scholarly journals An Automated Patient Self-Monitoring System to Reduce Health Care System Burden During the COVID-19 Pandemic in Malaysia: Development and Implementation Study (Preprint)

2020 ◽  
Author(s):  
Hooi Min Lim ◽  
Chin Hai Teo ◽  
Chirk Jenn Ng ◽  
Thiam Kian Chiew ◽  
Wei Leik Ng ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Monitoring System ◽  
Health Care System ◽  
Development Process ◽  
Lessons Learned ◽  
Self Monitoring ◽  
Symptom Monitoring ◽  
Development Method ◽  
Care System

BACKGROUND During the COVID-19 pandemic, there was an urgent need to develop an automated COVID-19 symptom monitoring system to reduce the burden on the health care system and to provide better self-monitoring at home. OBJECTIVE This paper aimed to describe the development process of the COVID-19 Symptom Monitoring System (CoSMoS), which consists of a self-monitoring, algorithm-based Telegram bot and a teleconsultation system. We describe all the essential steps from the clinical perspective and our technical approach in designing, developing, and integrating the system into clinical practice during the COVID-19 pandemic as well as lessons learned from this development process. METHODS CoSMoS was developed in three phases: (1) requirement formation to identify clinical problems and to draft the clinical algorithm, (2) development testing iteration using the agile software development method, and (3) integration into clinical practice to design an effective clinical workflow using repeated simulations and role-playing. RESULTS We completed the development of CoSMoS in 19 days. In Phase 1 (ie, requirement formation), we identified three main functions: a daily automated reminder system for patients to self-check their symptoms, a safe patient risk assessment to guide patients in clinical decision making, and an active telemonitoring system with real-time phone consultations. The system architecture of CoSMoS involved five components: Telegram instant messaging, a clinician dashboard, system administration (ie, back end), a database, and development and operations infrastructure. The integration of CoSMoS into clinical practice involved the consideration of COVID-19 infectivity and patient safety. CONCLUSIONS This study demonstrated that developing a COVID-19 symptom monitoring system within a short time during a pandemic is feasible using the agile development method. Time factors and communication between the technical and clinical teams were the main challenges in the development process. The development process and lessons learned from this study can guide the future development of digital monitoring systems during the next pandemic, especially in developing countries.

Treatment patterns for patients with metastatic or recurrent head and neck cancer in a large integrated health-care system.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18015-e18015
Author(s):  
Tiffany Seto ◽  
Navendu D. Samant ◽  
Nina Shah ◽  
Aida Shirazi ◽  
A. Dimitrios Colevas ◽  
...  
Keyword(s):  
Health Care ◽  
Head And Neck Cancer ◽  
Clinical Practice ◽  
Head And Neck ◽  
Health Care System ◽  
Practice Patterns ◽  
First Line ◽  
Integrated Health Care System ◽  
Recurrent Head ◽  
Care System

e18015 Background: Since publication of the landmark KEYNOTE-048 Trial, pembrolizumab alone or with platinum-based chemotherapy and 5-fluorouracil (5FU) was established as a standard of care for the frontline treatment of patients with recurrent or metastatic head and neck squamous cell cancer (HNSCC), replacing the EXTREME regimen of Cetuximab with platinum and 5FU. In clinical practice, some clinicians modify the KEYNOTE-048 regimen by substituting a taxane for 5FU (i.e., Paclitaxel + Carboplatin + Pembrolizumab, PCT). Within the Kaiser Permanente Northern California (KPNCAL) network, we identified a cohort of 123 patients who received palliative first-line therapy for metastatic HNSCC to identify practice patterns in a real-world setting within a large health care delivery system. Methods: This is a data-only cohort study of all adult KPNCAL members diagnosed with metastatic HNSCC treated with palliative combination chemotherapy and/or immunotherapy between January 1, 2018 and July 31, 2020. Results: Among a cohort of 123 patients, 28 patients received the EXTREME regimen (platinum + 5FU + cetuximab), 10 received modified EXTREME (platinum + taxane + cetuximab), 14 received platinum + 5FU + pembrolizumab, 9 received platinum + taxane + pembrolizumab and 62 received single agent immunotherapy. From 2018 through mid-2020, there was an apparent shift away from cetuximab based regimens and a concurrent rise in immunotherapy-based regimens. By mid-2020, the majority of patients received an immunotherapy-based regimen (28 patients), while only 5 patients received a cetuximab based regimen (Table). Conclusions: Data from our cohort reported clinical practice patterns within a large multispecialty integrated health-care system in Northern California. Our findings highlight the marked variability in practice patterns within a single health care system for first-line metastatic therapy. While we identified trends away from cetuximab based therapy and toward immunotherapy-based therapy in clinical practice there remained wide practice variations among clinical oncologist treating patients with newly diagnosed metastatic HNSCC. This further emphasizes the need for prospective clinical trials to identify the optimal regimen or to confirm clinical equipoise between regimens among patients with metastatic or recurrent head and neck cancer. [Table: see text]

Health Product Manufacturers and Innovators COVID-19 Impact Assessment: Lessons Learned and Compelling Needs

2022 ◽  
Author(s):  
Mathai Mammen ◽  
◽  
Vas Narasimhan ◽  
Richard Kuntz ◽  
Freda Lewis-Hall ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Transformational Change ◽  
Lessons Learned ◽  
Health Product ◽  
Science Data ◽  
Public And Private ◽  
Public And Private Sector ◽  
The U.S ◽  
Care System

United States health care spending consumes nearly a fifth of the GDP [1]. While, in many respects, the U.S. health care system is enviable and highly innovative, it is also characterized by elements of ineffectiveness, inefficiency, and inequity. These aspects, resulting from pre-existing vulnerabilities within the system and interactions between the various stakeholders, were acutely highlighted by the COVID-19 pandemic. As health product manufacturers and innovators (HPMI) took steps to mitigate the immediate crisis and simultaneously begin to develop a longer-term sustainable solution, six common themes arose as areas for transformational change: support for science, data sharing, supply chain resiliency, stockpiling, and surge capacity, regulatory and reimbursement clarity and flexibility, public- and private-sector coordination and communication, and minimizing substandard care offerings. Within these categories, the authors of this paper suggest policy priorities to increase the effectiveness, efficiency, and equity of the HPMI sector and writ large across the U.S. health care system. These priorities call for increased scientific funding to diversify the pipeline for research and development, strengthening the nation’s public health infrastructure, building and maintaining “ever warm” manufacturing capacity and related stockpiles, instituting efficient and effective regulatory and reimbursement frameworks that promote innovation and creativity, devising structures and processes that enable more efficient collaboration and more effective communication to the public, and implementing rewards that incentivize desired behaviors among stakeholders. This assessment draws from the collective experience of the authors to provide a perspective for the diagnostics, hospital supplies and equipment, medical devices, therapeutics, and vaccines segments. While the authors of this paper agree on a common set of key policies, sub-sector-specific nuances are important to consider when putting any action priority into effect. With thoughtful implementation, these policies will enable a quicker, more robust response to future pandemics and enhance the overall performance of the U.S. health care system.

IOT Based Health Care System

2019 ◽  
Vol 1 (6) ◽  
pp. 41-46
Author(s):  
Kumar D ◽  
Ramkumar S ◽  
Rubini R
Keyword(s):  
Health Care ◽  
Monitoring System ◽  
Health Care System ◽  
Sudden Change ◽  
Health Condition ◽  
Rural And Remote Areas ◽  
Patient Will ◽  
Health Related ◽  
System Module ◽  
Care System

The aim of this paper is to design an IOT based architecture for health related issues such as Diabetics, Heart Monitoring system, to check body temperature, Pulse rate and kidney functioning. we are analyzing different methods and techniques used for healthcare monitoring system where doctor can continuously monitor the patient's condition. The Data obtained through sensors are uploaded to the Ethernet module which is an IOT connected device to cloud and collected data is accessed by Authorized person through internet. Also the patient history will be stored in the web server and doctor can access the information whenever needed from any corner of the world. If there is any sudden change in the health condition of the person who are using this health care system module, automatically the data of the patient will be uploaded to the concerned doctor, within few minutes user will get a prescription for his current situation. This will connect us with the doctors who are very far from us, and the immediate action will increase the health rate of people. This health care system will be most useful in rural and remote areas.

scholarly journals Adaptive reuse of former hospital sites in Ontario: lessons learned from the planning process

2021 ◽  
Author(s):  
Samantha Zandvliet
Keyword(s):  
Health Care ◽  
General Hospital ◽  
Case Studies ◽  
Health Care System ◽  
Planning Process ◽  
Adaptive Reuse ◽  
Lessons Learned ◽  
Municipal Planning ◽  
Care System

Since the 1990s, Ontario’s health care system has faced a number of changes with respect to increasing expenses not reflected in the allotted funding for hospitals. The restructuring of Ontario’s hospital landscape has resulted in amalgamations, takeovers and closures leaving behind viable surplus hospital sites. This paper focuses on the municipal planning process of adaptive reuse through the lens of former hospitals sites in Ontario. The opportunities and challenges that currently exist in the planning process are examined through four case studies of former hospital sites: Sault Area Hospital in Sault Ste. Marie, St. Catharines General Hospital in St. Catharines, St. Joseph's Hospital in Sudbury and St. Joseph’s Hospital in Peterborough. The findings are summarized in to a set of lessons learned from the planning process. These lessons can be used by municipalities to enhance the overall planning process for these former institutional buildings

Abstract 162: Procedural and 1-Year Outcomes between PCI Centers with and without On-Site CT Surgery: Insights from the VA CART Program

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Thomas M Maddox ◽  
Maggie Stanislawski ◽  
Colin O’Donnell ◽  
Mary E Plomondon ◽  
Steve Bradley ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Patient Outcomes ◽  
Health Care System ◽  
P Value ◽  
All Cause Mortality ◽  
Procedural Complications ◽  
Va Health Care System ◽  
The Impact ◽  
Care System

Background: Clinical trials demonstrate that percutaneous coronary intervention (PCI) can be safely performed at medical centers without on-site cardiothoracic (CT) surgery, and current PCI guidelines support this practice with effective quality oversight. Translation of these trial findings and guideline recommendations into clinical practice has not been described. In 2005, the VA initiated a policy to expand PCI access by performing procedures at centers without on-site CT surgery under strict quality standards. The impact of this policy on procedural and longer-term patient outcomes has not been evaluated. Methods: We studied all PCIs conducted in the VA health care system between 2007-2010. We used data from the VA Clinical Assessment, Reporting, and Tracking (CART) Program, a national clinical quality program that collects real-time data on coronary procedures, procedural complications, and outcomes. Procedural complications (need for emergent CABG and in-lab death), 1-year all-cause mortality, myocardial infarction (MI), and rates of repeat revascularization procedures were compared by presence of on-site CT surgery. We used multivariate survival analysis to assess the association between the presence of on-site CT surgery and 1-year outcomes. The analyses were further stratified by procedural indication (ACS vs. elective) and cath lab PCI volume (≥ vs. <165 PCIs/year). Results: 24,387 patients received a PCI at 59 centers in the VA health care system between 2007-2010. 6,900 (28.3%) patients underwent PCI at 19 centers without on-site CT surgery. Rates of procedural complications were similar for PCI centers with and without on-site CT surgery (emergent CABG: 13 (0.1%) at PCI centers with on-site CT surgery vs. 2 (<0.05%) at PCI centers without on-site CT surgery, p-value 0.26; deaths: 15 (0.1%) at PCI centers with on-site CT surgery vs. 5 (0.1%) at PCI centers without on-site CT surgery, p-value 0.74). Adjusted 1-year combined all-cause mortality and MI rates were similar between centers (HR 0.995, 95% CI 0.84, 1.17), but revascularization rates were higher at sites without on-site CT surgery centers (HR 1.20, 95% CI 1.05, 1.33). Neither PCI indication nor cath lab volume significantly modified these results. Conclusions: Our findings demonstrate that procedural and 1-year patient outcomes are similar between PCI centers with and without on-site CT surgery. These results indicate that the clinical trial evidence of PCI safety without on-site CT surgery can be effectively translated to clinical practice. The VA’s policy allowing for PCI centers without on-site CT surgery in the setting of a quality oversight program may serve as a potential model for improving PCI access in large, integrated health care systems.

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