenge, especially in a large, integrated health system. Methods: Aurora Cancer Care’s team developed quality charters and a coordinated process for its 15-hospital, integrated health system that outlines a course of action for metric selection, data distribution, peer review and development of process improvement plans. A weighted tool was developed and implemented to prioritize measure selection. The weighted tool described and scored each quality measure against its performance improvement opportunity, ease in data collection, national benchmarks, regulatory and reimbursement impact, value to the patient and consideration of the resources required to implement change. The final score was used to prioritize and select measures. The System Multidisciplinary Disease-Specific Quality Subcommittees established quality measures. Abstraction began, outliers were reviewed and results were disseminated to the System Cancer Leadership Council as well as the 15 hospitals via the Regional Cancer Quality Subcommittees (RCQS). The RCQS chairs and quality directors meet quarterly with the system quality liaison to ensure the communication of data back to the front-line providers. Results: We found a rise in the percentages of invasive rectal cancers diagnosed with endorectal ultrasound or magnetic resonance imaging (no stage IV) (2012: 76%, 2013: 84%) and treated with total mesorectal excision (no stage IV) (2012: 72%, 2013: 87%). In addition, increases in the examination of at least 12 regional lymph nodes for invasive colorectal cancer (2012: 93%, 2013: 98%; p<0.05) and partial, rather than total, nephrectomy for renal cancer patients with T1a tumors (2012: 71%, 2013: 95%; p<0.05) were statistically significant. Conclusions: Though our coordinated process to get quality data back to providers continues to evolve, our front-line providers have shown greater enthusiasm for the data, engaged in behavior modification and become more accountable with process improvement plans that are integral to establishing the best patient outcomes.

Dynamic Capacity Management (DCAMM™) in a Hospital Setting

2011 ◽  
pp. 46-68
Author(s):  
Pierce Story
Keyword(s):  
Health Systems ◽  
Process Improvement ◽  
Dynamic Systems ◽  
Six Sigma ◽  
Predictive Analytics ◽  
Hospital Setting ◽  
Simulation Models ◽  
Capacity Management ◽  
Dynamic Capacity ◽  
Care Structure

DCAMM starts with an analysis of dynamic demand, matched against dynamic capacity. This brings forth simple yet important operational concepts that take a dynamic, “systems” level view of the entire care structure (e.g. a hospital or a community). Using specially designed simulation models and the power of predictive analytics, we can achieve a very different perspective on the variability and interdependencies that were once considered chaos. By “managing to” the variation, and understanding and predicting the dynamism of the system, concepts such as “Dynamic Standardization” and “Outlier Management” can augment the existing, static process improvement systems such as Lean and Six Sigma. This chapter will provide an overview of the concepts and structures necessary to profoundly change the way our hospitals, and health systems, are managed.

What is the role of health systems in responding to domestic violence? An evidence review

2017 ◽  
Vol 41 (6) ◽  
pp. 639 ◽  
Author(s):  
Jo Spangaro
Keyword(s):  
Risk Assessment ◽  
Domestic Violence ◽  
Health Service ◽  
Health Services ◽  
Health System ◽  
Health Systems ◽  
Systematic Reviews ◽  
System Level ◽  
Safety Planning ◽  
First Line

Objective The aim of the present study was to review and analyse academic literature and program evaluations to identify promising evidence for health system responses to domestic violence in Australia and internationally. Methods English-language literature published between January 2005 and March 2016 was retrieved from search results using the terms ‘domestic violence’ or ‘intimate partner violence’ in different combinations with other relevant terms, resulting in 1671 documents, of which 59 were systematic reviews. Electronic databases (Medline (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psycinfo, Social work Abstracts, Informit, Violence and Abuse Abstracts, Family Studies Abstracts, Cochrane Library of Systematic Reviews and EMBASE) were searched and narrative analysis undertaken. Results This review details the evidence base for the following interventions by health services responding to domestic violence: first-line responses, routine screening, risk assessment and safety planning, counselling with women, mother–child interventions, responses to perpetrators, child protection notifications, training and system-level responses. Conclusions There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence. What is known about the topic? Domestic violence is a significant problem globally with enormous human, social and economic costs. Although women who have experienced abuse make extensive use of healthcare services, health services have lagged behind the policing, criminal justice and other human service domains in responding to domestic violence. What does this paper add? The present comprehensive review identifies best-practice health system responses to domestic violence. What are the implications for practitioners? Health systems can play a key role in identifying and responding to domestic violence for women who often do not access other services. There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence, in particular for specialist counselling, structured risk assessment and safety planning, training for first-line responses and interventions for mothers and children affected by domestic violence.

scholarly journals The influence of health systems on breast, cervical and colorectal cancer screening: an overview of systematic reviews using health systems and implementation research frameworks

2019 ◽  
Vol 25 (1) ◽  
pp. 49-58 ◽  
Author(s):  
Jennifer Priaulx ◽  
Eleanor Turnbull ◽  
Eveline Heijnsdijk ◽  
Marcell Csanádi ◽  
Carlo Senore ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Health System ◽  
Health Systems ◽  
Systematic Reviews ◽  
Healthcare Professionals ◽  
Barriers And Facilitators ◽  
Average Risk ◽  
Opportunistic Screening ◽  
Systems Research

Objectives Screening for breast, cervical and colorectal cancer in an average-risk population is widely recommended in national and international guidelines although their implementation varies. Using a conceptual framework that draws on implementation and health systems research, we provide an overview of systematic literature reviews that address health system and service barriers or facilitators to effective cancer screening. Methods Using a systematic approach, we searched Cochrane Database of Systematic Reviews, Ovid Medline, Ovid Embase, Web of Science, PsychInfo and other internet sources. We included systematic reviews of screening interventions (i.e. targeting people at average risk) for breast, cervical and colorectal cancer. The analysis included 90 systematic reviews. Results This review identified a multitude of barriers and facilitators affecting the health system, the capabilities of individuals in the system and their intentions. A large proportion of the available evidence focused on uptake. The reviews demonstrated that health system factors influenced participation, as well as quality and effectiveness of the service provided. The barriers with the biggest impact were knowledge/education, mainly of clients but also providers (capability barriers) and beliefs and values (intention barriers) of the eligible population. These findings complement the usual focus on psychological and social barriers to informed participation by individuals that dominate the screening literature. The facilitators with the most supporting evidence were educational interventions (overcoming capability and intention barriers), invitation letters, reminders and appointments. These were mainly directed at eligible individuals and, to a lesser extent, to providers and healthcare professionals. Only a small number of reviews, mainly from Europe, specified organized, rather than opportunistic, screening programmes. In those, low participation was the most frequently cited barrier and invitation letters (including physician endorsement, phone calls and reminders to non-responders and healthcare professionals) were the most prevalent facilitators. Conclusion Despite evidence of barriers and facilitators to screening participation and opportunistic screening, further health systems research covering the entire screening system for organized programmes is required.

Sign in / Sign up

Export Citation Format

Share Document