Case 19 Taking Advantage of Membership at a Local Health Club

BackgroundDespite a growing body of literature on integrated, there remains a relatively small evidence base to suggest which elements of integrated care are most effective and how to implement them successfully. This might also be due to the fact that policy thinking around integrated care is struggling to translate into organisation change at the point of delivery. Better understanding of patterns of collaborations and integrated pathways is crucial to understand frontline staff’s OD needs and provide adequate support.AimThis paper focuses on the frontline level to assess progress towards integrated care in East London.MethodWe use admission avoidance (Rapid Response service) and discharge services (Discharge to Assess) as a lens to examine how frontline staff from secondary care, community health services and social service work together to deliver more integrated care. The study uses the Researcher in Residence (RiR), where the researcher is embedded in the in the organisations she is evaluating, as a key member of the delivery team.ResultsInitial findings suggest that while work on integrated care has enabled some level of collaborative working at strategic levels in partner organisations, on the frontline professionals are grappling with issues such as professional identity, professional boundaries, mutual trust and accountability, as new services and roles struggle to be fully embedded within the local health system.ConclusionThe paper sheds light on to the complexity on integrated care at the point of delivery. Better understanding of integrated care pathways is crucial to evidence patterns of collaboration across organisations; assess how these new roles and teams are embedding themselves within the local health economy; identify organisation development needs; and provide adequate support to frontline staff.

Download Full-text

Measuring Spatial Effects in Presence of Institutional Constraints: The Case of Italian Local Health Authority Expenditure

SSRN Electronic Journal ◽

10.2139/ssrn.2260334 ◽

2013 ◽

Author(s):

Vincenzo Atella ◽

Federico Belotti ◽

Domenico Depalo ◽

Andrea Piano Mortari

Keyword(s):

Health Authority ◽

Institutional Constraints ◽

Local Health Authority ◽

Local Health ◽

Spatial Effects

Download Full-text

Ayurveda and Communicable Diseases

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v2i05.10260 ◽

2017 ◽

Vol 2 (05) ◽

Author(s):

Ashok G. Naikar ◽

Ganapathi Rao ◽

Panchal Vinayak J.

Keyword(s):

Oral Tradition ◽

World View ◽

Close Association ◽

Practical Aspect ◽

Oral Traditions ◽

Local Health ◽

The People ◽

The World ◽

Pertinent Question ◽

Cultural Domination

Indian medical heritage flows in two distinctive but mutually complimenting streams. The oral tradition being followed by millions of housewives and thousands of local health practitioners is the practical aspect of codified streams such as Ayurveda, Siddha, Unani. These oral traditions are head based and take care of the basic health needs of the people using immediately available local resources. Majority of these are plant based remedies, supplemented by animal and mineral products. Many of the practices followed by these local streams can be understood and evaluated by the codified stream such as Ayurveda. These streams are not static, historical scrutiny of their evolution shows the enriching phenomena at all times. Thus we have more than 7000 species of higher and lower plants and hundreds of minerals and animal product used in local health tradition to manage hundreds of disease conditions. A pertinent question that arises here is that in which basis these systems got enriched. Is it just trial error method over a point of time which gave rise to this rich tradition, is it an intuitive knowledge born out of close association with nature. One of the reasons for this attitude can be, that one is always made to believe that the science means that which can be explained by western models of logic and epistemology. The world view being developed and adopted by the dominant western scientific paradigm never fits in to the world view being followed and practiced by the indigenous traditions. This is well accepted by us due to the last 200 yrs of political and cultural domination by western and other alien forces.

Download Full-text

GPS mHealth Intervention among People Experiencing Homelessness: A Feasibility Study (Preprint)

10.2196/preprints.25553 ◽

2020 ◽

Author(s):

Leticia R. Moczygemba ◽

Whitney Thurman ◽

Kyler Tormey ◽

Anthony Hudzik ◽

Lauren Welton-Arndt ◽

...

Keyword(s):

Community Health ◽

Mobile Health ◽

Care Coordination ◽

Information Exchange ◽

Social Needs ◽

Local Health ◽

Hospital Visit ◽

Mhealth Intervention ◽

Significant Difference ◽

E Mail

BACKGROUND People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased utilization, poor health outcomes, and high health care costs. The majority of homeless individuals have a cell phone of some type, which makes mobile health interventions a feasible way to connect a person experiencing homelessness with providers. OBJECTIVE To investigate the accuracy, acceptability, and preliminary outcomes of a global positioning system-enabled mobile health (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness were in the ED or hospital. METHODS This was a pre-post design with baseline and 4-month post-enrollment assessments. A person experiencing homelessness taking at least two medications for chronic conditions who scored at least 10 on the Patient Health Questionnaire-9 (PHQ-9) and had at least two ED or hospital visits in the prior 6 months was eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily e-mail to assess medication adherence. GPS alerts were compared to ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t-tests compared scores on the PHQ-9, Medical Outcomes Study Social Support Survey, and ASK-12 adherence survey at baseline and exit. Semi-structured exit interviews examined perceptions and benefits of the intervention. RESULTS Thirty participants enrolled; the mean age was 44.1 years (SD 9.7). Most were male (67%; n = 20), White (57%; n = 17), and not working (63%; n = 19). The GPS app showed limited accuracy in ED or hospital visit alerts. Only 18.8% of the alerts aligned with HIE data (3/16), mainly due to patients not having the phone with them during the visit, phone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (M=16.9, SD=5.8) and exit (M=12.7, SD=8.2); t(19)=2.9, p=.009 and a significant difference in adherence barriers between baseline (M=2.4, SD=1.4) and exit (M=1.5, SD =1.5); t(17)=2.47, p = .025). Participants agreed that the app was easy to use (M=4.4/5 with 5 = strongly agree (SA)) and indicated the e-mail helped them remember to take their medications (M=4.6/5). Qualitative data indicated that unlimited phone access allowed participants to meet social needs and maintain reliable contact with case managers, healthcare providers, family, and friends. CONCLUSIONS mHealth interventions are feasible for and acceptable to people experiencing homelessness. Objective data from the HIE provided more accurate ED and hospital visit information, but unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination. CLINICALTRIAL Not applicable

Download Full-text

Derivation of Respiratory Metrics in Health and Asthma; Machine Learning Methodology (Preprint)

10.2196/preprints.25178 ◽

2020 ◽

Author(s):

Joseph Prinable ◽

Peter Jones ◽

David Boland ◽

Alistair McEwan ◽

Cindy Thamrin

Keyword(s):

Machine Learning ◽

Short Term Memory ◽

Reference Signal ◽

Machine Learning Algorithms ◽

Training Dataset ◽

Local Health ◽

Strongly Correlated ◽

Human Research Ethics ◽

Expiration Time ◽

Wide Variability

BACKGROUND The ability to continuously monitor breathing metrics may have indications for general health as well as respiratory conditions such as asthma. However, few studies have focused on breathing due to a lack of available wearable technologies. OBJECTIVE Examine the performance of two machine learning algorithms in extracting breathing metrics from a finger-based pulse oximeter, which is amenable to long-term monitoring. METHODS Pulse oximetry data was collected from 11 healthy and 11 asthma subjects who breathed at a range of controlled respiratory rates. UNET and Long Short-Term memory (LSTM) algorithms were applied to the data, and results compared against breathing metrics derived from respiratory inductance plethysmography measured simultaneously as a reference. RESULTS The UNET vs LSTM model provided breathing metrics which were strongly correlated with those from the reference signal (all p<0.001, except for inspiratory:expiratory ratio). The following relative mean bias(95% confidence interval) were observed: inspiration time 1.89(-52.95, 56.74)% vs 1.30(-52.15, 54.74)%, expiration time -3.70(-55.21, 47.80)% vs -4.97(-56.84, 46.89)%, inspiratory:expiratory ratio -4.65(-87.18, 77.88)% vs -5.30(-87.07, 76.47)%, inter-breath intervals -2.39(-32.76, 27.97)% vs -3.16(-33.69, 27.36)%, and respiratory rate 2.99(-27.04 to 33.02)% vs 3.69(-27.17 to 34.56)%. CONCLUSIONS Both machine learning models show strongly correlation and good comparability with reference, with low bias though wide variability for deriving breathing metrics in asthma and health cohorts. Future efforts should focus on improvement of performance of these models, e.g. by increasing the size of the training dataset at the lower breathing rates. CLINICALTRIAL Sydney Local Health District Human Research Ethics Committee (#LNR\16\HAWKE99 ethics approval).

Download Full-text