scholarly journals A scoping review of patient engagement activities during COVID-19: More consultation, less partnership

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257880
Author(s):  
Lauren Cadel ◽  
Michelle Marcinow ◽  
Jane Sandercock ◽  
Penny Dowedoff ◽  
Sara J. T. Guilcher ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Engagement ◽  
Care Delivery ◽  
Clinical Care ◽  
Grey Literature ◽  
Community Outreach ◽  
Healthcare Systems ◽  
Barriers And Facilitators ◽  
Organizational Level ◽  
System Quality

Background The COVID-19 pandemic has had a devastating impact on healthcare systems and care delivery, changing the context for patient and family engagement activities. Given the critical contribution of such activities in achieving health system quality goals, we undertook to address the question: What is known about work that has been done on patient engagement activities during the pandemic? Objective To examine peer-reviewed and grey literature to identify the range of patient engagement activities, broadly defined (inclusive of engagement to support clinical care to partnerships in decision-making), occurring within health systems internationally during the first six months of the COVID-19 pandemic, as well as key barriers and facilitators for sustaining patient engagement activities during the pandemic. Methods The following databases were searched: Medline, Embase and LitCOVID; a search for grey literature focused on the websites of professional organizations. Articles were required to be specific to COVID-19, describe patient engagement activities, involve a healthcare organization and be published from March 2020 to September 2020. Data were extracted and managed using Microsoft Excel. A content analysis of findings was conducted. Results Twenty-nine articles were included. Few examples of more genuine partnership with patients were identified (such as co-design and organizational level decision making); most activities related to clinical level interactions (e.g. virtual consultations, remote appointments, family visits using technology and community outreach). Technology was leveraged in almost all reported studies to interact or connect with patients and families. Five main descriptive categories were identified: (1) Engagement through Virtual Care; (2) Engagement through Other Technology; (3) Engagement for Service Improvements/ Recommendations; (4) Factors Impacting Patient Engagement; and (5) Lessons Learned though Patient Engagement. Conclusions Evidence of how healthcare systems and organizations stayed connected to patients and families during the pandemic was identified; the majority of activities involved direct care consultations via technology. Since this review was conducted over the first six months of the pandemic, more work is needed to unpack the spectrum of patient engagement activities, including how they may evolve over time and to explore the barriers and facilitators for sustaining activities during major disruptions like pandemics.

scholarly journals Metrics of Patient, Public, Consumer, and Community Engagement in Healthcare Systems: How Should We Define Engagement, What Are We Measuring, and Does It Matter for Patient Care? Comment on "Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review"

2018 ◽  
Vol 8 (1) ◽  
pp. 49-50
Author(s):  
Zackary Berger
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Patient Engagement ◽  
Clinical Care ◽  
Healthcare Systems ◽  
System Level ◽  
Patient Representatives ◽  
Conceptual Foundations

In a rigorous systematic review, Dukhanin and colleagues categorize metrics and evaluative tools of the engagement of patient, public, consumer, and community in decision-making in healthcare institutions and systems. The review itself is ably done and the categorizations lead to a useful understanding of the necessary elements of engagement, and a suite of measures relevant to implementing engagement in systems. Nevertheless, the question remains whether the engagement of patient representatives in institutional or systemic deliberations will lead to improved clinical outcomes or increased engagement of individual patients themselves in care. Attention to the conceptual foundations of patient engagement would help make this systematic review relevant to the clinical care of patients.

scholarly journals Patient Engagement Approaches in Total Joint Arthroplasty: A Review of Two Decades

2021 ◽  
Vol 8 ◽  
pp. 237437352110365
Author(s):  
Aaron Alokozai ◽  
David N. Bernstein ◽  
Linsen T. Samuel ◽  
Atul F. Kamath
Keyword(s):  
Decision Making ◽  
Patient Engagement ◽  
Total Joint Arthroplasty ◽  
Remote Monitoring ◽  
Patient Involvement ◽  
Care Delivery ◽  
Joint Arthroplasty ◽  
Virtual Rehabilitation ◽  
The Past ◽  
Future Work

Patient engagement is a comprehensive approach to health care where the physician inspires confidence in the patient to be involved in their own care. Most research studies of patient engagement in total joint arthroplasty (TJA) have come in the past 5 years (2015-2020), with no reviews investigating the different patient engagement methods in TJA. The primary purpose of this review is to examine patient engagement methods in TJA. The search identified 31 studies aimed at patient engagement methods in TJA. Based on our review, the conclusions therein strongly suggest that patient engagement methods in TJA demonstrate benefits throughout care delivery through tools focused on promoting involvement in decision making and accessible care delivery (eg, virtual rehabilitation, remote monitoring). Future work should understand the influence of social determinants on patient involvement in care, and overall cost (or savings) of engagement methods to patients and society.

scholarly journals Quality of patient, family, caregiver and public engagement in decision-making in healthcare systems: a scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032788
Author(s):  
Clayon Hamilton ◽  
M Elizabeth Snow ◽  
Nancy Clark ◽  
Shannon Gibson ◽  
Maryam Dehnadi ◽  
...  
Keyword(s):  
Decision Making ◽  
Scoping Review ◽  
Family Caregiver ◽  
Research Question ◽  
Grey Literature ◽  
Healthcare Systems ◽  
Evaluation Framework ◽  
Bibliographic Databases ◽  
Scientific Article

IntroductionTo advance person- and family-centred healthcare, government initiatives have supported the engagement of patients and family caregivers in decision-making in healthcare systems. There is, however, no consensus on how to define success for such initiatives. This scoping review aims to identify the key elements for defining the quality of patient and family caregiver engagement in decision-making across the engagement domains (individual, community/organisation, system) of British Columbia’s healthcare system. We will use those elements to develop a conceptual evaluation framework.Methods and analysisThis scoping review follows Arskey and O’Malley’s methodology. (1) The research question was identified through team discussions. (2) Articles for data source will be identified using a librarian-informed search strategy for seven bibliographic databases as well as grey literature sources. (3) Selected articles will be relevant to the evaluation of patient and family caregiver engagement in healthcare systems. (4) Two researchers will independently extract data into predefined and emerging categories. (5) The researchers will reconcile and organise the identified elements. The research team’s collective perspective will then refine the elements, and select, interpret and summarise the results. (6) Persons from key stakeholder groups will be consulted to refine the emergent conceptual framework.Ethics and disseminationWe will seek ethics approval for the stakeholder consultation. This study follows an integrated knowledge translation approach. The results will inform evaluation of the Patients as Partners Initiative of the British Columbia Ministry of Health, and will be disseminated as a scientific article, a research brief, and presentations at conferences and stakeholder meetings.

scholarly journals Adoption of the concept of person-centred care into discourse in Europe: a systematic literature review

2021 ◽  
Vol 35 (9) ◽  
pp. 265-280 ◽  
Author(s):  
Kristina Rosengren ◽  
Petra Brannefors ◽  
Eric Carlstrom
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Literature Review ◽  
Systematic Approach ◽  
Grey Literature ◽  
Quality Of Healthcare ◽  
Healthcare Systems ◽  
Evidence Based ◽  
Content Type ◽  
Healthcare Settings

PurposeThis study aims to describe how person-centred care, as a concept, has been adopted into discourse in 23 European countries in relation to their healthcare systems (Beveridge, Bismarck, out of pocket).Design/methodology/approachA literature review inspired by the SPICE model, using both scientific studies (CINHAL, Medline, Scopus) and grey literature (Google), was conducted. A total of 1,194 documents from CINHAL (n = 139), Medline (n = 245), Scopus (n = 493) and Google (n = 317) were analysed for content and scope of person-centred care in each country. Countries were grouped based on healthcare systems.FindingsResults from descriptive statistics (percentage, range) revealed that person-centred care was most common in the United Kingdom (n = 481, 40.3%), Sweden (n = 231, 19.3%), the Netherlands (n = 80, 6.7%), Northern Ireland (n = 79, 6.6%) and Norway (n = 61, 5.1%) compared with Poland (0.6%), Hungary (0.5%), Greece (0.4%), Latvia (0.4%) and Serbia (0%). Based on healthcare systems, seven out of ten countries with the Beveridge model used person-centred care backed by scientific literature (n = 999), as opposed to the Bismarck model, which was mostly supported by grey literature (n = 190).Practical implicationsAdoption of the concept of person-centred care into discourse requires a systematic approach at the national (politicians), regional (guidelines) and local (specific healthcare settings) levels visualised by decision-making to establish a well-integrated phenomenon in Europe.Social implicationsEvidence-based knowledge as well as national regulations regarding person-centred care are important tools to motivate the adoption of person-centred care in clinical practice. This could be expressed by decision-making at the macro (law, mission) level, which guides the meso (policies) and micro (routines) levels to adopt the scope and content of person-centred care in clinical practice. However, healthcare systems (Beveridge, Bismarck and out-of-pocket) have different structures and missions owing to ethical approaches. The quality of healthcare supported by evidence-based knowledge enables the establishment of a well-integrated phenomenon in European healthcare.Originality/valueOur findings clarify those countries using the Beveridge healthcare model rank higher on accepting/adopting the concept of person-centered care in discourse. To adopt the concept of person-centred care in discourse requires a systematic approach at all levels in the organisation—from the national (politicians) and regional (guideline) to the local (specific healthcare settings) levels of healthcare.

scholarly journals Innovative Care Delivery of Acute Rehabilitation for Patients With COVID-19: A Case Report

2020 ◽  
Author(s):  
Tara Livingston ◽  
Elle K Sullivan ◽  
Grace Wilske ◽  
Allison M Gustavson
Keyword(s):  
Decision Making ◽  
Communication Systems ◽  
Discharge Planning ◽  
Care Delivery ◽  
Case Reports ◽  
Healthcare Systems ◽  
Video Communication ◽  
Viral Spread ◽  
Decision Making Models ◽  
Acute Rehabilitation

ABSTRACT Objectives The novel coronavirus 2019 (COVID-19) has impacted acute rehabilitation delivery by challenging the reliance on in-person care and the standard practice of delivering separate physical and occupational therapy services. Healthcare systems are rapidly developing innovative models of care that provide essential acute rehabilitation services while mitigating viral spread. We present two case reports to illustrate how we used technology and COVID-19 specific decision-making frameworks to deliver acute rehabilitation. Methods We iteratively developed two decision-making models regarding care delivery and discharge planning in the context of the challenges to delivering care in a pandemic. We leveraged use of video communication systems installed in all COVID-19 rooms to reduce the number of in-room providers and frequency of contact. Two patients were admitted to the hospital with symptomatic COVID-19 (males, ages 65 and 40 years). Results With the use of video communication system and the decision-making frameworks for care delivery and discharge planning, we avoided 7 in-person sessions. Both patients demonstrated functional gains and were discharged home. Conclusion The two case reports highlight the innovative use of a technology and COVID-19 specific decision-making processes to provide patient-centered care given the challenges to care delivery during the COVID-19 pandemic. Impact Statement The use of technology and decision-making models allows for delivery of safe acute rehabilitation care that minimizes contact, conserves personal protective equipment, and prepares for COVID-19 surges. The discussion points raised have applicability to patients without COVID-19 and other healthcare systems. Future research is needed to determine the effectiveness, costs, and downstream effects of our novel approach to acute rehabilitation for patients with COVID-19.

scholarly journals Barriers and facilitators to implement community outreach work and collaboration with partners

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Roy ◽  
É Lavoie-Trudeau ◽  
M Benlkhalti ◽  
Y Couturier ◽  
J Lane ◽  
...  
Keyword(s):  
Health Services ◽  
Interprofessional Collaboration ◽  
Grey Literature ◽  
Community Outreach ◽  
Organizational Factors ◽  
Community Services ◽  
Barriers And Facilitators ◽  
Positive Interaction ◽  
Outreach Work ◽  
Outreach Workers

Abstract Background Community outreach workers support individuals to access health and community services through various form of proximity approaches. Even though community outreach work is present in the province of Quebec (Canada) since the past 40 years, it is still difficult to implement and sustained, especially with families with young children. The aim of this study was to document barriers and facilitators to implement community outreach work, and to describe how such workers collaborate with sectoral (e.g. healthcare) and intersectoral (e.g. municipality, community organizations, schools) partners. Methods A content analysis was performed on 55 scientific and grey literature documents, and on the transcriptions of 24 individual interviews and 3 focus groups with stakeholders including parents, community outreach workers, healthcare employees, and inter-sectoral partners. Results This study reveals four categories of barriers and facilitators acting on the implementation of community outreach work: factors related to organizational factors, to the nature of community outreach work, to the intervention with families, and external/uncontrollable factors. With regards to collaboration, community outreach workers collaborate with many partners. Good interprofessional collaboration is achieved with a positive interaction and communication, shared or co-constructed activities for the families, co-intervention with the families, and strategies to be known and intersectoral meetings. Conclusions Results highlighted that many factors interact and can either influence positively or negatively the opportunity to implement community outreach work. The collaborative practices identified might help maximizing facilitators and overcoming barriers. Advocacy and a better understanding of how to integrate community outreach work within health services while maintaining the workers' flexibility are needed to sustain this practice. Key messages Advocacy and a better understanding of how to integrate community outreach work within health services while maintaining the workers’ flexibility are needed to sustain this practice. Community outreach workers help to reduce inequalities in health.

scholarly journals SYSTEMS APPROACHES TO HEALTHCARE SYSTEMS DESIGN AND CARE DELIVERY: AN OVERVIEW OF THE LITERATURE

2021 ◽  
Vol 1 ◽  
pp. 2941-2950
Author(s):  
Alexander Komashie ◽  
Saba Hinrichs-Krapels ◽  
P. John Clarkson
Keyword(s):  
Current Practice ◽  
Systems Approach ◽  
Care Delivery ◽  
Grey Literature ◽  
Systems Design ◽  
Evidence Base ◽  
Healthcare Systems ◽  
Healthcare Sector ◽  
Systems Approaches ◽  
Service Outcomes

AbstractThe healthcare sector is facing significant challenges that require a systems approach, resulting in a rapid growth in the application of systems approaches in healthcare since the beginning of the 21st century. Consequently, healthcare practitioners and policymakers now desire to understand the evidence-base for the approach, but little evidence of the kind desired exists. This paper is a first step in conducting a narrative review of the application of systems approaches in healthcare based on a systematic review of the academic and grey literature. First, the emergence of the approach in healthcare is explored. Second, specific examples of applications of systems approaches in healthcare are examined to identify any missing elements in current practice. Third, fourteen reviews of the approach in healthcare published in the last ten years are analysed. The results suggest that the use of the approach in healthcare will most likely continue to increase, however, significant work remains for the design and systems community to demonstrate the effectiveness of systems approaches, specifically in providing convincing measures of impact on patient and service outcomes.

scholarly journals Machine Learning Applications in Solid Organ Transplantation and Related Complications

2021 ◽  
Vol 12 ◽  
Author(s):  
Jeremy A. Balch ◽  
Daniel Delitto ◽  
Patrick J. Tighe ◽  
Ali Zarrinpar ◽  
Philip A. Efron ◽  
...  
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Organ Transplantation ◽  
Clinical Decision Making ◽  
Care Delivery ◽  
Clinical Care ◽  
Solid Organ Transplantation ◽  
Machine Learning Algorithms ◽  
Machine Learning Techniques ◽  
Solid Organ

The complexity of transplant medicine pushes the boundaries of innate, human reasoning. From networks of immune modulators to dynamic pharmacokinetics to variable postoperative graft survival to equitable allocation of scarce organs, machine learning promises to inform clinical decision making by deciphering prodigious amounts of available data. This paper reviews current research describing how algorithms have the potential to augment clinical practice in solid organ transplantation. We provide a general introduction to different machine learning techniques, describing their strengths, limitations, and barriers to clinical implementation. We summarize emerging evidence that recent advances that allow machine learning algorithms to predict acute post-surgical and long-term outcomes, classify biopsy and radiographic data, augment pharmacologic decision making, and accurately represent the complexity of host immune response. Yet, many of these applications exist in pre-clinical form only, supported primarily by evidence of single-center, retrospective studies. Prospective investigation of these technologies has the potential to unlock the potential of machine learning to augment solid organ transplantation clinical care and health care delivery systems.

Interventions to change clinician behaviour in relation to suicide prevention care in the emergency department: A scoping review protocol

2020 ◽  
Author(s):  
Hwayeon Danielle Shin ◽  
Christine Cassidy ◽  
Janet Curran ◽  
Lori Weeks ◽  
Leslie Anne Campbell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Suicide Prevention ◽  
Behaviour Change ◽  
Clinical Care ◽  
Grey Literature ◽  
Allied Health Professionals ◽  
Wide Range ◽  
Knowledge And Attitude ◽  
Clinician Behaviour ◽  
Google Search

Objective: This review aims to explore, characterize, and map the literature on interventions implemented to change emergency department (ED) clinicians’ behaviour related to suicide prevention using the Behaviour Change Wheel (BCW) as a guiding theoretical framework. Introduction: An ED is a critical place for suicide prevention. Yet, many patients who present with suicide-related thoughts and behaviours are discharged without proper assessment or appropriate treatment. Supporting clinicians (who provide direct clinical care, including nurses, physicians, allied health professionals) to make the desired behaviour change following evidence-based suicide prevention care is an essential step toward improving patient outcomes. However, reviews to date have yet to take a theoretical approach to investigate interventions implemented to change clinicians’ behaviour. Inclusion criteria: This review will consider literature that includes interventions that target ED clinicians’ behaviour change related to suicide prevention. Behaviour change refers to observable practice changes as well as proxy measures of behaviour change including knowledge and attitude. There are many ways in which an intervention can change clinicians’ behaviour (e.g., education, altering service delivery). This review will include a wide range of interventions that target behaviour change regardless of the type but exclude interventions that exclusively target patients.Methods: Multiple databases will be searched: PubMed, PsycInfo, CINAHL and Embase. We will also include grey literature, including Google search, ProQuest Dissertations and Theses Global, and Scopus conference papers. Full text of included studies will be reviewed, critically appraised and extracted. Extracted data will be coded to identify intervention functions using the BCW. Findings will be summarized in tables accompanied by narrative reports.

Patient-Centered Care and Autonomy: Shared Decision-Making in Practice and a Suggestion for Practical Application in the Critically Ill

2019 ◽  
Vol 35 (11) ◽  
pp. 1352-1355
Author(s):  
Marianna V. Mapes ◽  
Peter A. DePergola ◽  
William T. McGee
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Critically Ill ◽  
Care Service ◽  
Clinical Care ◽  
Patient Centered Care ◽  
Practical Application ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care

Decision-making for the hospitalized dying and critically ill is often characterized by an understanding of autonomy that leads to clinical care and outcomes that are antithetical to patients’ preferences around suffering and quality of life. A better understanding of autonomy will facilitate the ultimate goal of a patient-centered approach and ensure compassionate, high-quality care that respects our patients’ values. We reviewed the medical literature and our experiences through the ethics service, palliative care service, and critical care service of a large community teaching hospital. The cumulative experience of a senior intensivist was filtered through the lens of a medical ethicist and the palliative care team. The practical application of patient-centered care was discerned from these interactions. We determined that a clearer understanding of patient-centeredness would improve the experience and outcomes of care for our patients as well as our adherence to ethical practice. The practical applications of autonomy and patient-centered care were evaluated by the authors through clinical interactions on the wards to ascertain problems in understanding their meaning. Clarification of autonomy and patient-centeredness is provided using specific examples to enhance understanding and application of these principles in patient-centered care.

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