scholarly journals Effect of a Health System–Sponsored Mobile App on Perinatal Health Behaviors: Retrospective Cohort Study (Preprint)

2019 ◽  
Author(s):  
Caroline Cawley ◽  
Hannelore Buckenmeyer ◽  
Trina Jellison ◽  
Joseph B Rinaldi ◽  
Keri B Vartanian
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Information ◽  
Gestational Age ◽  
Infant Care ◽  
Mobile App ◽  
Evidence Based ◽  
Healthy Behaviors ◽  
Behavior Outcomes ◽  
The Impact

BACKGROUND Pregnancy mobile apps are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is personalized and reliable. Previous studies have looked at whether prenatal apps impact health and behavior outcomes among pregnant and postpartum individuals; however, research has been limited. OBJECTIVE The primary objective of this study is to assess whether the use of a health system–sponsored mobile app—Circle by Providence—aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users. METHODS This observational study compared app users and app nonusers using a self-reported survey and electronic medical records. The study took place over 18 months and was conducted at Providence St. Joseph Health in Portland, Oregon. The sample included patients who received prenatal care at one of seven Providence clinics and had a live birth at a Providence hospital. Recruitment occurred on a rolling basis and only those who completed the survey were included. Survey respondents were separated into app users and app nonusers, and survey responses and clinical outcomes were compared across groups using univariate and adjusted multivariate logistic regression. RESULTS A total of 567 participants were enrolled in the study—167 in the app user group and 400 in the nonuser group. We found statistically significant differences between the two groups for certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (<i>P</i>=.012), were less likely to miss prenatal appointments (<i>P</i>=.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (<i>P</i>=.04). There were no differences in nutritional measures, including whether they took prenatal vitamins, ate 5 fruits or vegetables a day, or drank caffeine. We found no differences in many of the infant care outcomes; however, there was an increase in awareness of “purple crying.” Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stays (in minutes), low birth weight infants, preterm births, small-for-gestational-age births, large-for-gestational-age births, and neonatal intensive care unit stays. CONCLUSIONS The use of the Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge, although there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care.

scholarly journals Effect of a Health System–Sponsored Mobile App on Perinatal Health Behaviors: Retrospective Cohort Study

10.2196/17183 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e17183
Author(s):  
Caroline Cawley ◽  
Hannelore Buckenmeyer ◽  
Trina Jellison ◽  
Joseph B Rinaldi ◽  
Keri B Vartanian
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Information ◽  
Gestational Age ◽  
Infant Care ◽  
Mobile App ◽  
Evidence Based ◽  
Healthy Behaviors ◽  
Behavior Outcomes ◽  
The Impact

Background Pregnancy mobile apps are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is personalized and reliable. Previous studies have looked at whether prenatal apps impact health and behavior outcomes among pregnant and postpartum individuals; however, research has been limited. Objective The primary objective of this study is to assess whether the use of a health system–sponsored mobile app—Circle by Providence—aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users. Methods This observational study compared app users and app nonusers using a self-reported survey and electronic medical records. The study took place over 18 months and was conducted at Providence St. Joseph Health in Portland, Oregon. The sample included patients who received prenatal care at one of seven Providence clinics and had a live birth at a Providence hospital. Recruitment occurred on a rolling basis and only those who completed the survey were included. Survey respondents were separated into app users and app nonusers, and survey responses and clinical outcomes were compared across groups using univariate and adjusted multivariate logistic regression. Results A total of 567 participants were enrolled in the study—167 in the app user group and 400 in the nonuser group. We found statistically significant differences between the two groups for certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (P=.012), were less likely to miss prenatal appointments (P=.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (P=.04). There were no differences in nutritional measures, including whether they took prenatal vitamins, ate 5 fruits or vegetables a day, or drank caffeine. We found no differences in many of the infant care outcomes; however, there was an increase in awareness of “purple crying.” Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stays (in minutes), low birth weight infants, preterm births, small-for-gestational-age births, large-for-gestational-age births, and neonatal intensive care unit stays. Conclusions The use of the Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge, although there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care.

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

scholarly journals Facilitators and Barriers to Access to Pediatric Medical Services in a Community Hospital

2020 ◽  
Vol 11 ◽  
pp. 215013272090451 ◽  
Author(s):  
Qiyun Shi ◽  
Fiorella Castillo ◽  
Kusum Viswanathan ◽  
Fernanda Kupferman ◽  
Joy C. MacDermid
Keyword(s):  
Health Outcomes ◽  
Food Insecurity ◽  
Medical Care ◽  
Parental Support ◽  
Missed Appointments ◽  
Social Inequity ◽  
Healthy Behaviors ◽  
Barriers To Access ◽  
Missed Visits ◽  
The Impact

Background: Missed medical appointments decrease continuity of medical care, waste resources, and may affect health outcomes. We examined the factors associated with missed children’s supervision visits in Eastern Brooklyn, NY, USA. Methods: We surveyed guardians whose children received routine medical care at four pediatric clinics. Participants filled out a questionnaire that queried: demographics, food security, recent relocation, parental support of healthy behaviors, and length of knowing provider. Preexisting disease(s) and missed visits were retrieved from medical records. Regression analyses were used to determine factors that were associated with missing medical appointments. Results: Among 213 families, 33% faced food insecurity and 16.4% reported moving within the past 12 months. Forty percent of children missed at least 1 visit. Food insecurity (adjusted odds ratio [aOR] 2.3, 95% confidence interval [CI 1.0% to 5.2%) and recent relocation (aOR 1.8, 95% CI 1.1-3.4 were associated with missed health supervision visits, whereas greater parental healthy behaviors (aOR 0.5, 95% CI 0.3-0.9) and longer length of knowing provider (aOR 0.8, 95% CI 0.7-1.0) were associated with fewer missed appointments. Conclusion: This study indicates that social inequity may contribute to poor adherence to medical appointments through multiple mechanisms, including food insecurity, lack of social stability, and parental health behaviors. Multidimensional proactive prevention, and reactive tolerance should be considered as opportunities to mitigate the impact of social inequity on health outcomes.

scholarly journals Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Meyer Swanepoel ◽  
Bob Mash ◽  
Tracey Naledi
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Health System ◽  
System Performance ◽  
Positive Impact ◽  
Family Physicians ◽  
Health System Performance ◽  
District Health ◽  
District Health System ◽  
The Impact

Background: In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS) of the Western Cape.Methods: Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method.Results: There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, noncommunicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers.Conclusion: Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes.

scholarly journals Confounding in Observational Studies Explained

2012 ◽  
Vol 5 (1) ◽  
pp. 18-20 ◽  
Author(s):  
Bikaramjit Mann ◽  
Evan Wood
Keyword(s):  
Randomized Controlled Trial ◽  
Health Information ◽  
Observational Studies ◽  
Controlled Trial ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Disease Outcomes ◽  
Different Types ◽  
Based Medicine ◽  
The Impact

Practical and ethical constraints mean that many clinical and/or epidemiological questions cannot be answered through the implementation of a randomized controlled trial. Under these circumstances, observational studies are often required to assess relationships between certain exposures and disease outcomes. Unfortunately, observational studies are notoriously vulnerable to the effect of different types of “confounding,” a concept that is often a source of confusion among trainees, clinicians and users of health information. This article discusses the concept of confounding by way of examples and offers a simple guide for assessing the impact of is effects for learners of evidence-based medicine.

scholarly journals Interdisciplinary Collaboration among Health Professionals: A Panacea for effective and Evidence-based Health Care delivery

2020 ◽  
Vol 34 (1) ◽  
pp. 12-23
Author(s):  
Joseph D Z ◽  
Aminu B ◽  
Halilu S ◽  
Mark A D ◽  
Kayode O ◽  
...  
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Patient Care ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Interdisciplinary Collaboration ◽  
Healthcare Delivery ◽  
Evidence Based ◽  
Search Term ◽  
The Impact

Introduction: Interdisciplinary collaboration (IDC) is important in health care settings as the complex nature and demands of the health care work environment requires the expertise and knowledge of different individuals or specialists working together to solve multifaceted and complex patient care problems. Objective: To assess the health professionals' attitude towards the development of an interdisciplinary collaborative approach to patient care in health institutions and to systematically review the impact of IDC as a panacea for effective health outcomes in Nigeria. Methodology: The research is a systematic review that provides various approaches for studying interdisciplinary teams. Fifty articles were selected from different search engines such as Google, google scholar, science direct and research gate with the search term Interdisciplinary collaboration among health care professionals. Articles were arranged based on most relevant, relevant and closely related articles. Result: The study revealed that IDC is pivotal in evidence-based care and contributes immensely to effective and efficient health outcomes. It puts the patient at the centre of the healthcare team's focus and allows all health professionals, with the patient, to collaboratively provide input, be part of the decision making, and improve outcomes. Although there are several obstacles to IDC, adopting this team-based culture of mutual respect and understanding is possible and, in fact, necessary. Conclusion: This study reveals that there are many benefits to IDC. It can improve safety and healthcare delivery, as well as reduce costs. The interprofessional team supports patient and personnel engagement, organizational efficiency and innovation.

scholarly journals Improving the Measurement of Health System Performance across the Rural-Urban Continuum

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Naushaba Degani ◽  
Sharon Gushue ◽  
Alex Yurkiewich ◽  
Emmalin Buajitti ◽  
Matthew Kumar ◽  
...  
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Health System ◽  
Performance Indicators ◽  
System Performance ◽  
Working Group ◽  
Geographic Location ◽  
Key Performance Indicators ◽  
Health System Performance ◽  
The Impact

IntroductionWe report on key performance indicators to highlight quality and variation in health care. Given Ontario’s diverse geography, we have prioritized improving measurement across the rural-urban continuum. This will improve our ability to discern the impact of geography on health care and health status to inform planning and decision making. Objectives and ApproachBuilding on previous work to advance measurement of equity in health care, we struck a technical working group of experts to review methods for stratifying health system performance data by geographic location in the Ontario context. These methods were applied to a set of key performance indicators. The working group’s review of the results of this analysis will lead to recommendations for the best method to refine and standardize how geographic location is measured and stratified. This will improve our ability to discern the impact of geography on health system performance and health status for our suite of public-reporting products. ResultsThe technical working group identified three methodologies for consideration that used linked postal code data: Population Centre (POPCTR), Statistical Area Classification (SAC) and a hybrid POPCTR/SAC methodology. These methods were tested against a set of key performance indicators across dimensions of quality including timeliness, effectiveness, population health and health outcomes. The results show that, in the health system performance dimensions of effectiveness and timeliness, as well as for a subset of health outcomes, there is variation in performance across the urban-rural continuum, though not always in a linear way. This may reflect differences in health care access, health risk factors, sociodemographic or socioeconomic characteristics across the urban-rural continuum. More definitive conclusions and recommendations will be available when the working group meets to review the results. Conclusion/ImplicationsIdentifying a robust methodology for measuring performance across geographic locations will improve our ability to discern the impact of geography on health care including where geography may impact access and effectiveness of services as well as health outcomes. This information will enable better health system planning and decision-making.

scholarly journals Title: Perspectives on an Iterative and Bidirectional Information System in Western Kenya and Its Role in Improving Health Outcomes

2021 ◽  
Author(s):  
Beverly M. Ochieng ◽  
Dan C. Kaseje
Keyword(s):  
Information System ◽  
Information Systems ◽  
Health Outcomes ◽  
Health System ◽  
Information Sharing ◽  
Health Information ◽  
Qualitative Data ◽  
Health Information System ◽  
Health Facilities ◽  
And Control

Abstract Background A perennial problem in information systems is the unidirectional flow of information. Bidirectional information systems are mechanisms by which consumers and providers generate, discuss and use information at each level of data collection. This paper describes opportunities in the health service delivery system for bidirectional information flow that can be established as part of the health information system to inform decisions, planning, and action by both providers and consumers of care. Methods The study was quasi-experimental and involved pre and post-intervention, cross-sectional surveys at intervention and control sites. The intervention was a Community Based Health Information System. Quantitative and qualitative data were collected. The surveys covered five health facilities in the intervention sites and five in the control sites in each of the six study districts. Five clients were interviewed at each intervention and control health facility. Communities served by the selected health facilities were included in household cluster sample surveys. Thirty clusters of 10 households, each with under-five children, were included in each community served by the selected health facilities. Quantitative data were cross-tabulated to compare health outcomes at intervention and control sites. A content analysis was performed on the qualitative data; themes and sub-themes that identified opportunities for bidirectional information-sharing were identified. Results We identified five nodal points in the health system that provide opportunities for bidirectional information sharing at the household, community, and health facility levels. Immunization coverage, skilled delivery, water treatment, and latrine use improved more at the intervention than control sites. Where all of the mechanisms were implemented, there was better performance in outcomes. Conclusion A conscious engagement of service providers and consumers in dialogue, using available health system information to iteratively inform decisions and actions, improves health outcomes.

The Assessment of Actions of the Environment and the Impact of Preventive Medicine for Public Health in Poland

2021 ◽  
pp. 809-822
Author(s):  
Anna Rosiek
Keyword(s):  
Public Health ◽  
Health Outcomes ◽  
Health System ◽  
Influencing Factors ◽  
Preventive Medicine ◽  
Health Sciences ◽  
Healthcare Organization ◽  
Medical Environment ◽  
Single Feature ◽  
The Impact

This chapter describes how the actions of the medical environment is aiming to improve the health of society can and must be seen on many levels. The author refers to the organizational, ethical, legal and psychological aspects. Also covered are not only patients' education, but also the scope of functioning healthcare organization, which adapts to the needs of the changing environment e.g. requirements of the patient, the development of technology, advances in medicine. Public health problems appear as complex components of the system and cannot be dealt with by a single, simple intervention, whether perceived by the prism of a single feature or element, but must be perceived as influencing factors in the system e.g. several attributes, factors. These together may potentially be used in the future to generate better health outcomes or the functioning of the entire health system in the areas of health sciences, medicine or public health.

Diagnosis and prognosis of Australia&s health information for evidence-based policy

2002 ◽  
Vol 7 (1_suppl) ◽  
pp. 40-45 ◽  
Author(s):  
Kees Van Gool ◽  
Emily Lancsar ◽  
Rosalie Viney ◽  
Jane Hall ◽  
Philip Haywood
Keyword(s):  
Health Information ◽  
Waiting Times ◽  
Specific Treatment ◽  
Waiting Lists ◽  
Data Availability ◽  
Evidence Based ◽  
Cost Shifting ◽  
Public And Private ◽  
Evidence Based Policy ◽  
The Impact

Without adequate information it is difficult to determine the success or failure of health policies. This paper assesses the adequacy of Australia&s health information for evidence-based policy. Three policy areas are analysed: the impact of changing the public and private health financing mix; waiting lists and waiting times; and pooling of funds. In each, the issue is analysed to identify the key policy questions, the available data and existing analyses are examined, and gaps in data availability and analysis are assessed. There is variability in the extent and usefulness of current health information. In terms of the impact of changing the financing mix, there is good information on the distribution of finance, but much less available on comparative use or efficiency of public and private hospitals. There is comprehensive information available on waiting lists and waiting times but little analysis of the implications of this for equity of access or the costs and benefits of reducing waiting times. There is insufficient information for the development of the capitation based formulae required for the introduction of the pooling of funds, nor enough information to assess the extent and impact of current cost-shifting which might be addressed by pooling funds. While the concept of evidence-based medicine has been embraced with regard to specific treatment decisions, there has not been a parallel investment in the use of evidence to drive policy decisions.

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