scholarly journals Telemonitoring for Patients With COVID-19: Recommendations for Design and Implementation

10.2196/20953 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e20953
Author(s):  
Anna V Silven ◽  
Annelieke H J Petrus ◽  
María Villalobos-Quesada ◽  
Ebru Dirikgil ◽  
Carlijn R Oerlemans ◽  
...  
Keyword(s):  
Health Care ◽  
Care Pathway ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Suspected Case ◽  
Care Hospital ◽  
Scarce Resources ◽  
Design And Implementation ◽  
Care Systems ◽  
Care Capacity

Despite significant efforts, the COVID-19 pandemic has put enormous pressure on health care systems around the world, threatening the quality of patient care. Telemonitoring offers the opportunity to carefully monitor patients with a confirmed or suspected case of COVID-19 from home and allows for the timely identification of worsening symptoms. Additionally, it may decrease the number of hospital visits and admissions, thereby reducing the use of scarce resources, optimizing health care capacity, and minimizing the risk of viral transmission. In this paper, we present a COVID-19 telemonitoring care pathway developed at a tertiary care hospital in the Netherlands, which combined the monitoring of vital parameters with video consultations for adequate clinical assessment. Additionally, we report a series of medical, scientific, organizational, and ethical recommendations that may be used as a guide for the design and implementation of telemonitoring pathways for COVID-19 and other diseases worldwide.

scholarly journals Telemonitoring for Patients With COVID-19: Recommendations for Design and Implementation (Preprint)

2020 ◽  
Author(s):  
Anna V Silven ◽  
Annelieke H J Petrus ◽  
María Villalobos-Quesada ◽  
Ebru Dirikgil ◽  
Carlijn R Oerlemans ◽  
...  
Keyword(s):  
Health Care ◽  
Care Pathway ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Suspected Case ◽  
Care Hospital ◽  
Scarce Resources ◽  
Design And Implementation ◽  
Care Systems ◽  
Care Capacity

UNSTRUCTURED Despite significant efforts, the COVID-19 pandemic has put enormous pressure on health care systems around the world, threatening the quality of patient care. Telemonitoring offers the opportunity to carefully monitor patients with a confirmed or suspected case of COVID-19 from home and allows for the timely identification of worsening symptoms. Additionally, it may decrease the number of hospital visits and admissions, thereby reducing the use of scarce resources, optimizing health care capacity, and minimizing the risk of viral transmission. In this paper, we present a COVID-19 telemonitoring care pathway developed at a tertiary care hospital in the Netherlands, which combined the monitoring of vital parameters with video consultations for adequate clinical assessment. Additionally, we report a series of medical, scientific, organizational, and ethical recommendations that may be used as a guide for the design and implementation of telemonitoring pathways for COVID-19 and other diseases worldwide.

scholarly journals Identifying Disparities in the Management of Hip Fractures Within Europe: A Comparison of 3 Health-Care Systems

2019 ◽  
Vol 10 ◽  
pp. 215145931987294 ◽  
Author(s):  
Cliodhna E. Murray ◽  
Andreas Fuchs ◽  
Heide Grünewald ◽  
Owen Godkin ◽  
Norbert P. Südkamp ◽  
...  
Keyword(s):  
Health Care ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Care Pathway ◽  
Health Care Systems ◽  
Standards Of Care ◽  
Evidence Based ◽  
Care Hospital ◽  
Care Systems ◽  
The Uk

Introduction: This study investigates the management of hip fractures in a German maximum care hospital and compares these data to evidence-based standard and practice in 180 hospitals participating in the UK National Hip Fracture Database (NHFD) and 16 hospitals participating in the Irish Hip Fracture Database (IHFD). This is the first study directly comparing the management of hip fractures between 3 separate health-care systems within Europe. Methods: Electronic medical data were collected retrospectively describing the care pathway of elderly patients with a hip fracture admitted to a large trauma unit in the south of Germany “University Hospital Freiburg” (UHF). The audit evaluated demographics, postoperative outcome, and the adherence to the 6 “Blue Book” standards of care. These data were directly compared with the data from the UK NHFD and the IHFD acquired from 180 and 16 hospitals, respectively. Results: At 36 hours, 95.8% of patients had received surgery in UHF, compared to 71.5% in the NHFD and 58% of patients in the IHFD. The rate of in-hospital mortality was 4.7% compared to 7.1% in the NHFD and 5% in the IHFD. The mean average acute length of stay was 13.4 days compared to 16.4 days in the NHFD and 20 days in the IHFD. Reoperation rates are 3.3% compared to 1% in the NHFD and 1.1% in the IHFD; 50.5% of patients were discharged on bone protection medication, compared to 47% in the IHFD and 79.3% in the UK NHFD. Discussion: Despite uniformly acknowledged evidence-based treatment guidelines, the management of hip fractures remains heterogeneous within Europe. Conclusion: These data show that different areas of the hip fracture care pathway in Germany, England, and Ireland, respectively, show room for improvement in light of the growing socioeconomic burden these countries are expected to face.

scholarly journals Design and implementation of monitoring system for paralysis patient using IoT

2021 ◽  
Vol 4 (2) ◽  
pp. 10
Author(s):  
Hira Beenish ◽  
Fakeha Nasar ◽  
Ehsan Sheikh ◽  
Muhammad Fahad
Keyword(s):  
Health Care ◽  
Internet Of Things ◽  
Health Care Systems ◽  
Finger Movement ◽  
Design And Implementation ◽  
Leading Role ◽  
Patient Will ◽  
Care Systems ◽  
Paralyzed Patient ◽  
Modern Era

Internet of things represents a catch line of smart applications. At the same time it plays a leading role in the health care systems, as it provides the connectivity of the distant patients, who are not able to express their concerns.  In this modern era there are a lot of technologies that are being used in different healthcare fields for paralyzed people. This paper proposed a model for paralyzed patient by considering Arduino with the integration of gyro sensors for the patient hand and finger movement. Patient can easily be connected with this device by sending his message to caretaker only by moving their hands into respective directions, or they can send their message by moving their fingers and feet. Through this device paralyzed patient will be able to convey their messages to caretakers, so they can assist the patient. This system will enhance the medical care to those patients who are even not able to convey their message. 

scholarly journals On the Front (Phone) Lines: Results of a COVID-19 Hotline in Northeast Ohio

2020 ◽  
Author(s):  
David Margolius ◽  
Mary Hennekes ◽  
Jimmy Yaho ◽  
Douglas Einstadter ◽  
Douglas Gunzler ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Care ◽  
Smoking Status ◽  
Health Care Systems ◽  
Patient Characteristics ◽  
Care Practice ◽  
Scarce Resources ◽  
Wide Range ◽  
Care Systems ◽  
At Home

ABSTRACT Importance: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the associated coronavirus disease of 2019 (COVID-19) have presented immense challenges for health care systems. Many regions have struggled to adapt to disruptions to health care practice and employ systems that effectively manage the demand for services. Objective: To examine the effectiveness of the first five weeks of a 24/7 physician-staffed COVID-19 hotline. Design: Cohort study using electronic health records. Setting: A single large health care system in Northeast Ohio. Participants: During 5 weeks of operation, 10,112 patients called the hotline (callers) and were evaluated by a registered nurse (RN) using standardized protocols. Of these, 4,213 (42%) were referred for a physician telehealth visit (telehealth patients). The mean age of callers was 42 years. 67% were female, 51% white, and 46% were on Medicaid or uninsured. Intervention: Physician telehealth visits for COVID-19. Main Outcomes and Measures: We describe clinical diagnosis, patient characteristics (age, sex race/ethnicity, smoking status, insurance status), and visit disposition. We use logistic regression to evaluate associations between patient characteristics, visit disposition and subsequent emergency department use, hospitalization, and SARS-Cov-2 PCR testing. Results: Common caller concerns included cough, fever, and shortness of breath. Most telehealth patients (79%) were advised to self-isolate at home, 14% were determined to be unlikely to have COVID-19, 3% were advised to seek emergency care, and 4% had miscellaneous other dispositions. A total of 287 (7%) patients had a subsequent ED visit, and 44 (1%) were hospitalized with a COVID-19 diagnosis. Of the callers, 482 (5%) had a COVID-19 test reported with 69 (14%) testing positive. Among patients advised to stay at home, 83% had no further face-to-face visits. In multivariable results, only a physician recommendation to seek emergency care was associated with emergency room use (OR=4.73, 95%CI 1.37-16.39, p=.014). Only older age was associated with having a positive test result. Conclusions and Relevance: Robust, physician-directed telehealth services can meet a wide range of needs during the acute phase of a pandemic, conserving scarce resources such as personal protective equipment and testing supplies and preventing the spread of infections to patients and health care workers.

Abstract WP64: City-wide Stroke Team in the U.S. Delivers the Highest Intravenous Thrombolysis Treatment Rate

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Andrei V Alexandrov ◽  
Georgios Tsivgoulis ◽  
Katherine Nearing ◽  
Marc Malkoff ◽  
Odysseas Kargiotis ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Intravenous Thrombolysis ◽  
Population Based ◽  
Treatment Rate ◽  
Practice Plan ◽  
Care Systems ◽  
Tertiary Care Centers ◽  
The U.S

Background: An increasing shortage of vascular neurologists forced an academic provider to find a city-wide solution to offer 24x7 access to intravenous thrombolysis (IVT) across independent and competing health care systems in the area. We sought to prospectively evaluate the annual IVT treatment delivery in our population and compare it to leading stroke centers worldwide. Methods: The largest single ER system and 3 other independent hospital providers in the area agreed to work with a single practice plan vascular neurology team (catchment area of 1,344,127 individuals). All acute ischemic stroke patients that were treated with IVT across all primary or tertiary care centers in our area were prospectively documented over a 12-month period (January-December 2015). A literature search was performed using narrative review methodology to document similar population-based treatment rates across leading stroke centers in North America, Europe and Australasia. Results: A total of 552 patients received IVT with tissue plasminogen activator (tPA) in 2015. Single ER system delivered 433 IV tPA treatments and 119 more patients were treated in the remaining hospitals. The annual tPA treatment rate was 41 per 100.000 individuals (95%CI: 38-44) favorably comparable to published annual treatment rates from leading international stroke centers (Table, 1998 thru 2015). Conclusions: A city-wide vascular neurology team can attend to patient populations across competing health care systems in the U.S. and deliver IVT at volumes and rates above those reported by leading treatment centers worldwide. Communities with competing systems can improve tPA delivery by sharing vascular neurology resources.

scholarly journals Big data modeling to predict platelet usage and minimize wastage in a tertiary care system

2017 ◽  
Vol 114 (43) ◽  
pp. 11368-11373 ◽  
Author(s):  
Leying Guan ◽  
Xiaoying Tian ◽  
Saurabh Gombar ◽  
Allison J. Zemek ◽  
Gomathi Krishnan ◽  
...  
Keyword(s):  
Health Care ◽  
Census Data ◽  
Blood Product ◽  
Complete Blood Count ◽  
Health Care Systems ◽  
Tertiary Care ◽  
The United States ◽  
Number Of Patients ◽  
Usage Patterns ◽  
Care Systems

Maintaining a robust blood product supply is an essential requirement to guarantee optimal patient care in modern health care systems. However, daily blood product use is difficult to anticipate. Platelet products are the most variable in daily usage, have short shelf lives, and are also the most expensive to produce, test, and store. Due to the combination of absolute need, uncertain daily demand, and short shelf life, platelet products are frequently wasted due to expiration. Our aim is to build and validate a statistical model to forecast future platelet demand and thereby reduce wastage. We have investigated platelet usage patterns at our institution, and specifically interrogated the relationship between platelet usage and aggregated hospital-wide patient data over a recent consecutive 29-mo period. Using a convex statistical formulation, we have found that platelet usage is highly dependent on weekday/weekend pattern, number of patients with various abnormal complete blood count measurements, and location-specific hospital census data. We incorporated these relationships in a mathematical model to guide collection and ordering strategy. This model minimizes waste due to expiration while avoiding shortages; the number of remaining platelet units at the end of any day stays above 10 in our model during the same period. Compared with historical expiration rates during the same period, our model reduces the expiration rate from 10.5 to 3.2%. Extrapolating our results to the ∼2 million units of platelets transfused annually within the United States, if implemented successfully, our model can potentially save ∼80 million dollars in health care costs.

scholarly journals Ayushman Bharat: An Ethical Analysis of the World’s Biggest Health Scheme

2021 ◽  
pp. 82-88
Author(s):  
Rajesh Kumar Bhola ◽  
B. B. Pradhan
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Indian Government ◽  
Private Hospitals ◽  
Indian People ◽  
Quality Healthcare ◽  
The People ◽  
Health Related ◽  
Care Systems

An affordable health scheme has been always required by the Indian people. Even after passing74 years of Indian independence, quality healthcare has not been accessible to the Indian people. The data have shown out of the vast population of India only 25 percent of people are insured under the private and government insurance scheme. To overcome this problem Indian government has launched the Ayushman Bharat scheme on 25 December 2018 on the occasion of the birth anniversary of Pt. Deen Dayal Upadhyaya. The Ayushman Bharat is the Hindi translation of “India blessed with long life”. This scheme is the biggest health care scheme in the world which covers the huge population of India and the covered population under this scheme is more than 100 million. The scheme has categories into the primary, secondary, and tertiary care domain to address the health-related problems of the people and the most important and fascinating feature of the scheme is that a beneficiary avails the facilities in government hospital along with private hospitals. The present study reviews different aspects of the scheme in relevance to the helath sector to provide better perpective towards Indian health care systems.

scholarly journals Structured Q1 headache services as the solution to the ill-health burden of headache: 1. Rationale and description

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Timothy J. Steiner ◽  
Rigmor Jensen ◽  
Zaza Katsarava ◽  
Lars Jacob Stovner ◽  
Derya Uluduz ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Cost Effective ◽  
High Demand ◽  
Patient Journey ◽  
Global Campaign ◽  
Care Systems ◽  
Economic Analyses

AbstractIn countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the “patient journey”) with perplexing obstacles.High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary.The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded.It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.

scholarly journals Analysis of Essential Medicines Used for Emergency Care in Pakistan

2020 ◽  
Vol 1 (1) ◽  
pp. 75-77
Author(s):  
Talha Khalid ◽  
Amna Khokhar ◽  
Naseem Jehan ◽  
Umar Sultan ◽  
Arooj Fatima
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Essential Medicine ◽  
Essential Medicines ◽  
World Health ◽  
Care Hospital ◽  
Care Needs ◽  
Cross Sectional ◽  
Health Organization

Introduction: According to the World Health Organization (WHO), essential medicines (EM) have the ability to meet the health care needs of maximum individuals. High accessibility to essential medicines (EM) was proposed under the Millennium Development Goal. The access to high quality, suitable, and inexpensive essential medicines is an essential constituent of health care systems. Methodology: This retrospective cross-sectional observational study was performed at Jinnah Hospital Lahore from February 2018 to November 2018, for analysis of essential medicine usage in a public sector tertiary care hospital of Pakistan. The data were collected from records of patients admitted in the emergency department. Results: Drugs prescribed per encounter were estimated to be 3. Most patients got a single antibiotic, and cephalosporin was the most commonly prescribed antibiotic. Conclusion: The concept of essential drugs has gained high acceptance, but the EMs should be prescribed logically, appropriately and should be in line with WHO guidelines.

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