Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers

Objective To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults. Materials and methods We deployed ENS alerts in 2 Veterans Affairs (VA) medical centers using regional health information exchange (HIE) networks from March 2016 to December 2019. Alerts targeted VA-based primary care teams when older patients (aged 65+ years) were hospitalized or attended emergency departments (ED) outside the VA system. We employed a concurrent cohort study to compare postdischarge outcomes between patients whose providers received ENS alerts and those that did not (usual care). Outcome measures included: timely follow-up postdischarge (actual phone call within 7 days or an in-person primary care visit within 30 days) and all-cause inpatient or ED readmission within 30 days. Generalized linear mixed models, accounting for clustering by primary care team, were used to compare outcomes between groups. Results Compared to usual care, veterans whose primary care team received notification of non-VA acute care encounters were 4 times more likely to have phone contact within 7 days (AOR = 4.10, P < .001) and 2 times more likely to have an in-person visit within 30 days (AOR = 1.98, P = .007). There were no significant differences between groups in hospital or ED utilization within 30 days of index discharge (P = .057). Discussion ENS was associated with increased timely follow-up following non-VA acute care events, but there was no associated change in 30-day readmission rates. Optimization of ENS processes may be required to scale use and impact across health systems. Conclusion Given the importance of ENS to the VA and other health systems, this study provides guidance for future research on ENS for improving care coordination and population outcomes. Trial Registration ClinicalTrials.gov NCT02689076. “Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization.” Registered February 23, 2016.

Context-Aware Naming and Forwarding in NDN-Based VANETs

Vehicular ad-hoc network (VANET) is a technology that allows ubiquitous mobility to mobile users. Inter-vehicle communication is an integral component of intelligent transportation systems that enables a wide variety of applications where vehicles interact and cooperate with each other, from safety applications to non-safety applications. VANETs applications have different needs (e.g., latency, reliability, delivery priorities, etc.) in terms of delivery effectiveness. In the last decade, named data networking (NDN) gained the attention of the research community for effective content retrieval and dissemination in mobile environments such as VANETs. In NDN, the content’s name has a vital role in storing and retrieving the content effectively and efficiently. In NDN-based VANETs, adaptive content dissemination solutions must be introduced that can make decisions related to forwarding, cache management, etc., based on context information represented by a content name. In this context, our main contributions are two-fold: (i) we present the hierarchical context-aware content-naming (CACN) scheme for NDN-based VANETs that enables naming the safety and non-safety applications, and (ii) we present a decentralized context-aware notification (DCN) protocol that broadcasts event notification information for awareness within the application-based geographical area. Simulation results show that the proposed DCN protocol succeeds in achieving reduced transmissions, bandwidth, and energy compared to existing critical contents dissemination protocols.

SARS event notification: template openEHR brasileiro para interoperabilidade semântica de dados com foco na Covid-19

Este artigo descreve a criação de um template no formato openEHR para interoperabilidade semântica de dados de saúde – um padrão aberto para informações clínicas. As informações coletadas através da ficha de notificação SRAG (síndrome respiratória aguda grave) foram utilizadas como conceitos base para composição do template. O template SARS event notification foi construído envolvendo o princípio que norteia a proposta openEHR: padronização, reutilização e abstração de conhecimentos técnicos, sendo o primeiro template brasileiro publicado no repositório CKM (Clinical Knowledge Manager) relacionado à COVID-19.

Nurses’ Perceptions on the Implementation of a Safe Drug Administration Protocol and Its Effect on Error Notification

Patient safety and quality of care are fundamental pillars in the health policies of various governments and international organizations. The purpose of this study is to evaluate nurses’ perceptions on the degree of implementation of a protocol for the standardization of care and to measure its influence on notification of adverse events related to the administration of medications. This comparative study used data obtained from questionnaires completed by 180 nurses from medical and surgical units. Our analyses included analysis of variance and regression models. We observe that the responses changed unevenly over time in each group, finding significant differences in all comparisons. The mean response rating was increased at 6 months in the intervention group, and this level was maintained at 12 months. With the new protocol, a total of 246 adverse events and 481 incidents without harm was reported. Thus, actions such as the use of protocols and event notification systems should be implemented to improve quality of care and patient safety.

The risk factors of recurrent falls among inpatients: A retrospective study (Preprint)

BACKGROUND Recurrent falls are more likely to cause injuries and disabilities than single falls. OBJECTIVE This study investigated the incidence and risk factors of recurrent falls among inpatients. METHODS Adopting a retrospective research design, we collected and analyzed inpatient fall data from the anomaly event notification database of a teaching hospital in Taiwan in coordination with electronic medical records in the four years from January 1, 2016 to December 31, 2019. RESULTS We collected data from 1,059 inpatients. Among these inpatients were 390 recurrent-fall inpatients (36.83%) who had a fallen more than once. After controlling the other variables, we found that inpatients in the orthopedics and neurology wards were at higher risk of recurrent falls within a year than those in surgical wards (OR=2.44, p< .001; OR=1.93, p= .002); inpatients who were completely physically dependent on others or required assistance before their falls were at higher risk of recurrent falls within a year than those who were physically independent (OR = 2.10, p= .014; OR=1.57, p= .015); inpatients with self-perceived poor vision were at lower risk of recurrent falls within a year than those without this issue (OR=0.61, p< .001), and inpatients who were using antidepressants were at higher risk of recurrent falls within a year than those who were not using antidepressants (OR=1.44, p= .042). CONCLUSIONS There are multiple aspects to the factors of recurrent falls among inpatients within a year and that the risk of recurrent falls is highly correlated with ward type (orthopedics and neurology), physical independence (completely dependent or requiring assistance), no poor vision, and use of antidepressants. CLINICALTRIAL NA

Organizational characteristics and perceptions of clinical event notification services in healthcare settings: a study of health information exchange

Objective Event notification systems are an approach to health information exchange (HIE) that notifies end-users of patient interactions with the healthcare system through real-time automated alerts. We examined associations between organizational capabilities and perceptions of event notification system use. Materials and Methods We surveyed representatives (n = 196) from healthcare organizations (n = 96) that subscribed to 1 of 3 Health Information Organizations’ event notification services in New York City (response rate = 27%). The survey was conducted in Fall 2017 and Winter 2018. Surveys measured respondent characteristics, perceived organizational capabilities, event notification use, care coordination, and care quality. Exploratory factor analysis was used to identify relevant independent and dependent variables. We examined the relationship between organizational capabilities, care coordination, and care quality using multilevel linear regression models with random effects. Results Respondents indicated that the majority of their organizations provided follow-up care for emergency department visits (66%) and hospital admissions (73%). Perceptions of care coordination were an estimated 57.5% (β = 0.575; P &lt; 0.001) higher among respondents who reported event notifications fit within their organization’s existing workflows. Perceptions of care quality were 46.5% (β = 0.465; P &lt; 0.001) higher among respondents who indicated event notifications fit within existing workflows and 23.8% (β = 0.238; P &lt; 0.01) higher where respondents reported having supportive policies and procedures for timely response and coordination of event notifications. Discussion and Conclusion Healthcare organizations with specific workflow processes and positive perceptions of fit are more likely to use event notification services to improve care coordination and care quality. In addition, event notification capacity and patient consent procedures influence how end-users perceive event notification services.

Adverse event notification analysis through patient safety culture research

Objetivo: a avaliação da cultura de segurança do paciente permite aos hospitais identificar e gerir prospectivamente questões relevantes de segurança em suas rotinas de trabalho. Método: estudo quantitativo, transversal e descritivo, ocorrida no ano de 2017 na Unidade de Terapia Intensiva Adulta em um hospital privado, localizado em Niterói/RJ. A população foram os profissionais médicos e equipe de enfermagem, utilizando análise estatística por meio de programa R, com a interface Rcmdr. Resultados: baseados nas respostas às perguntas sobre notificação de eventos aplicada com a Pesquisa de Cultura de Segurança do Paciente a 97 profissionais, com uma taxa de resposta de 85,6%, correspondendo a 83 profissionais. Menos de 45% dos participantes da pesquisa sempre notificam um erro, engano ou falha, que afete ou não o paciente, 59,0% não fizeram nenhuma notificação nos últimos 12 meses antecedentes à pesquisa e não houve diferença significativa na quantidade de notificação que destacasse uma categoria profissional, graduados ou não. Discussão: houve maior adesão à notificação de eventos pelos com maior tempo de hospital e com maior tempo naquela terapia intensiva. Não se encontrou correlação do número de notificações relatadas com o tempo de profissão e com a carga horária de trabalho. Conclusão: no que tange à conscientização de incrementar a adesão à notificação de eventos, a análise realizada contribuiu para a melhoria da segurança do paciente.