An exploration of the role of advanced clinical practitioners in the East of England

Medical staff shortages in the UK have provided impetus for the introduction of advanced clinical practitioners (ACPs). This case study explored the views of 22 ACPs, managers and doctors in primary and acute settings in a region of England, to understand how the role is used, and barriers and facilitators to its success. ACP roles improved the quality of service provision, provided clinical career development and enhanced job satisfaction for staff and required autonomous clinical decision-making, with a high degree of self-awareness and individual accountability. Barriers included disparate pay-scales and funding, difficulty accessing continuing education and research, and lack of agreed role definition and title, due to a lack of standardised regulation and governance, and organisational barriers, including limited access to referral systems. Facilitators were supportive colleagues and opportunities for peer networking. Regulation of ACP roles is urgently needed, along with evaluation of the cost-effectiveness and patient experience of such roles.

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Learning to Accept Uncertainty as a Quality of Care Dimension

E-Health Technologies and Improving Patient Safety: Exploring Organizational Factors ◽

10.4018/978-1-4666-2657-7.ch001 ◽

2013 ◽

pp. 1-12

Author(s):

Vahé A. Kazandjian

Keyword(s):

Health Care ◽

Decision Making ◽

Information Technology ◽

Health Care Services ◽

Clinical Decision Making ◽

Clinical Decision ◽

Care Process ◽

Care Services

Uncertainty in clinical decision-making is integral to the pathways chosen while applying available knowledge to a patient’s care process. This chapter explores the ways in which uncertainty can be incorporated into the understanding of better performance approaches, and is thus proposed as an enabling dimension of performance. Tracing the keystone definitions of uncertainty from Hippocrates to Osler, the discussion addresses the dimensions of decision - making appropriateness, its timeliness, the expected and actual value of the care services, and the role of systematic communication between providers of care as well as with patients. The crucial role of Health Information Technology is emphasized, and a unifying model is proposed where the inclusion of uncertainty as a dimension of performance promotes an encompassing evaluation of the quality of health care services.

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The Role of Digital Clinical Decision Support Tool in Improving Quality of Intrapartum and Postpartum Care: Experiences From Two States of India.

10.21203/rs.3.rs-108018/v1 ◽

2020 ◽

Author(s):

Gulnoza Usmanova ◽

Kamlesh Lalchandani ◽

Ashish Srivast ◽

Chandra Joshi ◽

Deepak Bhatt ◽

...

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Clinical Decision Making ◽

Multivariate Logistic Regression Analysis ◽

Clinical Decision ◽

Interrupted Time Series Analysis ◽

Clinical Practices ◽

The Impact

Abstract Background: Computerized clinical decision support (CDSS) –digital information systems designed to improve clinical decision making by providers – are a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes. Methods: We have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August –October 2017 (baseline) and the data collected between December 2019 – March 2020 was analysed (latest). Results: The completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded to significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased. Conclusions: Our study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.

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The Usability, Acceptability, and Functionality of Smart Oral Multidose Dispensing Systems for Medication Adherence: A Scoping Review

Journal of Pharmacy Practice ◽

10.1177/0897190020977756 ◽

2020 ◽

pp. 089719002097775

Author(s):

Sadaf Faisal ◽

Jessica Ivo ◽

Catherine Lee ◽

Caitlin Carter ◽

Tejal Patel

Keyword(s):

Medication Adherence ◽

Scoping Review ◽

Clinical Decision Making ◽

Relevant Literature ◽

Clinical Decision ◽

Poor Quality ◽

Future Studies ◽

Adherence Data

Background: Medication non-adherence is a leading cause of non-optimal disease management, resulting in poor health outcomes, poor quality of life, and increased healthcare costs. Smart oral multidose dispensing systems (SOMDS) are being developed to address non-adherence; however, little is known about their integration into daily use by patients. Methods: Using Arksey and O’Malley’s scoping review framework, relevant literature was searched for in electronic databases (PubMed, EMBASE, International Pharmaceutical Abstracts, and Scopus). Observational and interventional studies reporting the integration and impact on adherence from SOMDS in adults ≥18 years and published after 1960 were included. Results: Thirteen articles including one case study, 8 cohort studies, and 4 randomized trials were eligible. SOMDS included smart blister packaging, automated dispensers, and electronic medication trays. The number of medications dispensed per SOMDS was one (n = 3), >1 (n = 2), placebo (n = 1) and not reported (n = 7). Reported outcomes included impact on medication adherence (n = 3), integration (n = 2) and both parameters (n = 8). Conclusion: Although most studies reported that SOMDS appear usable, there was significant variability in the SOMDS types, patient populations, medication adherence definitions, and measurements; impacting the interpretation of results. Future studies should be designed to address effectiveness of SOMDS on medication adherence in patients with multi-drug therapy and the utilization of real-time adherence data for informing clinical decision making.

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The Role of Health-Related Quality of Life Outcomes in Clinical Decision Making in Surgery for Esophageal Cancer: A Systematic Review

Annals of Surgical Oncology ◽

10.1245/s10434-008-0042-8 ◽

2008 ◽

Vol 15 (9) ◽

pp. 2372-2379 ◽

Cited By ~ 60

Author(s):

R. Parameswaran ◽

A. McNair ◽

K. N. L. Avery ◽

R. G. Berrisford ◽

S. A. Wajed ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Clinical Decision Making ◽

Clinical Decision ◽

Health Related Quality ◽

Life Outcomes ◽

Related Quality ◽

Health Related

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SOCIO EDUPRENENUR SEBAGAI UPAYA PENINGKATAN KUALITAS PENDIDIKAN DI INDONESIA

Jurnal Riset Entrepreneurship ◽

10.30587/jre.v3i2.1560 ◽

2020 ◽

Vol 3 (2) ◽

pp. 23

Author(s):

Hadi Ismanto ◽

Vembri Aulia Rahmi ◽

Nanang Bagus Setiawan

Keyword(s):

Qualitative Research ◽

Quality Of Education ◽

Case Study Approach ◽

Study Approach ◽

The Right ◽

The Cost ◽

To Receive

Additional learning or tutoring is urgently needed to help improve learning but due to high costs, some communities, especially those in the middle to lower economic level, are unable to register their children to attend tutoring (additional tutoring). The existence of Socioedupreneur is an alternative solution for those who do not have the cost to experience tutoring. Paying sincerely or not at all can alleviate them in terms of costs and can show the importance of education for the future and instill that all have the right to receive the same education. This research was conducted to determine the role of socio edupreneur in improving the quality of education. The purpose of this study was to determine the role of socio edupreneur as an effort to improve the quality of education in Indonesia. The method used by researchers in this study uses qualitative research methods, this type of research is descriptive qualitative research, a case study approach that is an approach to study, explain or interpret a case. In essence, this study seeks to highlight a decision or set of decisions or set of decisions why the decision was taken, how it was implemented, and what the results were. This research intensively focuses on an object that is about how the role of socioedupreneur in improving the quality of education.

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Using On-Line Medical Knowledge to Support Evidence-Based Practice

Knowledge Media in Healthcare ◽

10.4018/978-1-930708-13-6.ch011 ◽

2011 ◽

pp. 187-203

Author(s):

Daniel L. Moody ◽

Graeme G. Shanks

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Point Of Care ◽

Medical Knowledge ◽

Clinical Decision ◽

Evidence Based ◽

On Line ◽

Management Project

This paper describes a successful knowledge management project in one of Australia’s state health departments. The objective of the project was to provide medical staff with on-line access to the latest medical knowledge at the point of care in order to improve the quality of clinical decision making. We believe this represents an important case study from both a theoretical and practical viewpoint:

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A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction

Global Spine Journal ◽

10.1177/2192568217703089 ◽

2017 ◽

Vol 7 (3_suppl) ◽

pp. 221S-230S ◽

Cited By ~ 19

Author(s):

Michael G. Fehlings ◽

Allan R. Martin ◽

Lindsay A. Tetreault ◽

Bizhan Aarabi ◽

Paul Anderson ◽

...

Keyword(s):

Decision Making ◽

Outcome Prediction ◽

Clinical Decision Making ◽

Surgical Intervention ◽

Clinical Decision ◽

Clinical Expertise ◽

Resonance Imaging ◽

Cord Injury

Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.

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The role of digital clinical decision support tool in improving quality of intrapartum and postpartum care: experiences from two states of India

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03710-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gulnoza Usmanova ◽

Kamlesh Lalchandani ◽

Ashish Srivastava ◽

Chandra Shekhar Joshi ◽

Deepak Chandra Bhatt ◽

...

Keyword(s):

Time Series ◽

Decision Support ◽

Clinical Decision Support ◽

Clinical Decision Making ◽

Interrupted Time Series ◽

Clinical Decision ◽

Clinical Practices ◽

The Impact

Abstract Background Computerized clinical decision support (CDSS) –digital information systems designed to improve clinical decision making by providers – is a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes. Methods We have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August –October 2017 (baseline) and the data collected between December 2019 – March 2020 (latest) was analysed. The data sources included: digitized labour room registers, case sheets, referral and discharge summary forms, observation checklist and complication format. Descriptive, univariate and multivariate and interrupted time series regression analyses were conducted. Results The completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased. Conclusions Our study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.

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