Diaspora engagement: a scoping review of diaspora involvement with strengthening health systems of their origin country

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

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Artificial intelligence for good health: a scoping review of the ethics literature

BMC Medical Ethics ◽

10.1186/s12910-021-00577-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kathleen Murphy ◽

Erica Di Ruggiero ◽

Ross Upshur ◽

Donald J. Willison ◽

Neha Malhotra ◽

...

Keyword(s):

Public Health ◽

Artificial Intelligence ◽

Global Health ◽

Population Health ◽

Health Systems ◽

Scoping Review ◽

Industrial Revolution ◽

Ethical Issues ◽

Grey Literature ◽

Ethical Implications

Abstract Background Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective? Methods Eight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed. Results Upon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries (LMICs). Conclusions The ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere.

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Strategies for reducing out of pocket payments in the health system: a scoping review

Cost Effectiveness and Resource Allocation ◽

10.1186/s12962-021-00301-8 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Faride Sadat Jalali ◽

Parisa Bikineh ◽

Sajad Delavari

Keyword(s):

Health System ◽

Health Systems ◽

Scoping Review ◽

Health Financing ◽

Developed Countries ◽

Vulnerable Groups ◽

System A ◽

Out Of Pocket Payments ◽

Review Study ◽

Developing And Developed Countries

Abstract Background Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. Methods Articles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. Results Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. Conclusion The present review identified some strategies that affect the OOP payments According to the health system functions framework. Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures.

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Structural stigma and its impact on healthcare for consumers with borderline personality disorder: protocol for a scoping review

Systematic Reviews ◽

10.1186/s13643-021-01580-1 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Pauline Klein ◽

Alicia Kate Fairweather ◽

Sharon Lawn ◽

Helen Margaret Stallman ◽

Paul Cammell

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Health Services ◽

Health Systems ◽

Scoping Review ◽

Borderline Personality ◽

Cochrane Library ◽

Cultural Norms ◽

International Literature ◽

Institutional Policies

Abstract Background Structural stigma in health systems experienced by consumers diagnosed with Borderline Personality Disorder (BPD) is a widespread phenomenon that causes major health inequities and harm for this population. Structural stigma in this context relates to institutional policies, cultural norms, and organizational practices that limit consumers’ access to health services, quality of care, and capacity to achieve optimal health and well-being. BPD is a serious mental illness with high morbidity and mortality, characterized by instability in interpersonal relationships, self-image, and emotional and behavioral deregulation, which stem from significant traumatic childhood/life events, and/or biological etiologies. The objectives of this scoping review are to explore the international literature on structural stigma in healthcare systems specific to BPD, and to provide an overview of the impact of structural stigma on health services for BPD consumers and their carers/families. Methods This scoping review will follow the Joanna Briggs Institute (JBI) scoping review guidelines. We will search the following electronic databases (from inception onwards): MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI-Evidence databases. Grey literature will be identified through the Google search engine. We will include all types of literature in English, published and unpublished, including any study design, reviews, clinical practice guidelines, policy reports, and other documents. No restrictions on publication date of sources of evidence will be applied. International literature should examine structural stigma associated with BPD in any healthcare setting such as, outpatients, inpatients, primary health care, or community-based facilities. Two reviewers will independently screen all titles, abstracts, and full-text citations. Quality appraisal of the included sources of evidence will be assessed using the Mixed Methods Appraisal Tool (MMAT) 2018 version. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., thematic analysis) methods. Discussion This review is anticipated to enhance both identification and understanding of those structures in health systems (i.e., institutional policies, cultural norms, and practices) that manifest and perpetuate stigma experienced by consumers with BPD and their carers/families. The findings can be used to inform future research, policy, and practice relating to stigma reduction strategies that can be adopted to improve the provision of BPD-responsive services and care for this population. Systematic review registration Open Science Framework (https://osf.io/bhpg4).

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Elements of Trust in Digital Health Systems: Scoping Review

Journal of Medical Internet Research ◽

10.2196/11254 ◽

2018 ◽

Vol 20 (12) ◽

pp. e11254 ◽

Cited By ~ 16

Author(s):

Afua Adjekum ◽

Alessandro Blasimme ◽

Effy Vayena

Keyword(s):

Health Systems ◽

Scoping Review ◽

Digital Health

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Meaningful Information in the Age of Big Data: A Scoping Review on Social Determinants of Health Data Collection for Electronic Health Records

10.21203/rs.2.16433/v1 ◽

2019 ◽

Author(s):

Kelsey Berg ◽

Chelsea Doktorchik ◽

Hude Quan ◽

Vineet Saini

Keyword(s):

Big Data ◽

Data Collection ◽

Electronic Health Records ◽

Social Determinants Of Health ◽

Health Systems ◽

Social Determinants ◽

Scoping Review ◽

Determinants Of Health ◽

Health Records ◽

Automated Technology

Abstract Background: Electronic Health Records (EHRs) are key tools for integrating patient data into health information systems (IS). Advances in automated data collection methodology, particularly the collection of social determinants of health (SDOH), provide opportunities to advance health promotion and illness prevention through advanced analytics (i.e. “Big Data” techniques). We ask how current data collection processes in EHRs permit SDOH data to flow throughout health systems. Methods: Using a scoping review framework, we searched through medical literature to identify current practices in SDOH data collection within EHR systems. We extracted relevant information on data collection methodology, specifically focusing on uses of automated technology. We discuss our findings in the context of research methodology and potential for health equity. Results: Practitioners collect a variety of SDOH data at point of care through EHR, predominantly via embedded screening tools and clinical notes, and primarily capturing data on financial security, housing status, and social support. Health systems are increasingly using digital technology in data collection, including natural language processing algorithms. However overall use of automated technology is limited to date. End uses of data pertain to improving system efficiency, patient care-coordination, and addressing health disparities. Discussion & Conclusion: EHRs can realistically promote collection and meaningful use of SDOH data, although EHRs have not extensively been used to collect and manage this type of information. Future applied research on systems-level application of SDOH data is necessary, and should incorporate a range of stakeholders and interdisciplinary teams of researchers and practitioners in fields of health, computing, and social sciences.

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What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

BMC Public Health ◽

10.1186/s12889-019-7707-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 14

Author(s):

Jennifer B. Nuzzo ◽

Diane Meyer ◽

Michael Snyder ◽

Sanjana J. Ravi ◽

Ana Lapascu ◽

...

Keyword(s):

Public Health ◽

Infectious Disease ◽

Health System ◽

Natural Hazards ◽

Health Systems ◽

Scoping Review ◽

Disease Outbreaks ◽

World Health ◽

Infectious Disease Outbreaks ◽

System Resilience

Abstract Background The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.

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Type and use of digital technology in learning health systems: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2018-026204 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026204

Author(s):

Lysanne Lessard ◽

Agnes Grudniewicz ◽

Antoine Sauré ◽

Agnieszka Szczotka ◽

James King ◽

...

Keyword(s):

Health Systems ◽

Scoping Review ◽

Digital Technology ◽

Technology Use ◽

Data Extraction ◽

Grey Literature ◽

Future Research ◽

Efficiency And Effectiveness ◽

Ethical Approval ◽

Review Protocol

IntroductionHealth systems in North America and Europe have been criticised for their lack of safety, efficiency and effectiveness despite rising healthcare costs. In response, healthcare leaders and researchers have articulated the need to transform current health systems into continuously and rapidly learning health systems (LHSs). While digital technology has been envisioned as providing the transformational power for LHSs by generating timely evidence and supporting best care practices, it remains to be ascertained if it is indeed playing this role in current LHS initiatives. This paper presents a protocol for a scoping review that aims at providing a comprehensive understanding of how and to what extent digital technology is used within LHSs. Results will help to identify gaps in the literature as a means to guide future research on this topic.Methods and analysisMultiple databases and grey literature will be searched with terms related to learning health systems. Records selection will be done in duplicate by two reviewers applying pre-defined inclusion and exclusion criteria. Data extraction from selected records will be done by two reviewers using a piloted data charting form. Results will be synthesised through a descriptive numerical summary and a mapping of digital technology use onto types of LHSs and phases of learning within LHSs.Ethics and disseminationEthical approval is not required for this scoping review. Preliminary results will be shared with stakeholders to account for their perspectives when drawing conclusions. Final results will be disseminated through presentations at relevant conferences and publications in peer-reviewed journals.

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Medical assistance in dying: implications for health systems from a scoping review of the literature

Journal of Health Services Research & Policy ◽

10.1177/1355819619834962 ◽

2019 ◽

Vol 24 (3) ◽

pp. 207-216 ◽

Cited By ~ 2

Author(s):

Jamie K. Fujioka ◽

Raza M. Mirza ◽

Christopher A. Klinger ◽

Lynn P. McDonald

Keyword(s):

Health Systems ◽

Scoping Review ◽

Grey Literature ◽

Models Of Care ◽

Careful Examination ◽

Multidisciplinary Teams ◽

Medical Assistance ◽

Implementation Barriers ◽

Regulatory Oversight ◽

Medical Assistance In Dying

Objective Medical assistance in dying (MAiD) is the medical provision of substances to end a patient’s life at their voluntary request. While legal in several countries, the implementation of MAiD is met with ethical, legislative and clinical challenges, which are often overshadowed by moral discourse. Our aim was to conduct a scoping review to explore key barriers for the integration of MAiD into existing health systems. Methods We searched electronic databases (CINAHL, Embase, MEDLINE, and PsycINFO) and grey literature sources from 1990 to 2017. Studies discussing barriers and/or challenges to implementing MAiD from a health system’s perspective were included. Full-text papers were screened against inclusion/exclusion criteria for article selection. A thematic content analysis was conducted to summarize data into themes to highlight key implementation barriers. Results The final review included 35 articles (see online Appendix 1). Six categories of implementation challenges emerged: regulatory (n = 26), legal (n = 15), social (n = 9), logistical (n = 9), financial (n = 3) and compatibility with palliative care (n = 3). Within four of the six identified implementation barriers (regulatory, legal, social and logistical) were subthemes, which described barriers related to legalizing MAiD in more detail. Conclusion Despite multiple challenges related to its implementation, MAiD remains a requested end-of-life option, requiring careful examination to ensure adequate integration into existing health services. Comprehensive models of care incorporating multidisciplinary teams and regulatory oversight alongside improved clinician education may be effective to streamline MAiD services.

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