scholarly journals Collaborative Chronic Care Model Implementation within Outpatient Behavioral Health Care Teams: Qualitative Results from a Multisite Trial using Implementation Facilitation

2020 ◽  
Author(s):  
Jennifer L Sullivan ◽  
Bo Kim ◽  
Christopher Miller ◽  
A. Rani Elwy ◽  
Karen Drummond ◽  
...  
Keyword(s):  
Mental Health ◽  
Information Systems ◽  
Clinical Information ◽  
Self Management ◽  
Clinical Information Systems ◽  
Work Role ◽  
Community Resources ◽  
Management Support ◽  
Outpatient Mental Health ◽  
Leadership Support

Abstract Background: This paper reports on a qualitative evaluation of a hybrid II stepped-wedge trial using implementation facilitation to implement team-based care in the form of the Collaborative Chronic Care Model (CCM) in interdisciplinary outpatient mental health teams. The objective of this study was to compare the alignment of sites’ clinical processes with the CCM elements at baseline (Time 1) and after 12 months of implementation facilitation (Time 2) from the perspective of providers.Methods: We conducted semi-structured interviews to assess the extent to which six CCM elements were in place: work role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and organizational/leadership support. Interviews were transcribed and a priori CCM elements were coded using a directed content analysis approach at Time 1 and 2. We sought consensus on, and compared, the extent to which each CCM element was in place at Times 1 and 2.Results: We conducted 27 and 31 telephone interviews at Times 1 and 2, respectively, with outpatient mental health providers at nine participating sites. At Time 1 and Time 2, three CCM elements were most frequently present across the sites: work role redesign, patient self-management support, and provider decision support. The CCM elements with increased implementation from Time 1 to Time 2 were: work role redesign, patient self-management support, and clinical information systems. For two CCM elements, linkages to community resources and organizational/leadership support, some sites had increased implementation at Time 2 compared to Time 1, while others had reductions.Conclusions: Sites increased the extent of implementation on several CCM elements. The most progress was made in the CCM elements where sites had CCM-aligned processes already in place at Time 1. Teams made progress on elements they could more easily control, such as work role redesign. Our results suggest that maximizing the benefits of CCM-based outpatient mental health care may require targeting resources and training toward specific CCM elements—especially in the use of clinical information systems and linking with community resources. Trial Registration: Clinical Trials NCT02543840Registered 7 September 2015.

scholarly journals Collaborative chronic care model implementation within outpatient behavioral health care teams: qualitative results from a multisite trial using implementation facilitation

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Jennifer L. Sullivan ◽  
Bo Kim ◽  
Christopher J. Miller ◽  
A. Rani Elwy ◽  
Karen L. Drummond ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Support ◽  
Information Systems ◽  
Clinical Information ◽  
Self Management ◽  
Clinical Information Systems ◽  
Work Role ◽  
Community Resources ◽  
Management Support ◽  
Outpatient Mental Health

Abstract Background This paper reports on a qualitative evaluation of a hybrid type II stepped-wedge, cluster randomized trial using implementation facilitation to implement team-based care in the form of the collaborative chronic care model (CCM) in interdisciplinary outpatient mental health teams. The objective of this analysis is to compare the alignment of sites’ clinical processes with the CCM elements at baseline (time 1) and after 12 months of implementation facilitation (time 2) from the perspective of providers. Methods We conducted semi-structured interviews to assess the extent to which six CCM elements were in place: work role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and organizational/leadership support. Interviews were transcribed and a priori CCM elements were coded using a directed content analysis approach at times 1 and 2. We sought consensus on, and compared, the extent to which each CCM element was in place at times 1 and 2. Results We conducted 27 and 31 telephone interviews at times 1 and 2, respectively, with outpatient mental health providers at nine participating sites. At time 1 and time 2, three CCM elements were most frequently present across the sites: work role redesign, patient self-management support, and provider decision support. The CCM elements with increased implementation from time 1 to time 2 were work role redesign, patient self-management support, and clinical information systems. For two CCM elements, linkages to community resources and organizational/leadership support, some sites had increased implementation at time 2 compared to time 1, while others had reductions. For the provider decision support element, we saw little change in the extent of its implementation. Conclusions Sites increased the extent of implementation on several CCM elements. The most progress was made in the CCM elements where sites had CCM-aligned processes in place at time 1. Teams made progress on elements they could more easily control, such as work role redesign. Our results suggest that maximizing the benefits of CCM-based outpatient mental health care may require targeting resources and training toward specific CCM elements—especially in the use of clinical information systems and linking with community resources. Trial registration Clinical Trials NCT02543840.

Effectivness of Health Information System Applications: Clinical Information and Diagnosis-Treatment Systems in Turkey

2017 ◽  
Vol 5 (1) ◽  
pp. 122
Author(s):  
Assist. Prof. Dr. Demokaan DEMİREL
Keyword(s):  
Decision Making ◽  
Information System ◽  
Information Systems ◽  
Management Information System ◽  
Health Sector ◽  
Health Information System ◽  
Clinical Information ◽  
Clinical Decision ◽  
Clinical Information Systems ◽  
Management Information

The distinctive quality of the new social structure is that information becomes the only factor of production. In today's organizations, public administrators are directly responsible for applying information to administrative processes. In addition to his managerial responsibilities, a knowledge based organization requires every employee to take responsibility for achieving efficiency. This has increased the importance of information systems in the decision-making process. Information systems consist of computer and communication technology, data base management and model management and include activity processing system, management information system, decision support systems, senior management information system, expert systems and office automation systems. Information systems in the health sector aim at the management and provision of preventive and curative health services. The use of information systems in healthcare has the benefits of increasing service quality, shortening treatment processes, maximizing efficiency of the time, labour and medical devices. The use of information systems for clinical decision making and reducing medical errors in the healthcare industry dates back to the 1960s. Clinical information systems involve processing, storing and re-accessing information that supports patient care in a hospital. Clinical information systems are systems that are directly or indirectly related to patient care. These systems include electronic health/patient records, clinical decision support systems, nurse information systems, patient tracking systems, tele-medicine, case mix and smart card applications. Diagnosis-treatment systems are information-based systems used in the diagnosis and treatment of diseases. It consists of laboratory information systems, picture archiving and communication system, pharmacy information system, radiology information system, nuclear medicine information system. This study aims to evaluate the effectiveness of health information system applications in Turkey. The first part of the study focuses on the concept of information systems and the types of information systems in organization structures. In the second part, clinical information systems and applications for diagnosis-treatment systems in Turkey are examined. Finally, the study evaluates applications in the health sector qualitatively from the new organizational structure, which is formed by information systems.

History and Trends in Clinical Information Systems in the United States

2001 ◽  
Vol 33 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Nancy Staggers ◽  
Cheryl Bagley Thompson ◽  
Rita Snyder-Halpern
Keyword(s):  
United States ◽  
Information Systems ◽  
Clinical Information ◽  
The United States ◽  
Clinical Information Systems

scholarly journals Clinical Information Systems – Seen through the Ethics Lens

2020 ◽  
Vol 29 (01) ◽  
pp. 104-114
Author(s):  
Ursula H. Hübner ◽  
Nicole Egbert ◽  
Georg Schulte
Keyword(s):  
Information Systems ◽  
Health Information ◽  
Information Exchange ◽  
Ethics Education ◽  
Health Information Exchange ◽  
Evaluation Studies ◽  
Clinical Information ◽  
Clinical Decision ◽  
Clinical Information Systems ◽  
Smart Systems

Objective: The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately. Methods: A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education. Results: By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders’ attitudes, but not to evaluate specific implementations. Conclusion: Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.

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