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Objectives: This article describes how a home visit solution was developed in a co-design process between patients in treatment for severe spasticity, their caregivers and hospital nurses. The solution was developed using a participatory design approach and was based on the identified needs of the participants. Methods: We developed a home visit solution through an iterative process and a collective 'reflection-in-action' approach with patients, caregivers and healthcare professionals. Results: The study revealed the complexities of establishing new routines around home visits. The solution included a new workflow for the nurses and a new route and appointment planning tool. Conclusion: Through a participatory design approach, the users developed a home visit solution that minimised disruption to patients' daily lives and facilitated a dialogue between the nurses and the caregivers about the treatment and the patients' spasticity, which helped to adjust the treatment in line with the patient´s needs.
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Citas y Horarios , Visita Domiciliaria , Espasticidad Muscular , Humanos , Femenino , Masculino , Persona de Mediana Edad , Cuidadores/psicología , AdultoRESUMEN
Cross-institution collaborations are constrained by data-sharing challenges. These challenges hamper innovation, particularly in artificial intelligence, where models require diverse data to ensure strong performance. Federated learning (FL) solves data-sharing challenges. In typical collaborations, data is sent to a central repository where models are trained. With FL, models are sent to participating sites, trained locally, and model weights aggregated to create a master model with improved performance. At the 2021 Radiology Society of North America's (RSNA) conference, a panel was conducted titled "Accelerating AI: How Federated Learning Can Protect Privacy, Facilitate Collaboration and Improve Outcomes." Two groups shared insights: researchers from the EXAM study (EMC CXR AI Model) and members of the National Cancer Institute's Early Detection Research Network's (EDRN) pancreatic cancer working group. EXAM brought together 20 institutions to create a model to predict oxygen requirements of patients seen in the emergency department with COVID-19 symptoms. The EDRN collaboration is focused on improving outcomes for pancreatic cancer patients through earlier detection. This paper describes major insights from the panel, including direct quotes. The panelists described the impetus for FL, the long-term potential vision of FL, challenges faced in FL, and the immediate path forward for FL.
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Inteligencia Artificial , Neoplasias Pancreáticas , Humanos , Privacidad , Aprendizaje , Neoplasias PancreáticasRESUMEN
This study assesses the perceived impact and benefits of Project ECHO (Extension for Community Healthcare Outcomes), a tele-mentoring intervention for health and social care providers, patients and the health system in Northern Ireland. Having access to a specialist, a space to share experiences, and being able to disseminate up-to-date best practice were all cited as improving provider knowledge as well as improving quality of care for patients. Healthcare providers reported being more confident in managing patients and that relationships had been improved between different levels of the health system. ECHO was described as improving access to education and training by removing geographic and time barriers. This is one of the first studies to qualitatively analyse impact across a number of different clinical and social care ECHO networks. The results strongly indicate the perceived benefit of ECHO in improving provider, patient and health system outcomes such as increased healthcare provider knowledge and confidence to manage patients at primary levels of the health system. This has implications for future service design, particularly within the context of COVID-19 in which virtual and online training is necessitated by social distancing requirements.
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COVID-19 , Humanos , Irlanda del Norte , Servicios de Salud Comunitaria , Apoyo Social , Personal de Salud/educaciónRESUMEN
This paper describes the software design/development process leading to an improved computerized clinical/management solution-RSIPA (2016 version)-integrating care pathways (CPs) specifically designed to meet the needs of frail and disabled older adults in home care. The development methodology used Soft Systems Methodology (SSM) for the initial system design and participatory design (PD) to involve stakeholders and end users, along with AGILE SCRUM methodology to provide rapid iterations in adapting to new requests. Given scarce project resources, we opted to combine methodologies to efficiently deliver a fully functional system for three of the five CP clinical phases. The development methodology aggregated assessment-based data to identify risk factors and assist in needs prioritization leading to care plans and addressed in the current system. The new Quebec RSIPA solution incorporating CCPs is a promising example of technologies that support person-centered care, clinical and management processes, and proactive care in home-care settings.
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Protocolos Clínicos/normas , Personas con Discapacidad , Servicios de Atención de Salud a Domicilio/organización & administración , Atención Dirigida al Paciente/organización & administración , Diseño de Software , HumanosRESUMEN
Research on interoperability and information exchange between information technology systems touts the use of secondary data for a variety of purposes, including research, management, quality improvement, and accountability. However, many studies have pointed out that this is difficult to achieve in practice. Hence, this article aims to examine the causes for this by reporting an ethnographic study of the data work performed by medical records coders and birth certificate clerks working in a hospital system to uncover the practices of creating administrative data (e.g. secondary data). The article illustrates that clerks and coders use situated qualitative judgments of the accuracy and authority of different primary medical accounts. Coders and clerks also employ their understandings of the importance of different future uses of data as they make crucial decisions about how much discretion to exercise in producing accurate data and how much effort to put toward clarifying problematic medical data. These findings suggest that information technology systems designed for interoperability and secondary data also need to be designed in ways that support the qualculative practices of data workers in order to succeed, including making future uses of data clear to data workers and finding ways to minimize conflicting data before data workers encounter it.
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Registros Electrónicos de Salud/normas , Interoperabilidad de la Información en Salud/normas , Sistemas de Información/normas , Administradores de Registros Médicos , Mejoramiento de la Calidad , Antropología Cultural , Certificado de Nacimiento , Conducta Cooperativa , Atención a la Salud , Humanos , Entrevistas como AsuntoRESUMEN
Collaborative and multicenter studies permit a large number of patients to be enrolled within a reasonable time and providing the opportunity to collect different data. Informatics platforms play an important role in management, storage, and exchange of data between the participants involved in the study. In this article, we describe a modular informatics platform designed and developed to support collaborative and multicenter studies in cardiology. In each developed module, data management is implemented following local defined protocols. The modular characteristic of the developed platform allows independent transfer of different kinds of data, such as biological samples, imaging raw data, and patients' digital information. Moreover, it offers safe central storage of the data collected during the study. The developed platform was successfully tested during a European collaborative and multicenter study, focused on evaluating multimodal non-invasive imaging to diagnose and characterize ischemic heart disease.
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Cardiología/instrumentación , Conducta Cooperativa , Sistemas de Administración de Bases de Datos/instrumentación , Intercambio de Información en Salud/normas , Apoyo a la Investigación como Asunto/métodos , Sistemas de Administración de Bases de Datos/normas , Humanos , ItaliaRESUMEN
People with serious mental illness have reduced life expectancy compared with a control population, much of which is accounted for by significant physical comorbidity. Frontline clinical staff in mental health often lack confidence in recognition, assessment and management of such 'medical' problems. Simulation provides one way for staff to practise these skills in a safe setting. We produced a multidisciplinary simulation course around recognition and assessment of medical problems in psychiatric settings. We describe an audit of strategic and design aspects of the recognition and assessment of medical problems in psychiatric settings course, using the Department of Health's 'Framework for Technology Enhanced Learning' as our audit standards. At the same time as highlighting areas where recognition and assessment of medical problems in psychiatric settings adheres to these identified principles, such as the strategic underpinning of the approach, and the means by which information is collected, reviewed and shared, it also helps us to identify areas where we can improve.
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Comorbilidad , Relaciones Interprofesionales , Psiquiatría , Entrenamiento Simulado/métodos , Toma de Decisiones Clínicas , Personal de Salud/educación , Humanos , Trastornos MentalesRESUMEN
People with serious mental illness have reduced life expectancy compared with a control population, much of which is accounted for by significant physical comorbidity. Frontline clinical staff in mental health often lack confidence in recognition, assessment and management of such 'medical' problems. Simulation provides one way for staff to practise these skills in a safe setting. We produced a multidisciplinary simulation course around recognition and assessment of medical problems in psychiatric settings. We describe an audit of strategic and design aspects of the recognition and assessment of medical problems in psychiatric settings, using the Department of Health's 'Framework for Technology Enhanced Learning' as our audit standards. At the same time, as highlighting areas where recognition and assessment of medical problems in psychiatric settings adheres to these identified principles, such as the strategic underpinning of the approach, and the means by which information is collected, reviewed and shared, it also helps us to identify areas where we can improve.
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Comorbilidad , Tecnología Educacional , Relaciones Interprofesionales , Psiquiatría , Entrenamiento Simulado/métodos , Toma de Decisiones Clínicas , Personal de Salud/educación , Humanos , Trastornos MentalesRESUMEN
This article reviews large-scale digital developments in the National Health Service in England in recent years and argues that there is a mismatch between digital and organisational thinking and practice. The arguments are based on new institutional thinking, where the digital infrastructure is taken to be an institution, which has been shaped over a long period, and which in turn shapes the behaviour of health professionals, managers and others. Many digital services are still being designed in line with a bureaucratic data processing model. Yet health services are increasingly based on a network model, where health professionals and service managers require information systems that allow them to manage risks proactively and to coordinate multiple services on behalf of patients. This article further argues that the data processing model is being reinforced by Open Data policies and by related developments in the acquisition of genomic and telehealth data, suggesting that the mismatch will persist. There is, therefore, an ongoing tension between frontline and central objectives for digital services. It may be that the tension can only be resolved when--or if--there is trust between the interested parties.