scholarly journals Quantifying Missed Opportunities for Recruitment to Home Dialysis Therapies

2021 ◽  
Vol 8 ◽  
pp. 205435812199325
Author(s):  
Krishna Poinen ◽  
Lee Er ◽  
Michael A. Copland ◽  
Rajinder S. Singh ◽  
Mark Canney
Keyword(s):  
Health Care ◽  
British Columbia ◽  
Health Care System ◽  
Selection Process ◽  
Chronic Dialysis ◽  
Home Therapy ◽  
Missed Opportunities ◽  
Home Dialysis ◽  
Missed Opportunity ◽  
Care System

Background: Despite the recognized benefits of home therapies for patients and the health care system, most individuals with kidney failure in Canada continue to be initiated on in-center hemodialysis. To optimize recruitment to home therapies, there is a need for programs to better understand the extent to which potential candidates are not successfully initiated on these therapies. Objective: We aimed to quantify missed opportunities to recruit patients to home therapies and explore where in the modality selection process this occurs. Design: Retrospective observational study. Setting: British Columbia, Canada. Patients: All patients aged >18 years who started chronic dialysis in British Columbia between January 01, 2015, and December 31, 2017. The sample was further restricted to include patients who received at least 3 months of predialysis care. All patients were followed for a minimum of 12 months from the start of dialysis to capture any transition to home therapies. Methods: Cases were defined as a “missed opportunity” if a patient had chosen a home therapy, or remained undecided about their preferred modality, and ultimately received in-center hemodialysis as their destination therapy. These cases were assessed for: (1) documentation of a contraindication to home therapies; and (2) the type of dialysis education received. Differences in characteristics among patients classified as an appropriate outcome or a missed opportunity were examined using Wilcoxon rank-sum test or χ2 test, as appropriate. Results: Of the 1845 patients who started chronic dialysis during the study period, 635 (34%) were initiated on a home therapy. A total of 320 (17.3%) missed opportunities were identified, with 165 (8.9%) having initially chosen a home therapy and 155 (8.4%) being undecided about their preferred modality. Compared with patients who chose and initiated or transitioned to a home therapy, those identified as a missed opportunity tended to be older with a higher prevalence of cardiovascular disease. A contraindication to both peritoneal dialysis and home hemodialysis was documented in 8 “missed opportunity” patients. General modality orientation was provided to most (71%) patients who had initially chosen a home therapy but who ultimately received in-center hemodialysis. These patients received less home therapy–specific education compared with patients who chose and subsequently started a home therapy (20% vs 35%, P < .001). Limitations: Contraindications to home therapies were potentially under-ascertained, and the nature of contraindications was not systematically captured. Conclusions: Even within a mature home therapy program, we discovered a substantial number of missed opportunities to recruit patients to home therapies. Better characterization of modality contraindications and enhanced education that is specific to home therapies may be of benefit. Mapping the recruitment pathway in this way can define the magnitude of missed opportunities and identify areas that could be optimized. This is to be encouraged, as even small incremental improvements in the uptake of home therapies could lead to better patient outcomes and contribute to significant cost savings for the health care system. Trial Registration: Not applicable as this was a qualitative study.

scholarly journals Proposed Implementation of Blockchain in British Columbia’s Health Care Data Management (Preprint)

2020 ◽  
Author(s):  
Danielle Cadoret ◽  
Tamara Kailas ◽  
Pedro Velmovitsky ◽  
Plinio Morita ◽  
Okechukwu Igboeli
Keyword(s):  
Health Care ◽  
British Columbia ◽  
Data Management ◽  
Health Care System ◽  
Information Flow ◽  
Health Care Data ◽  
Canadian Health ◽  
Canadian Health Care ◽  
Lag Period ◽  
Care System

BACKGROUND There are several challenges such as information silos and lack of interoperability with the current electronic medical record (EMR) infrastructure in the Canadian health care system. These challenges can be alleviated by implementing a blockchain-based health care data management solution. OBJECTIVE This study aims to provide a detailed overview of the current health data management infrastructure in British Columbia for identifying some of the gaps and inefficiencies in the Canadian health care data management system. We explored whether blockchain is a viable option for bridging the existing gaps in EMR solutions in British Columbia’s health care system. METHODS We constructed the British Columbia health care data infrastructure and health information flow based on publicly available information and in partnership with an industry expert familiar with the health systems information technology network of British Columbia’s Provincial Health Services Authorities. Information flow gaps, inconsistencies, and inefficiencies were the target of our analyses. RESULTS We found that hospitals and clinics have several choices for managing electronic records of health care information, such as different EMR software or cloud-based data management, and that the system development, implementation, and operations for EMRs are carried out by the private sector. As of 2013, EMR adoption in British Columbia was at 80% across all hospitals and the process of entering medical information into EMR systems in British Columbia could have a lag of up to 1 month. During this lag period, disease progression updates are continually written on physical paper charts and not immediately updated in the system, creating a continuous lag period and increasing the probability of errors and disjointed notes. The current major stumbling block for health care data management is interoperability resulting from the use of a wide range of unique information systems by different health care facilities. CONCLUSIONS Our analysis of British Columbia’s health care data management revealed several challenges, including information silos, the potential for medical errors, the general unwillingness of parties within the health care system to trust and share data, and the potential for security breaches and operational issues in the current EMR infrastructure. A blockchain-based solution has the highest potential in solving most of the challenges in managing health care data in British Columbia and other Canadian provinces.

scholarly journals Proposed Implementation of Blockchain in British Columbia’s Health Care Data Management

10.2196/20897 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e20897
Author(s):  
Danielle Cadoret ◽  
Tamara Kailas ◽  
Pedro Velmovitsky ◽  
Plinio Morita ◽  
Okechukwu Igboeli
Keyword(s):  
Health Care ◽  
British Columbia ◽  
Data Management ◽  
Health Care System ◽  
Information Flow ◽  
Health Care Data ◽  
Canadian Health ◽  
Canadian Health Care ◽  
Lag Period ◽  
Care System

Background There are several challenges such as information silos and lack of interoperability with the current electronic medical record (EMR) infrastructure in the Canadian health care system. These challenges can be alleviated by implementing a blockchain-based health care data management solution. Objective This study aims to provide a detailed overview of the current health data management infrastructure in British Columbia for identifying some of the gaps and inefficiencies in the Canadian health care data management system. We explored whether blockchain is a viable option for bridging the existing gaps in EMR solutions in British Columbia’s health care system. Methods We constructed the British Columbia health care data infrastructure and health information flow based on publicly available information and in partnership with an industry expert familiar with the health systems information technology network of British Columbia’s Provincial Health Services Authorities. Information flow gaps, inconsistencies, and inefficiencies were the target of our analyses. Results We found that hospitals and clinics have several choices for managing electronic records of health care information, such as different EMR software or cloud-based data management, and that the system development, implementation, and operations for EMRs are carried out by the private sector. As of 2013, EMR adoption in British Columbia was at 80% across all hospitals and the process of entering medical information into EMR systems in British Columbia could have a lag of up to 1 month. During this lag period, disease progression updates are continually written on physical paper charts and not immediately updated in the system, creating a continuous lag period and increasing the probability of errors and disjointed notes. The current major stumbling block for health care data management is interoperability resulting from the use of a wide range of unique information systems by different health care facilities. Conclusions Our analysis of British Columbia’s health care data management revealed several challenges, including information silos, the potential for medical errors, the general unwillingness of parties within the health care system to trust and share data, and the potential for security breaches and operational issues in the current EMR infrastructure. A blockchain-based solution has the highest potential in solving most of the challenges in managing health care data in British Columbia and other Canadian provinces.

scholarly journals Analysis of the budgetary impact of alogliptin in type 2 diabetes and unachieved target glycemia with metformin

2021 ◽  
Vol 5 (9) ◽  
pp. 559-567
Author(s):  
S.V. Nedogoda ◽  
◽  
A.S. Salasyuk ◽  
I.N. Barykina ◽  
V.O. Lutova ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Health Care System ◽  
Target Population ◽  
Medical Costs ◽  
Missed Opportunities ◽  
Budgetary Impact ◽  
Essential Drugs ◽  
Care System

within the preferential medication supply according to the List of Vital and Essential Drugs. Patients and Methods: the analytical model of decision-making was created using the MS Excel software to analyze the budgetary impact and "missed opportunities" when using alogliptin compared to other DPP-4 inhibitors for T2D. This model included only direct medical costs for one patient (medical costs of medical treatment with DPP-4 inhibitors). The target population included adults with T2D who received DPP-4 inhibitors from the List of Vital and Essential Drugs to enhance ineffective therapy with metformin based on the monitoring of the IQVIA drug purchase in 2021. Results: complete switch to alogliptin in the target population (249,700 patients with T2D) eased the strain on a budget of the health care system by 18%, or 839.7 million of RUB, over a 1-year therapy. Considering the previously calculated penetration rate, the average budget savings of the health care system over a 5-year therapy will be 11% or 448.6 of RUB. In addition, the analysis of "missed opportunities" has demonstrated that prescribing alogliptin in adults with T2D (considering replacement schedule) allows for additional treatment of 13,693 patients within the first year and 146,311 patients within five years in a fixed budget. Conclusion: in T2D, alogliptin is more effective compared to other DPP-4 inhibitors in terms of economics due to lower cost and similar efficacy. KEYWORDS: diabetes, dipeptidyl peptidase 4 inhibitors, alogliptin, analysis of budgetary impact, pharmacoeconomics. FOR CITATION: Nedogoda S.V., Salasyuk A.S., Barykina I.N. et al. Analysis of the budgetary impact of alogliptin in type 2 diabetes and unachieved target glycemia with metformin. Russian Medical Inquiry. 2021;5(9):559–567 (in Russ.). DOI: 10.32364/2587-6821-2021-5-9-559-567.

scholarly journals Missed Opportunities for HIV Testing of Patients Tested for Sexually Transmitted Infections at a Large Urban Health Care System From 2010 to 2015

2018 ◽  
Vol 5 (7) ◽  
Author(s):  
Shashi N Kapadia ◽  
Harjot K Singh ◽  
Sian Jones ◽  
Samuel Merrick ◽  
Carlos M Vaamonde
Keyword(s):  
Health Care ◽  
Hiv Testing ◽  
Health Care System ◽  
Urban Health ◽  
Urban Health Care ◽  
Hiv Care ◽  
Hiv Positive ◽  
Missed Opportunities ◽  
Hiv Test ◽  
Care System

Abstract Background Appropriate testing of people at risk for HIV is an important piece of the HIV care continuum. We analyzed HIV testing patterns of patients tested for gonorrhea and chlamydia (GC/CT) at a large urban health care system in New York City. Methods We retrospectively studied HIV and GC/CT testing from 2010 to 2015. Data were collected from a clinical laboratory database and linked to electronic health records. Patients were older than age 13 years, not known to be HIV positive, and had had a GC/CT test. The main outcome was the proportion of patients who had both HIV and GC/CT testing performed at the same encounter. Results We analyzed 85 768 patients with 139 404 GC/CT testing encounters. Most of the testing encounters (88% for men and 94% for women) were in the outpatient setting. Same-day HIV testing improved from 59% in 2010 to 70% in 2015 for male patients, and from 41% to 51% for female patients. In multivariate regression, male sex was associated with receipt of an HIV test (odds ratio [OR], 2.49; P &lt; .001). Emergency department (OR, 0.22; P &lt; .0001) and inpatient (OR, 0.10; P &lt; .0001) locations were negatively associated with receipt of HIV testing. Among patients with HIV and GC/CT testing at the same encounter, 37 were HIV positive. Conclusions Concurrent HIV testing of patients being evaluated for GC/CT increased from 2010 to 2015. However, many patients failed to receive HIV testing, especially in emergency and inpatient settings. There continue to be missed opportunities for diagnosis of HIV among individuals with ongoing high-risk behavior.

Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

2014 ◽  
Vol 4 (1) ◽  
pp. 23-29
Author(s):  
Constance Hilory Tomberlin
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Patient Care ◽  
Health Care System ◽  
Gulf Coast ◽  
New Technology ◽  
Cost Effective ◽  
Veterans Health ◽  
Potential Benefits ◽  
Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

What is the best way to reform the U.S. health care system?

2007 ◽  
Vol 38 (1) ◽  
pp. 18
Author(s):  
KEVIN GRUMBACH ◽  
ROBERT MOFFIT
Keyword(s):  
Health Care ◽  
Health Care System ◽  
The U.S ◽  
Care System
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