scholarly journals LAGOS: learning health systems and how they can integrate with patient care

2019 ◽  
Vol 26 (1) ◽  
pp. e100037 ◽  
Author(s):  
Scott McLachlan ◽  
Kudakwashe Dube ◽  
Evangelia Kyrimi ◽  
Norman Fenton
Keyword(s):  
Health Systems ◽  
Medical Practice ◽  
Health Informatics ◽  
Clinical Care ◽  
Care Process ◽  
Daily Routine ◽  
Study Approach ◽  
Correct Analysis ◽  
Conceptual Setting

ProblemLearning health systems (LHS) are an underexplored concept. How LHS will operate in clinical practice is not well understood. This paper investigates the relationships between LHS, clinical care process specifications (CCPS) and the established levels of medical practice to enable LHS integration into daily healthcare practice.MethodsConcept analysis and thematic analysis were used to develop an LHS characterisation. Pathway theory was used to create a framework by relating LHS, CCPS, health information systems and the levels of medical practice. A case study approach evaluates the framework in an established health informatics project.ResultsFive concepts were identified and used to define the LHS learning cycle. A framework was developed with five pathways, each having three levels of practice specificity spanning population to precision medicine. The framework was evaluated through application to case studies not previously understood to be LHS.DiscussionClinicians show limited understanding of LHS, increasing resistance and limiting adoption and integration into care routine. Evaluation of the presented framework demonstrates that its use enables: (1) correct analysis and characterisation of LHS; (2) alignment and integration into the healthcare conceptual setting; (3) identification of the degree and level of patient application; and (4) impact on the overall healthcare system.ConclusionThis paper contributes a theoretical framework for analysis, characterisation and use of LHS. The framework allows clinicians and informaticians to correctly identify, characterise and integrate LHS within their daily routine. The overall contribution improves understanding, practice and evaluation of the LHS application in healthcare.

scholarly journals Towards standardisation of evidence-based clinical care process specifications

2020 ◽  
Vol 26 (4) ◽  
pp. 2512-2537 ◽  
Author(s):  
Scott McLachlan ◽  
Evangelia Kyrimi ◽  
Kudakwashe Dube ◽  
Graham Hitman ◽  
Jennifer Simmonds ◽  
...  
Keyword(s):  
Clinical Care ◽  
Care Process ◽  
Clinical Environment ◽  
The United Kingdom ◽  
Process Specification ◽  
Care Processes ◽  
Starting Point ◽  
Core Elements ◽  
High Quality Information

There is a strong push towards standardisation of treatment approaches, care processes and documentation of clinical practice. However, confusion persists regarding terminology and description of many clinical care process specifications which this research seeks to resolve by developing a taxonomic characterisation of clinical care process specifications. Literature on clinical care process specifications was analysed, creating the starting point for identifying common characteristics and how each is constructed and used in the clinical setting. A taxonomy for clinical care process specifications is presented. The De Bleser approach to limited clinical care process specifications characterisation was extended and each clinical care process specification is successfully characterised in terms of purpose, core elements and relationship to the other clinical care process specification types. A case study on the diagnosis and treatment of Type 2 Diabetes in the United Kingdom was used to evaluate the taxonomy and demonstrate how the characterisation framework applies. Standardising clinical care process specifications ensures that the format and content are consistent with expectations, can be read more quickly and high-quality information can be recorded about the patient. Standardisation also enables computer interpretability, which is important in integrating Learning Health Systems into the modern clinical environment. The approach presented allows terminologies for clinical care process specifications that were widely used interchangeably to be easily distinguished, thus, eliminating the existing confusion.

scholarly journals The complexity of scaling up an mHealth intervention: the case of SMS for Life in Tanzania from a health systems integration perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carmen Sant Fruchtman ◽  
Selemani Mbuyita ◽  
Mary Mwanyika-Sando ◽  
Marcel Braun ◽  
Don de Savigny ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Large Scale ◽  
Digital Health ◽  
Health Sector ◽  
Building Blocks ◽  
Scaling Up ◽  
Stock Management ◽  
Study Approach

Abstract Background SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. Its goal was to increase visibility to antimalarial stock-outs through the use of SMS technology. The objective of this case study was to show the multiple innovations that SMS for Life brought to the Tanzanian public health sector and to discuss the challenges of scaling up that led to its discontinuation from a health systems perspective. Methods A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Data collection was informed by the health system building blocks. We then carried out a thematic analysis using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework. This served to identify the key reasons for the discontinuation of the programme. Results SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after 4 years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers. Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system. Conclusion This study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.

scholarly journals Molecular point-of-care testing for SARS-CoV-2 using the ID NOW(TM) System in Emergency Department: Prospective Evaluation and Implementation in the Care Process

2021 ◽  
Author(s):  
Stefan O. Kortuem ◽  
Marina Krause ◽  
Hans-Juergen Ott ◽  
Lisa Kortuem ◽  
Hans-Peter Schlaudt
Keyword(s):  
Point Of Care ◽  
Clinical Care ◽  
Care Process ◽  
Daily Routine ◽  
Rt Pcr ◽  
Essential Information ◽  
Testing Procedures ◽  
Patient Pathways ◽  
The Impact ◽  
Second Wave

Background. The increasing number of cases and hospital admissions due to COVID-19 created an urgent need for rapid, reliable testing procedures for SARS-CoV-2 in Emergency Departments (ED) in order to effectively manage hospital resources, allocate beds and prevent nosocomial spread of infection. The ID NOW(TM) COVID-19 assay is a simple, user-friendly, rapid molecular test run on an instrument with a small footprint enabling point-of-care diagnostics. Methods. In the first wave, outsourced RT-PCR testing regularly required 36-48 hours before results were available. This prospective study was conducted in the second wave (October 2020-April 2021) and evaluated the impact the implementation of the ID NOW(TM) COVID-19 test in the ED had on clinical care processes and patient pathways. 710 patients were recruited upon arrival at the ED which included those presenting clinical symptoms, asymptomatic individuals or persons fulfilling epidemiological criteria. The first anterior nasal swab was taken by trained nurses in the ambulance or a separate consultation room. The ID NOW(TM) COVID-19 test was performed in the ED in strict compliance with the manufacturer's instructions and positive or suspected cases were additionally tested with RT_PCR (cobas SARS-COV-2 RT-PCR, Roche) following collection of a second nasopharyngeal NP specimen. Results. Swabs directly tested with the ID NOW(TM) COVID-19 test showed a diagnostic concordance of 98 % (sensitivity 99.59 %, specificity 94.55 %, PPV 97.6 %, NPV 99.05 %) compared to RT-PCR as reference. The 488 patients that tested positive with the ID NOW(TM) COVID-19 had a Ct range in RT-PCR results between 7.94 to 37.42 (in 23.2 % > 30). Two false negative results (0.28%) were recorded from patients with Ct values > 30. 14 (1.69%) discordant results were reviewed case-by-case and usually associated with either very early or very advanced stages of infection. Furthermore, patients initially negative with the ID NOW(TM) COVID-19 test and admitted to the hospital were tested again on days 5 and 12: no patient became positive. Discussion. The ID NOW(TM) COVID-19 test for detection of SARS-CoV-2 demonstrated excellent diagnostic agreement with RT-PCR under the above-mentioned patients pathways implemented during the second wave. The main advantage of the system was the provision of reliable results within a few minutes. This not only allowed immediate initiative of appropriate therapy and care for COVID-19 (patient benefit) but provided essential information on isolation and thus available beds. This drastically helped the overall finances of the department and additionally allowed more patients to be admitted including those requiring immediate attention; this was not possible during the first wave since beds were blocked waiting for diagnostic confirmation. Our findings also show that when interpreting the results, the clinical condition and epidemiological history of the patient must be taken into account, as with any test procedure. Overall, the ID NOW(TM) COVID-19 test for SARS-CoV-2 provided a rapid and reliable alternative to laboratory-based RT-PCR in the real clinical setting which became an acceptable part of the daily routine within the ED and demonstrated that early patient management can mitigate the impact of the pandemic on the hospital.

scholarly journals Kaizen–Kata, a Problem-Solving Approach to Public Service Health Care in Mexico. A Multiple-Case Study

2020 ◽  
Vol 17 (9) ◽  
pp. 3297 ◽  
Author(s):  
Manuel F. Suárez-Barraza ◽  
José A. Miguel-Davila
Keyword(s):  
Health Care ◽  
Public Hospitals ◽  
Care Process ◽  
Customer Complaints ◽  
Study Approach ◽  
Operational Problem ◽  
Multiple Case ◽  
The Impact ◽  
Practical Implications

Purpose: Mexico’s public hospitals are experiencing major operational problems which seriously affect the care of Mexican citizens. Some hospitals have initiated efforts to apply the Kaizen philosophy to improve this situation. Therefore, the purpose of this article is to analyze the methodological impact of Kaizen–Kata implementation in Mexican public hospitals that have tried to solve operational problems using this improvement approach. Design/Methodology/Approach: The service organization implemented Kaizen–Kata methodology in order to improve one operational problem-process in health care. A case-study approach was used in this research in order to understand the effects of the Kaizen–Kata methodology in solving problems in their operational procedures. Findings: Six specific drivers were identified when applying the Kaizen–Kata methodology. Furthermore, the impact on the levels of implementation of the Kaizen–Kata methodology in each of the improvement teams studied was also identified. Research Limitations: The main limitation of the research is that only three case-studies are presented thus it is not possible to generalize its results. Practical Implications (Where Possible): Other public hospitals can use this specific example as a working guide to solve the operational problems of health systems. Originality/Value: A methodology of continuous improvement in manufacturing was imported from the industry sector for application in an operational health care process. The Kaizen–Kata methodology contributed significantly to improving issues involving delays, customer complaints, process reworks and extra-cost, among other effects of operational problems.

scholarly journals Gambaran Penerimaan Diri Ibu Tiri yang Memiliki Anak Tunarungu

2018 ◽  
Vol 1 (1) ◽  
pp. 247-251
Author(s):  
Debby A Daulay ◽  
Rizqi Chairiyah
Keyword(s):  
Care Process ◽  
Deaf Children ◽  
Hearing Impairments ◽  
Study Approach ◽  
The People ◽  
The Status ◽  
Self Acceptance ◽  
Observation Method ◽  
Adaptation Processes

Penelitian ini bertujuan untuk mengetahui gambaran penerimaan diri ibu tiri yang memiliki anak tunarungu. Status ibu tiri yang umumnya memiliki penilaian negatif di masyarakat membuat ibu tiri membutuhkan proses adaptasi lebih, untuk pada akhirnya mampu menerima status diri, keadaan keluarga maupun kondisi anak tirinya yang mengalami ketunarunguan. Anak tuna rungu, dengan segala keterbatasan yang dimiliki khususnya dari segi bahasa dan lisan sudah barang tentu membutuhkan perhatian ‗ekstra‘ baik dari orang tua ataupun orang-orang disekitar yang turut berperan dalam proses pengasuhannya. Berkaitan dengan sejumlah kompleksitas dalam menyandang status sebagai ibu tiri yang harus mengasuh anak dengan kondisi tuna rungu, maka akan menjadi sangat menarik untuk melihat gambaran dinamika dari proses penerimaan diri ibu tiri tersebut. Adapun teori yang digunakan dalam penelitian ini adalah teori penerimaan diri dari Jersild (1963). Penerimaan diri adalah derajat dimana individu memiliki kesadaran terhadap karakteristiknya, sehingga diharapkan ia mampu dan bersedia untuk hidup dengan karakteristik tersebut. Penelitian ini menggunakan metode penelitian kualitatif dengan pendekatan studi kasus intrinsik. Melibatkan 2 orang partisipan dengan menggunakan teknik pengambilan partisipan berdasarkan theory-based operational construct sampling. Teknik pengambilan data yang digunakan adalah metode wawancara dan observasi. Hasil penelitian menunjukkan bahwa kedua partisipan memiliki penerimaan diri yang baik terhadap statusnya sebagai ibu tiri.Dalam hal ini, pemikiran positif dan realistik ternyata memiliki pengaruh yang besar terhadap proses penerimaan diri pada partisipan 1 maupun partisipan 2 berjalan secara lebih baik. Partisipan 1 telah menerima status dirinya sebagai ibu tiri yang memiliki anak tunarungu dan mampu menjalani kesepuluh aspek penerimaaan diri dengan baik. Tidak jauh berbeda, partisipan 2 juga telah memiliki penerimaan diri yang baik terhadap statusnya sebagai ibu tiri dan mampu menjalani kesembilan aspek penerimaan diri dengan baik. Adapun aspek yang tidak terpenuhi pada partisipan 2 yaitu ‗penerimaan yang baik dari orang lain‘. Partisipan 2 belum bisa menerima dan menganggap anak tirinya yang tunarungu sebagai anaknya sendiri, dikarenakan faktor-faktor eksternal yang dalam hal ini adalah perilaku kasar dari anak tirinya tersebut serta adanya penolakan dari ibu mertua terhadap dirinya.   This study aimed to describe the self-acceptance of stepmothers who have deaf children. The status of stepmothers who generally have negative judgments in the community makes stepmothers need more adaptation processes, in order to finally be able to accept self-status, family circumstances, and the condition of their stepchildren who experience phlegm. Deaf children, with all the limitations possessed, especially in terms of language and oral, of course require the attention of 'extras' both from parents or the people around them who play a role in the care process. Regarding the complexity in carrying out status as a stepmother to care for children with hearing impairments, it will be very interesting to see the dynamic picture of the stepmother's self-acceptance process. The theory used in this research was Jersild's self-acceptance theory (1963). Self-acceptance is the degree to which an individual has an awareness of his characteristics, so he is expected to be able and willing to live with these characteristics. This study used a qualitative research method with an intrinsic case study approach. Involved 2 participants using participant taking techniques based on theory-based operational construct sampling. The data collection techniques used in this research were the interview and observation method. The results showed that both participants had good self-acceptance of their status as stepmothers. In this case, positive and realistic thinking turned out to have a big influence on the process of self-acceptance in participant 1 and participant 2 to run well. Participant 1 had accepted her status as a stepmother who has deaf children and was able to undergo the ten aspects of self-acceptance well. Not much different, participant 2 also had good self-acceptance of her status as a stepmother and was able to undergo all nine aspects of self-acceptance well. The aspect that was not fulfilled in participant 2 was "good acceptance from others". Participant 2 had not been able to accept and assume that her stepson is deaf as his own child, because of external factors in this case was the rude behavior of her stepson and the rejection of her mother-in-law against her.

A case of irritable bowel syndrome that illustrates the biopsychosocial model of illness

2015 ◽  
Author(s):  
Doug Drossman
Keyword(s):  
Irritable Bowel Syndrome ◽  
Medical Practice ◽  
Biopsychosocial Model ◽  
Clinical Care ◽  
Research Strategies ◽  
Irritable Bowel

This chapter illustrates how the biopsychosocial model might work within the context of medical practice. It discusses its relevance to research using a case study as an example of the role of clinical care in developing research strategies for applying psychosocial principles. It argues that individual illnesses are a legitimate area of research into the biopsychosocial model.

Digitalising Healthcare in Developing Economies

2020 ◽  
pp. 332-353
Author(s):  
Mansah Preko ◽  
Richard Osei-Boateng ◽  
Adekunle Ezekiel Durosinmi
Keyword(s):  
Health Systems ◽  
Developing Economies ◽  
Digital Health ◽  
Contextual Factors ◽  
Multiple Case Study ◽  
Healthcare Industry ◽  
Study Approach ◽  
Multiple Case ◽  
Increasing Demand

There is an increasing demand for the healthcare industry in developing economies to reform their existing fragmented paper-based systems to take advantage of the several opportunities that digitalisation brings. However, the existence of specific contextual factors constrains the process of digitalisation in most developing economies. Underpinned by the concepts of installed base and cultivation, this chapter adopts a qualitative multiple-case study approach to examine the contextual factors that influence the development, implementation, and adoption of digital health systems in the Ghanaian and Nigerian contexts. Results of this chapter reveal 13 key challenges and their corresponding mitigating strategies that were adopted in specific instances to facilitate digitalisation in both contexts. A comparison of findings for the two contexts is also discussed.

scholarly journals Shaping Technique as a Media to Increase Independence in Adolescents with Diplegia Cerebral Palsy

2020 ◽  
Vol 8 ◽  
Author(s):  
Maftuhah Maftuhah ◽  
IGGA Noviekayatie
Keyword(s):  
Cerebral Palsy ◽  
Daily Living ◽  
Behavioral Therapy ◽  
Daily Routine ◽  
Case Study Approach ◽  
Daily Living Activity ◽  
Study Approach ◽  
Dependent Behavior ◽  
Therapy Intervention

Teenager with diplegia cerebral palsy has poor ADL (Activity Daily Living) ability. This is due to that he doesn’t train his ability while at home because his family choose to give him full support by preparing all his needs. The goal of this researches is to change dependent behavior to more independent in his simple daily routine that related to optimum hand utilization and also ability to move independently. Researcher is using experimental method with case study approach. Researcher give behavioral therapy intervention (shaping) to improve level of independence of subject. Intervention was done in 5 session, including rapport, determined activity, activity training, intervention and evaluation. Intervention was done in 6 days doing observation and using target achievement activity checklist. Before intervention, subject always aided in daily living activity. After intervention, subject want and able to do simple daily activity such as eat, using and tidy up his clothes and also moved independently. The result of this researches show that shaping behavioral therapy can be used to improve level of independence in teenager with cerebral palsy diplegia. 

Sign in / Sign up

Export Citation Format

Share Document