scholarly journals Health Care Professionals’ Perceptions of Pay-for-Performance in Practice: A Qualitative Metasynthesis

2020 ◽  
Vol 57 ◽  
pp. 004695802091749
Author(s):  
Barbara Martin ◽  
Jacqueline Jones ◽  
Matthew Miller ◽  
Rachel Johnson-Koenke
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Performance Measurement ◽  
Health Care Professionals ◽  
Financial Incentives ◽  
Pay For Performance ◽  
Research Process ◽  
Future Research ◽  
Limiting Factor ◽  
Integrate Health Care

Incentive-based pay-for-performance (P4P) models have been introduced during the last 2 decades as a mechanism to improve the delivery of evidence-based care that ensures clinical quality and improves health outcomes. There is mixed evidence that P4P has a positive effect on health outcomes and researchers cite lack of engagement from health care professionals as a limiting factor. This qualitative metasynthesis of existing qualitative research was conducted to integrate health care professionals’ perceptions of P4P in clinical practice. Four themes emerged during the research process: positive perceptions of the value of performance measurement and associated financial incentives; negative perceptions of the performance measurement and associated financial incentives; perceptions of how P4P programs influence the quality/appropriateness of care; and perceptions of the influence of P4P program on professional roles and workplace dynamics. Identifying factors that influence health care professionals’ perceptions about this type of value-based payment model will guide future research.

scholarly journals The Personalization of Conversational Agents in Health Care: Systematic Review (Preprint)

2019 ◽  
Author(s):  
Ahmet Baki Kocaballi ◽  
Shlomo Berkovsky ◽  
Juan C Quiroz ◽  
Liliana Laranjo ◽  
Huong Ly Tong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Natural Language ◽  
Health Outcomes ◽  
Health Care Professionals ◽  
User Satisfaction ◽  
Future Research ◽  
User Engagement ◽  
Conversational Agents ◽  
Design Factor

BACKGROUND The personalization of conversational agents with natural language user interfaces is seeing increasing use in health care applications, shaping the content, structure, or purpose of the dialogue between humans and conversational agents. OBJECTIVE The goal of this systematic review was to understand the ways in which personalization has been used with conversational agents in health care and characterize the methods of its implementation. METHODS We searched on PubMed, Embase, CINAHL, PsycInfo, and ACM Digital Library using a predefined search strategy. The studies were included if they: (1) were primary research studies that focused on consumers, caregivers, or health care professionals; (2) involved a conversational agent with an unconstrained natural language interface; (3) tested the system with human subjects; and (4) implemented personalization features. RESULTS The search found 1958 publications. After abstract and full-text screening, 13 studies were included in the review. Common examples of personalized content included feedback, daily health reports, alerts, warnings, and recommendations. The personalization features were implemented without a theoretical framework of customization and with limited evaluation of its impact. While conversational agents with personalization features were reported to improve user satisfaction, user engagement and dialogue quality, the role of personalization in improving health outcomes was not assessed directly. CONCLUSIONS Most of the studies in our review implemented the personalization features without theoretical or evidence-based support for them and did not leverage the recent developments in other domains of personalization. Future research could incorporate personalization as a distinct design factor with a more careful consideration of its impact on health outcomes and its implications on patient safety, privacy, and decision-making.

scholarly journals The Personalization of Conversational Agents in Health Care: Systematic Review

10.2196/15360 ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. e15360 ◽  
Author(s):  
Ahmet Baki Kocaballi ◽  
Shlomo Berkovsky ◽  
Juan C Quiroz ◽  
Liliana Laranjo ◽  
Huong Ly Tong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Natural Language ◽  
Health Outcomes ◽  
Health Care Professionals ◽  
User Satisfaction ◽  
Future Research ◽  
User Engagement ◽  
Conversational Agents ◽  
Design Factor

Background The personalization of conversational agents with natural language user interfaces is seeing increasing use in health care applications, shaping the content, structure, or purpose of the dialogue between humans and conversational agents. Objective The goal of this systematic review was to understand the ways in which personalization has been used with conversational agents in health care and characterize the methods of its implementation. Methods We searched on PubMed, Embase, CINAHL, PsycInfo, and ACM Digital Library using a predefined search strategy. The studies were included if they: (1) were primary research studies that focused on consumers, caregivers, or health care professionals; (2) involved a conversational agent with an unconstrained natural language interface; (3) tested the system with human subjects; and (4) implemented personalization features. Results The search found 1958 publications. After abstract and full-text screening, 13 studies were included in the review. Common examples of personalized content included feedback, daily health reports, alerts, warnings, and recommendations. The personalization features were implemented without a theoretical framework of customization and with limited evaluation of its impact. While conversational agents with personalization features were reported to improve user satisfaction, user engagement and dialogue quality, the role of personalization in improving health outcomes was not assessed directly. Conclusions Most of the studies in our review implemented the personalization features without theoretical or evidence-based support for them and did not leverage the recent developments in other domains of personalization. Future research could incorporate personalization as a distinct design factor with a more careful consideration of its impact on health outcomes and its implications on patient safety, privacy, and decision-making.

scholarly journals Mental Health Outcomes Associated with COVID-19 Pandemic in a Group of Health Care Professionals

2021 ◽  
Author(s):  
Michał Ziarko ◽  
Aleksandra Jasielska ◽  
Maia Stanisławska-Kubiak ◽  
Przemysław Daroszewski ◽  
Włodzimierz Samborski ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Outcomes ◽  
Health Care Professionals ◽  
Mental Health Outcomes

scholarly journals Interpreting in Sexual and Reproductive Health Consults With Burma Born Refugees Post Settlement: Insights From an Australian Qualitative Study

2021 ◽  
Vol 6 ◽  
Author(s):  
Amita Tuteja ◽  
Elisha Riggs ◽  
Lena Sanci ◽  
Lester Mascarenhas ◽  
Di VanVliet ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Best Practice ◽  
Qualitative Methodology ◽  
Future Research ◽  
Care Providers ◽  
Face To Face ◽  
Consultation Room ◽  
Privacy And Confidentiality

Interpreters work with health care professionals to overcome language challenges during sexual and reproductive (SRH) health discussions with people from refugee backgrounds. Disclosures of traumatic refugee journeys and sexual assault combined with refugees’ unfamiliarity with Western health concepts and service provision can increase the interpreting challenges. Published literature provides general guidance on working with interpreters in primary care but few studies focus on interpretation in refugee SRH consults. To address this, we explored the challenges faced by providers of refugee services (PRS) during interpreter mediated SRH consultations with Burma born refugees post settlement in Australia. We used qualitative methodology and interviewed 29 PRS involved with migrants from Burma including general practitioners, nurses, interpreters, bilingual social workers, and administrative staff. The interviews were audio-recorded, transcribed, and subjected to thematic analysis following independent coding by the members of the research team. Key themes were formulated after a consensus discussion. The theme of “interpretation related issues” was identified with six sub-themes including 1) privacy and confidentiality 2) influence of interpreter’s identity 3) gender matching of the interpreter 4) family member vs. professional interpreters 5) telephone vs. face-to-face interpreting 6) setting up the consultation room. When faced with these interpretation related challenges in providing SRH services to people from refugee backgrounds, health care providers combine best practice advice, experience-based knowledge and “mundane creativity” to adapt to the needs of the specific patients. The complexity of interpreted SRH consultations in refugee settings needs to be appreciated in making good judgments when choosing the best way to optimize communication. This paper identifies the critical elements which could be incorporated when making such a judgement. Future research should include the experiences of refugee patients to provide a more comprehensive perspective.

scholarly journals Romanian GPs Involvement in Caring for the Mental Health Problems of the Elderly Population: A Cross-Sectional Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Raluca Sfetcu ◽  
Daciana Toma ◽  
Catalina Tudose ◽  
Cristian Vladescu
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Professionals ◽  
Financial Incentives ◽  
Mental Health Problems ◽  
Early Recognition ◽  
The Elderly ◽  
Health Problems ◽  
National Society

The mental health of the elderly is a matter of increased concern in the context of an aging population since currently only a small fraction of this population is receiving adequate care. The provision of treatment in primary care by the General Practitioners (GPs) has been proposed for over a decade as a potential solution, as services offered by GPs are more accessible, less susceptible to stigma, and have a more comprehensive view of the other health care problems that the elderly might suffer from. In this study, we explored the perception of Romanian GPs regarding their practice and roles in caring for the mental health of the elderly as well as the willingness to increase their future involvement in the management of dementia and other mental health problems. Data was collected via an online questionnaire structured on four dimensions: (1) GPs' sociodemographic profile and practice characteristics, (2) GPs assessment of the services available for elderly with mental health problems, (3) GPs current involvement in mental health care for different categories of problems, and (4) factors that might influence the future involvement of GPs in providing care for elderly with mental health problems. The survey was sent via the member mailing lists of the National Society for Family Medicine. Results show that GPs are currently limited by prescribing possibilities, available resources and knowledge in the area, but they are willing to expand their role in the areas of early recognition and prevention of mental health problems as well as providing disease management and collaborative care. An improved communication with mental health care professionals, a better access to resources and having more financial incentives are the three most important categories for GPs to increase their involvement. In conclusion, increasing the access to personal and professional resources and setting up functional communication channels with specialized mental health care could motivate GPs to provide timely mental health support to elderly patients.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2017 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This chapter contains 56 references.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2015 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This chapter contains 56 references.

69 What Health Outcomes Matter to Frail Older People?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i21-i21
Author(s):  
K S Tipping
Keyword(s):  
Health Care ◽  
Focus Group ◽  
Older People ◽  
Health Outcomes ◽  
Health Care Professionals ◽  
Focus Group Interview ◽  
Group Interview ◽  
Health Priorities ◽  
Frail Older People ◽  
Clinical Frailty Scale

Abstract Introduction The purpose of this project was to explore what health outcomes matter to frail older people. This would provide information that would be of use to both providers and payers of health care services to align their priorities in line with these. Frailty is an important and relevant topic in healthcare. In England 5% of people aged 60-69 have frailty. This rises to 65% in people aged over 90. There are 1.8 million people aged over 60 and 0.8 million people aged over 80 living with frailty. (English Longitudinal Study of Ageing (2016)). This number is due to increase. The aims of this research were: To review the literature on health outcomes in older people including frail older people.To conduct a focus group interview with frail older people to ascertain their views on health outcomes.To disseminate and share the reviews and study findings via presentations and publications. Ethics Ethical approval was granted by the University of Liverpool’s Health and Life Sciences Research Ethics Committee (application number 4163). Methods A systematic review of the literature was undertaken. Thereafter a focus group interview was held with six frail older people. The participants were aged 65 years and over and had mild to moderate frailty using the Clinical Frailty Scale. The interview recording was transcribed, and common themes identified and analysed. Results Eight themes were identified from the focus group: - Trust in medical professionalsVulnerability of being an older person in hospitalPolypharmacy and wastage of medicationDischarge Planning & Co-Ordination of Care at HomeTaking responsibility for your own healthNomenclatureAutonomyFalls Conclusion This study has identified themes that can be utilised to raise awareness among health care professionals on what matters to frail older people. The study findings will hopefully provide an opportunity for meaningful discussions around what is needed to better meet these desired health outcomes. References 1. Akpan A, Roberts C, Bandeen-Roche K, Batty B, Bausewein C, Bell D, et al. Standard set of health outcome measures for older persons. BMC Geriatr 2018;18(1):36. 2. Naik AD, Dindo LN, Van Liew JR, Hundt NE, Vo L, Hernandez-Bigos K, et al. Development of a Clinically Feasible Process for Identifying Individual Health Priorities. Journal of the American Geriatrics Society 2018;66(10):1872–9.

scholarly journals Patients’ Needs Regarding Anxiety Management in Palliative Cancer Care: A Qualitative Study in a Hospice Setting

2019 ◽  
Vol 36 (11) ◽  
pp. 947-954 ◽  
Author(s):  
Danielle Zweers ◽  
Alexander de Graeff ◽  
Jette Duijn ◽  
Everlien de Graaf ◽  
Petronella O. Witteveen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Symptom Management ◽  
World Health ◽  
Future Research ◽  
Common Symptom ◽  
Structured Interviews ◽  
Open Communication ◽  
Hospice Patients ◽  
Health Organization

Introduction: Anxiety is a common symptom in the palliative phase, and symptom management depends on the competencies of individual professionals. This study aims to get insight into the needs of anxious hospice patients with advanced cancer regarding support. Method: Semi-structured interviews were performed in admitted hospice patients with cancer. Patients admitted from May 2017 till May 2018 were eligible whether or not they were anxious. Interviews were analyzed and coded within predefined topics. Results: Fourteen patients were included: 10 females, median age 71, and median World Health Organization performance score 3. Most patients were highly educated. Thirteen patients were interviewed within 6 months before death. Information, open communication, sense of control, safety, adequate symptom management, and respect for patients’ coping strategy were the 6 main expressed needs. Conclusion: Assessing patients’ needs regarding anxiety provided important angles where health-care professionals can make a difference in order to support anxious patients in their final stage of life to realize tailored palliative care. Future research should focus on the development of a systematic approach for health-care professionals to manage anxiety in daily care of terminal patients.

Making Ethics Work in Collaborative Projects

2005 ◽  
Vol 11 (3) ◽  
pp. 101
Author(s):  
Emily Mauldon
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Research Ethics ◽  
Health Care Professionals ◽  
Ethics Committees ◽  
Research Process ◽  
Ethical Review ◽  
Ethical Research ◽  
Team Members ◽  
Primary Health

This article discusses problems a research team had managing their ethical obligations during a short project, and considers the implications of these problems for better understanding and carrying out ethical research in the future. Two key points will be proposed. Initially, it will be argued that the culture of ethical research as articulated within the research community may not be universally accepted within the primary health care sector. The nature of "ethical conduct" within clinical practice, service provision and research is not the same. Further, practical difficulties the researchers experienced while trying to gain approval from ethics committees and implement the proposed research plan highlight some ways in which institutional ethical review processes are structurally unsuited to the requirements of small collaborative projects. Understanding the different ways in which the term "ethics" is used will allow for a more expedient translation of concepts between different health professionals. Recognising the practical constraints ethical review places on the research process may help reduce some of the frustration primary health care professionals can experience when faced with the requirements of research ethics committees. Due to the history of, and cultural commitment to, ethical research within the university sector, those with formal academic training in research are well placed to assume responsibility for managing the ethics process when involved in cross-sectoral research. This responsibility may include the need to educate team members and study participants about the importance of research ethics.

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