A Comprehensive E-prescribing Model to Allow Representing, Comparing, and Analyzing Available Systems

2013 ◽  
Vol 52 (03) ◽  
pp. 199-219 ◽  
Author(s):  
L. Mazzola ◽  
S. Bonacina ◽  
P. Tarquini ◽  
P. Donzelli ◽  
F. Pinciroli ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Care Delivery ◽  
Heterogeneous Systems ◽  
Cost Benefit ◽  
Healthcare Systems ◽  
Cost Evaluation ◽  
The Individual ◽  
Formal Properties ◽  
The Impact

SummaryBackground: Even though ePrescribing systems are now available in many healthcare systems and have been a crucial milestone of the roadmaps towards eHealth in the last years, there is still a large heterogeneity among functionalities and performances of different systems.Objective: In this paper, we propose an updated comprehensive model for the ePre-scribing process able to represent, analyze, and compare current systems and to support the design of new, more general, systems suitable also to sustain the ePrescription process in National Healthcare Systems.Methods: After a preliminary literature review, we identified six main phases of the ePrescribing process, namely Assign, Transmit, Dispense, Administer, Monitor, and Analysis & Decision. Each phase produces a digital object characterized by formal properties that ensure the collection of appropriate data and information and works as input for the next one. The impact, in terms of benefits, of ePrescribing on governance, drug sur -veillance, and quality of care at the individual, territorial, and governmental levels are related to the formal properties of the digital objects created at the end of each phase.Results and Conclusions: The model-based implementation of each phase has an impact on the quality of care, the access to care, and the effectiveness of care delivery. The model does not cover cost evaluation, but the benefits identified can be used as basis for cost-benefit or cost-effectiveness analysis of heterogeneous systems.

scholarly journals Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar

2020 ◽  
Author(s):  
Bénédicte Razafinjato ◽  
Luc Rakotonirina ◽  
Jafeta Benony Andriantahina ◽  
Laura F. Cordier ◽  
Randrianambinina Andriamihaja ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Community Health ◽  
Access To Health Care ◽  
Care Delivery ◽  
Local Level ◽  
Scale Up ◽  
P Value ◽  
The Impact

AbstractDespite the widespread global adoption of community health (CH) systems, there are evidence gaps in how to best deliver community-based care aligned with global best practice in remote settings where access to health care is limited and community health workers (CHWs) may be the only available providers. PIVOT partnered with the Ministry of Public Health to pilot a new two-pronged approach for care delivery in rural Madagascar: one CHW provided care at a stationary CH site while 2-5 additional CHWs provided care via proactive household visits. The pilot included professionalization of the CHW workforce (i.e. recruitment, training, financial incentive) and twice monthly supervision of CHWs. We evaluated the impact of the CH pilot on utilization and quality of integrated community case management (iCCM) in the first six months of implementation (October 2019-March 2020).We compared utilization and proxy measures of quality of care (defined as adherence to the iCCM protocol for diagnosis, classification of disease severity, treatment) in the intervention commune and five comparison communes, using a quasi-experimental study design and relying on routinely collected programmatic data. Average per capita monthly under-five visits were 0.28 in the intervention commune and 0.22 in the comparison communes. In the intervention commune, 40.0% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 77.8% of observed visits in the intervention commune (vs 49.5% in the comparison communes, p-value=<0.001). A two-pronged approach to CH delivery and professionalization of the CHW workforce increased utilization and demonstrated satisfactory quality of care. National stakeholders and program managers should evaluate program re-design at a local level prior to national or district-wide scale-up.

scholarly journals Protocol: Improving Access to Specialist Nephrology Care Among Rural/Remote Dwellers of Alberta: The Role of Electronic Consultation in Improving Care for Patients With Chronic Kidney Disease

2019 ◽  
Vol 6 ◽  
pp. 205435811987871
Author(s):  
Aminu Bello ◽  
Deenaz Zaidi ◽  
Branko Braam ◽  
Mark Courtney ◽  
Jodi Glassford ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Access To Care ◽  
Care Delivery ◽  
Care Quality ◽  
Care Providers ◽  
Practice Facilitation ◽  
Specialist Care ◽  
Nephrology Care ◽  
The Impact

Background: As the burden of chronic kidney disease (CKD) continues to increase, many geographically dispersed Canadians have limited access to specialist nephrology care, which tends to be centralized in major urban areas. As a result, many rural/remote-dwellers in Canada experience poor quality of care and related adverse outcomes. It is imperative to develop alternative care delivery mechanisms to ensure optimal health outcomes for all Canadians. Objective: To investigate the feasibility and effectiveness of electronic consultation (eConsult) as a new model for interactions between specialists and primary care providers (PCPs) to improve access to care for patients with CKD. Design: This is a sequential, mixed methods study that will be conducted in 3 phases. Setting: The study will be conducted across the entire province of Alberta, supported by Alberta Kidney Care (formerly, Northern and Southern Alberta Renal Programs [NARP/SARP]). Patients: Patients suffering from CKD will be included in the study. Measurements: We will assess the barriers and enablers of implementation and adoption of an e-consultation protocol to facilitate access to care for patients with CKD in Alberta with a focus on rural/remote-dwellers with CKD. We will also evaluate the impact of the eConsult system (eg, improved access to specialist care, reduction in care gaps), assess the feasibility of province-wide implementation, and compare eConsult with practice facilitation versus eConsult alone in terms of access to specialist care, quality of care, and related outcomes. Methods: The study will be conducted in 3 phases. In phase 1, we will assess the perceptions of stakeholders (ie, PCPs, nephrologists, patients, policymakers, and other care providers) to improve CKD care delivery, quality, and outcomes in Alberta with focus groups and semistructured interviews. Phase 2 will engage specific family physicians for their input on key factors and logistical issues affecting the feasibility of implementing eConsult for the care of patients with CKD. Phase 3 will provide academic detailing including practice facilitation to clinics in Alberta to assess how eConsult with practice facilitation compares with eConsult alone in terms of access to specialist care, quality of care, and related outcomes. Results: We will assess stakeholder perceptions about potential barriers to and enablers of a new eConsult and decision support system strategy, focusing on elements that are most important for the design of a feasible and implementable intervention. We will develop, pilot test, and assess the impact of the eConsult model in improving access to specialist nephrology care and the feasibility of province-wide implementation. The final phase of the project will address key challenges for optimal care for patients with CKD living in rural, remote, and underserved areas of Alberta, particularly timely referral and disease management as well as the cost-effective benefits of eConsult. Limitations: Lack of high-speed Internet in many rural and remote areas of Alberta may lead to more time spent in completing the eConsult request online versus faxing a referral the traditional way. Allied health care staff (referral coordinators, administrative staff) require training to the eConsult system, and physicians at many remote sites do not have adequate staff to handle eConsult as an added task. Conclusions: Implementation of eConsult can favorably influence referral patterns, access to care, care quality, patient outcomes, and health care costs for people with CKD. Results of this study will inform the optimization of care for rural/remote-dwellers with CKD and will facilitate future partnerships with policymakers and provincial renal programs in Alberta to ensure optimal kidney health for all residents. Trial registration: Not required.

scholarly journals A COMBINED MULTI-OBJECTIVE SIMULATION-OPTIMIZATION AND AHP APPROACH: A HEALTHCARE CASE STUDY

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohammad Dehghanimohammadabadi ◽  
Nihan Kabadayi
Keyword(s):  
Quality Of Care ◽  
Care Delivery ◽  
Simulation Optimization ◽  
Quality Care ◽  
Health Providers ◽  
Patients Satisfaction ◽  
Combined Simulation ◽  
The Impact

Quality of care is crucial for patients' satisfaction and safety in healthcare centers. The majority of hospitals attempt to implement facility-wide improvements to ensure high-quality care delivery. This study aims to propose a combined Simulation-Optimization and MCDM approach to accurately assess the impact of quality improvement initiatives on different facets of healthcare systems. In this framework, first, the importance (weights) of the different healthcare criteria is determined by health providers’ using an AHP approach. Then, the weights provided by AHP are applied in a simulation-optimization environment to determine the most efficient action with the most desirable quality of care. Simulation provides a platform to examine the effectiveness of different improvement efforts and calculate their impact on the system performance measures.

scholarly journals Responsibilities for patients? A comparison between US-based VA and the Danish healthcare system

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Jervelund ◽  
I Miake-Lye ◽  
P Shekelle ◽  
C Goldzweig ◽  
A Froelich ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Healthcare Systems ◽  
Care Patient ◽  
Coordinated Care ◽  
High Quality ◽  
Vulnerable Patients ◽  
Patient Outreach ◽  
The Individual ◽  
Danish Healthcare System

Abstract Background The European healthcare systems aim to leave no one behind. Responsibility for the patients may nevertheless be less clearly placed, even in a welfare context such as the Danish healthcare system (DHS). Contrastingly, the Veterans Affairs (VA) in the US is known for their high quality of care and strong care coordination. To understand how responsibility for patients is understood in VA and DHS, we investigated how health providers in the two healthcare systems view their responsibilities to the patients and which tools are used to support responsibility for patients. Methods Semi-structured face-to-face interviews with 23 managers and healthcare providers in VA and DHS were conducted in 2013 and 2014. The interviews were of 42-82 minutes of duration and transcribed verbatim. Data were analysed using thematic analysis. Results The responsibility for the individual patient was clearly placed on the general practitioner in VA, and VA providers felt responsible for their enrolled patients and not just the patients who seek care. In DHS, the responsibility of the treatment was often divided between several providers and this often created dissonance on who is responsible for the care. VA providers made a systematic and active effort to reach out to the individual patients who do not turn up for an appointment as well as for clinical outliers who had pronounced medical needs. In DHS, the responsibility of seeking and attending healthcare laid upon the individual patient. DHS providers seldom played an active part in contacting no-show patients resulting that vulnerable patients may not get the care they need. Conclusions Learning from VA suggests that a clear placement of responsibility will help patients, especially vulnerable patients, to get timely and well-coordinated care. Patient outreach is an important tool to grasp vulnerable patients who are likely to fall between two stools or who need the care the most supporting high quality of care. Key messages Clear placement of responsibility for patients will help vulnerable patients to get timely and well-coordinated care. Patient outreach is an important tool to grasp vulnerable patients who are likely to fall between two stools.

AI, robotics and digital disruption—rise of the humans?

2019 ◽  
pp. 119-128
Author(s):  
Mark Britnell
Keyword(s):  
Artificial Intelligence ◽  
Machine Learning ◽  
Quality Of Care ◽  
Productivity Growth ◽  
Healthcare Systems ◽  
Work Activities ◽  
Working Age ◽  
Digital Disruption ◽  
The Impact

The McKinsey Global Institute suggests productivity could increase by nearly 50%, boosting the economy at a time of lacklustre productivity growth and helping offset the impact of a declining share of the population being of working age. Investing in automation at scale can enhance productivity. Today, advances in robotics, artificial intelligence, and machine learning, in which machines mimic cognitive functions such as learning and problem solving, are ushering in a new age of automation as machines match or outperform humans in a range of work activities, including those requiring cognitive capabilities. In this chapter, Mark Britnell looks at the advances in artificial intelligence, robotics, and digital tools in relation to healthcare systems and healthcare workers, all with the aim of improving the quality of care.

scholarly journals Who needs patient satisfaction surveys? Perspectives of Polish doctors, nurses, and patients

2015 ◽  
Vol 125 (2) ◽  
pp. 72-76
Author(s):  
Ludmiła Marcinowicz ◽  
Renata Sierżantowicz ◽  
Agnieszka Dudzik ◽  
Jolanta Sawicka-Powierza ◽  
Zbysław Grajek ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Health Care Providers ◽  
Quality Of Health Care ◽  
Care Delivery ◽  
Care Providers ◽  
The Impact ◽  
Satisfaction Surveys

Abstract Introduction. Patient satisfaction surveys are still popular tools for obtaining feedback on the quality of health care. Nonetheless, there is a paucity of data to indicate whether health care providers even want patients to assess the quality of care delivered. Neither it is certain whether patients are interested in participating in such surveys. Aim. To present and compare the perspectives of doctors, nurses, and patients on the validity of health care customer satisfaction surveys. Material and methods. A cross-sectional survey design was used. The questionnaires were administered to doctors, nurses and patients in three hospitals of different sizes (small, medium, and large), all in the north-east of Poland. Each sample group was given 200 questionnaires; responses were received from 95 doctors (47.5%), 190 nurses (95%), and 182 patients (91%), and included in the final analyses. Results. Most respondents (doctors - 64.2%; nurses - 61.6%; patients - 87.4%) answered ‘Yes’ to the question ‘Do you think that patients should evaluate the quality of health care?’ Analysis of data allowed to identify the following main reasons why patients should evaluate the quality of health care: 1. to enhance the quality of care; 2. to recognise patients as evaluators; 3. to motivate providers to work more efficiently; and 4. to emphasise the impact of evaluation on a core value, i.e. health. Doctors and nurses outlined reasons why they did not advocate conducting patient satisfaction surveys: satisfaction surveys are redundant; negative evaluations; unwillingness to be evaluated by patients; satisfaction surveys hamper effective work with patients; surveys are not objective; survey results are not communicated to providers. Conclusions. Patient satisfaction surveys are desirable tools for evaluating the quality of health care delivery despite the fact that they frequently raise concerns amongst providers and patients. There is, therefore, a definite need for providers to experience the benefits of measuring patient satisfaction. Another important practical implication is that patients need to be convinced that their opinions do matter and contribute to improving the quality of services.

scholarly journals Needs-appropriate services for people with young onset dementia: The perspectives of healthcare professionals

Dementia ◽  
2021 ◽  
pp. 147130122110093
Author(s):  
Giovanni Ottoboni ◽  
Vasileios Stamou ◽  
Ilaria Chirico ◽  
Laura De Riso ◽  
Luisa Allione ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Care Delivery ◽  
Healthcare Services ◽  
Healthcare Systems ◽  
Young Onset ◽  
National Healthcare ◽  
Young Onset Dementia ◽  
Provision Of Care ◽  
The Impact

Young onset dementia has become a growing challenge in national healthcare systems. Concerns about the situation have already been expressed; however, they mostly report the views of services end-users. Aimed at finding out useful further improvement, interviews documenting the working experiences of professionals addressing healthcare services to people with young onset dementia (YOD) were analysed qualitatively. The interviews resulted in four themes and twelve categories. The themes regarded services’ complexity and responsiveness, the levels of education and knowledge on YOD, the impact that serving people with YOD reflects on staff working experience and quality of life, and a series of proposals aimed at improving services by giving people with YOD and families the provision of care they deserve. Although some of the themes recapped the ones reported in the previous literature, the mixture of internally and externally driven instances represented in the themes depict the complexity of care delivery in the services. Findings are discussed in the light of a pragmatical framework capable of suggesting what changes services should implement to be timely responsive.

Reduced influence of affective disorders on perioperative complication rates, length of hospital stay, and healthcare costs following spinal fusion for adolescent idiopathic scoliosis

2019 ◽  
Vol 24 (6) ◽  
pp. 722-727
Author(s):  
Aladine A. Elsamadicy ◽  
Andrew B. Koo ◽  
Megan Lee ◽  
Adam J. Kundishora ◽  
Christopher S. Hong ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Idiopathic Scoliosis ◽  
Affective Disorder ◽  
Affective Disorders ◽  
Complication Rates ◽  
Total Cost ◽  
Adolescent Patients ◽  
Perioperative Complication ◽  
The Impact

OBJECTIVEIn the past decade, a gradual transition of health policy to value-based healthcare has brought increased attention to measuring the quality of care delivered. In spine surgery, adolescents with scoliosis are a population particularly at risk for depression, anxious feelings, and impaired quality of life related to back pain and cosmetic appearance of the deformity. With the rising prevalence of mental health ailments, it is necessary to evaluate the impact of concurrent affective disorders on patient care after spinal surgery in adolescents. The aim of this study was to investigate the impact that affective disorders have on perioperative complication rates, length of stay (LOS), and total costs in adolescents undergoing elective posterior spinal fusion (PSF) (≥ 4 levels) for idiopathic scoliosis.METHODSA retrospective study of the Kids’ Inpatient Database for the year 2012 was performed. Adolescent patients (age range 10–17 years old) with AIS undergoing elective PSF (≥ 4 levels) were selected using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Patients were categorized into 2 groups at discharge: affective disorder or no affective disorder. Patient demographics, comorbidities, complications, LOS, discharge disposition, and total cost were assessed. The primary outcomes were perioperative complication rates, LOS, total cost, and discharge dispositions.RESULTSThere were 3759 adolescents included in this study, of whom 164 (4.4%) were identified with an affective disorder (no affective disorder: n = 3595). Adolescents with affective disorders were significantly older than adolescents with no affective disorders (affective disorder: 14.4 ± 1.9 years vs no affective disorder: 13.9 ± 1.8 years, p = 0.001), and had significantly different proportions of race (p = 0.005). Aside from hospital region (p = 0.016), no other patient- or hospital-level factors differed between the cohorts. Patient comorbidities did not differ significantly between cohorts. The number of vertebral levels involved was similar between the cohorts, with the majority of patients having 9 or more levels involved (affective disorder: 76.8% vs no affective disorder: 79.5%, p = 0.403). Postoperative complications were similar between the cohorts, with no significant difference in the proportion of patients experiencing a postoperative complication (p = 0.079) or number of complications (p = 0.124). The mean length of stay and mean total cost were similar between the cohorts. Moreover, the routine and nonroutine discharge dispositions were also similar between the cohorts, with the majority of patients having routine discharges (affective disorder: 93.9% vs no affective disorder: 94.9%, p = 0.591).CONCLUSIONSThis study suggests that affective disorders may not have a significant impact on surgical outcomes in adolescent patients undergoing surgery for scoliosis in comparison with adults. Further studies are necessary to elucidate how affective disorders affect adolescent patients with idiopathic scoliosis, which may improve provider approach in managing these patients perioperatively and at follow-up in hopes to better the overall patient satisfaction and quality of care delivered.

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