RESUMEN

Purpose: Assess the effectiveness of standardizing multidisciplinary case conferences (MDCs). Methods: Anonymous electronic surveys gauged opinions of abdominal radiologists engaged in recurring MDCs. A standardized Excel template, following Cancer Care Ontario guidelines and relevant literature, was distributed to MDC managers. Physicians were instructed to send cases 36 hours prior to MDC. Template adherence was assessed at 1.5 and 8 months. A follow-up survey at 4 months evaluated the intervention's effectiveness. Results: 27/34 abdominal radiologists provided 47 baseline responses, and 12 delegated radiologists provided 23 follow-up responses. "Often/always" being provided the image's location increased from 36% (17/47) at baseline to 70% (16/23) at follow-up. Non-adherence to the 36-hour cut-off decreased from 36% (16/45) to 17% (4/23). 72% disagreed that uploading remote imaging to hospital servers is easy (33/46), similar to follow-up (18/23, 78%). In assessing the intervention, 41% noted improved standardization (9/22), another 41% considered MDCs already standardized (9/22), and 18% reported no change (4/22). Those reporting no change experienced a higher frequency of non-adherence to the 36-hour cut-off (3/4, 75%) than others (1/18, 6%), and less frequent "often/always" ratings for image location being provided (3/4, 75%) than others (2/18, 11%). 89% (25/28) of MDCs adhered to the template. Issues regarding last-minute add-on cases may be mitigated through EPIC force functions. Artificial intelligence advancements may assist in retrieving external images and patient information. Conclusion: Adherence to MDC standardization was high, allowing for more efficient preparation, potentially reducing radiologist administrative burdens. Future force functions and artificial intelligence integration into electronic patient records may further augment this.

RESUMEN

INTRODUCTION: Kazakhstan has made significant strides in digital health implementation since 2013, transitioning from paper-based systems to wide implementation of digital solutions. However, challenges persist, notably the misalignment between existing data collection requirements and ongoing digital transformations. To address this obstacle, the development of a new digital-friendly requirements for health data collection at provider levels was initiated. MATERIAL AND METHODS: A comparative analysis of all existing requirements on health and care data collection set a foundation for further actions. A dedicated technical working group, established by the Ministry of Healthcare, oversaw this process, while several specialized expert groups participated in detailed discussions to ensure alignment with healthcare needs. We took as a basis the legislative act enforcing use of data forms inherited from pre-digital era. Data elements from most used forms were cataloged, checked for consistency, and standardized. ISO 13940 standard guided transformation of rigid paper-based forms into flexible digital-friendly data sets. RESULTS: Analysis of the healthcare legislation reveals significant optimization opportunities. We categorized 157 forms into four groups by their content and role and focusing on clinical and administrative records for transformation. Data elements' analysis led to developing 209 standardized classifications with data values. 83 data sets, encompassing clinical and administrative domains, were developed to substitute 63 (out of 157) forms. Therefore, the foundation for better data and structure interoperability was set. DISCUSSION: The top-down approach to digital health standardization, combined with open market policies, results in inconsistent data collection practices. Developed data sets align with the goal of developing the national Electronic Health Records system as enabler for interoperability and adds a bottom-up perspective to digital health standardization. This effort addresses the lack of guidance for digital data model development, however additional efforts required to change the current practice and finalize the national legislation transformation into digital-friendly mode.

RESUMEN

INTRODUCTION: Conducting clinical studies is an integral part of the clinical research repertoire of university hospitals. A wealth of organizational competences must always be available in a central location and in an up-to-date form for appropriate administration. Information such as the number of ongoing studies, and the number of enrolled participants is required for tasks related to e.g. sponsor quality management and KPIs. A registry for clinical trials can answer these questions and enhance the exchange of information. METHODS: Requirements for an in-house registry for clinical trials were defined in a multidisciplinary task force. The requirements included interfaces and key abilities to create customized reports to fulfill the obligation to provide evidence. RESULTS: The study registry is productive since May 2020 and internal interfaces have been implemented to ensure consistency between systems and the documented studies. Manually recorded data is enhanced by interfaces to primary registers. The comprehensive data set in the study register enables the creation of individual queries at any time for a variety of questions. DISCUSSION: The UKSH study register has already demonstrated its usefulness in various applications and several projects. The extensive data set and the modular realization allows many current and future requirements to be met.

Asunto(s)

RESUMEN

BACKGROUND: Data quality in health information systems has a complex structure and consists of several dimensions. This research conducted for identify Common data quality elements for health information systems. METHODS: A literature review was conducted and search strategies run in Web of Knowledge, Science Direct, Emerald, PubMed, Scopus and Google Scholar search engine as an additional source for tracing references. We found 760 papers, excluded 314 duplicates, 339 on abstract review and 167 on full-text review; leaving 58 papers for critical appraisal. RESULTS: Current review shown that 14 criteria are categorized as the main dimensions for data quality for health information system include: Accuracy, Consistency, Security, Timeliness, Completeness, Reliability, Accessibility, Objectivity, Relevancy, Understandability, Navigation, Reputation, Efficiency and Value- added. Accuracy, Completeness, and Timeliness, were the three most-used dimensions in literature. CONCLUSIONS: At present, there is a lack of uniformity and potential applicability in the dimensions employed to evaluate the data quality of health information system. Typically, different approaches (qualitative, quantitative and mixed methods) were utilized to evaluate data quality for health information system in the publications that were reviewed. Consequently, due to the inconsistency in defining dimensions and assessing methods, it became imperative to categorize the dimensions of data quality into a limited set of primary dimensions.

Asunto(s)

RESUMEN

BACKGROUND: With the increasing number of protracted refugee crises globally, it is essential to ensure strong national health information systems (HIS) in displacement settings that include refugee-sensitive data and disaggregation by refugee status. This multi-country study aims to assess the degree of integration of refugee health data into national HIS in Jordan, Lebanon, and Uganda and identify the strengths and weaknesses of their national HIS in terms of collecting and reporting on refugee-related health indicators. METHODS: The study employs a comparative country analysis approach using a three-phase framework. The first phase involved reviewing 4120 indicators compiled from global health organizations, followed by a multi-stage refinement process, resulting in 45 indicators distributed across five themes. The second phase consisted of selecting relevant criteria from the literature, including data sources, annual reporting, disaggregation by refugee status, refugee population adjustments, accuracy, and consistency. The third phase involved assessing data availability and quality of the selected indicators against these criteria. RESULTS: Our analysis uncovered significant challenges in assessing the health status of refugees in Jordan, Lebanon, and Uganda, primarily stemming from limitations in the available health data and indicators. Specifically, we identified significant issues including incomplete local data collection with reliance on international data sources, fragmented data collection from various entities leading to discrepancies, and a lack of distinction between refugees and host populations in most indicators. These limitations hinder accurate comparisons and analyses. In light of these findings, a set of actionable recommendations was proposed to guide policymakers in the three countries to improve the integration of refugee health data into their national HIS ultimately enhancing refugees' well-being and access to healthcare services. CONCLUSION: The current status of refugee-related health data in Jordan, Lebanon, and Uganda indicates the need for improved data collection and reporting practices, disaggregation by refugee status and better integration of refugee health data into national HIS to capture the health status and needs of refugees in host countries. Key improvement strategies include establishing a centralized authority for consistent and efficient data management, fostering transparent and inclusive data governance, and strengthening workforce capacity to manage refugee health data effectively.

RESUMEN

Data quality in health information systems (HIS) is essential for informed decision-making in the health sector, particularly in sub-Saharan Africa (SSA) where these systems face many challenges like resource limitations and weak infrastructure. This systematic review assessed the quality of HIS data in the region, focusing on the dimensions, and factors influencing this quality. It highlights the importance of systematic evaluation, ongoing training for data collectors in the analysis and use of data for decision-making, and the adoption of information and communication technologies in the healthcare system to improve data quality. These findings point the way to better use of health data and the need for a more integrated approach to digital health in SSA.

Asunto(s)

RESUMEN

BACKGROUND: District-based public private mix (DPPM) tuberculosis in Purwakarta district was strengthened by the MitraTB application. This research is aimed to explore perception of user about MitraTB application and measure their perception of this application in dimensions; design, usefulness, ease of use, and acceptance. METHODS: This study was exploratory sequential mixed methods research. A qualitative study was first conducted in order to gain an in-depth understanding about user's perception of MitraTB application through in-depth interviews. Data were analyzed through coding and categorizing. Based on qualitative finding, a questionnaire was developed and used in the following quantitative study. A cross sectional study was then conducted in quantitative phase. Data were analyzed using Rasch modeling. RESULT: The design of the MitraTB application looks simple and attractive to users. This application is useful to make it easier for private practitioners to report TB cases and it is easy to use. Respondents can accept the MitraTB application well. Most respondents have good perception about MitraTB application in dimensions; design (56.25%), usefulness (69.79%), ease of use (55.20%), and acceptance (73.96%). CONCLUSIONS: MitraTB application has a good design feature, useful, easy to use, and acceptable. This application facilitates the private sector to be involved in the TB program by reporting TB cases. Follow-up and local regulations are required for the continued use of this application.

Asunto(s)

RESUMEN

Introduction: an effective health information system (HIS) ensures the production, analysis, dissemination and use of reliable and up-to-date information on the determinants of health. However, it can encounter obstacles that hinder its functioning, such as armed conflicts, which limit access and quality of healthcare services. The purpose of our study was to help improve data management for routine health information system in the health district of Timbuktu during a security crisis. Methods: we conducted a descriptive cross-sectional study, among health information management professionals in the Timbuktu Health District from 15 April to 08 September 2023. Data obtained from a survey questionnaire were analyzed using Epi Info version 7.2.2. and processed using Microsoft Word and Excel 2016. Results: a total of 6 health facilities were surveyed. Data collection, analysis and feedback were very poor. Data quality was 100% complete, 92.40% prompt and 68.11% accurate. The major constraints were: low involvement of health workers in the SIS (22.22%), insufficient training on the SISR (29.63%), supervision (47.06%), internet inaccessibility (66.67%), feeling of insecurity (37.04%) and fear (61.76%) in health facilities. Conclusion: our results show low-level processes, poor network coverage, shortage of qualified health information management professionals and increasing insecurity. A broader mixed-methods research would provide a better understanding.

Asunto(s)

RESUMEN

BACKGROUND: Although Ethiopia has made remarkable progress in the uptake of the District Health Information System version 2 (DHIS2) for national aggregate data reporting, there has been no comprehensive assessment of the maturity level of the system. OBJECTIVE: This study aims to assess the maturity level of DHIS2 implementation in Ethiopia and propose a road map that could guide the progress toward a higher level of maturity. We also aim to assess the current maturity status, implementation gaps, and future directions of DHIS2 implementation in Ethiopia. The assessment focused on digital health system governance, skilled human resources, information and communication technology (ICT) infrastructure, interoperability, and data quality and use. METHODS: A collaborative assessment was conducted with the engagement of key stakeholders through consultative workshops using the Stages of Continuous Improvement tool to measure maturity levels in 5 core domains, 13 components, and 39 subcomponents. A 5-point scale (1=emerging, 2=repeatable, 3=defined, 4=managed, and 5=optimized) was used to measure the DHIS2 implementation maturity level. RESULTS: The national DHIS2 implementation's maturity level is currently at the defined stage (score=2.81) and planned to move to the manageable stage (score=4.09) by 2025. The domain-wise maturity score indicated that except for ICT infrastructure, which is at the repeatable stage (score=2.14), the remaining 4 domains are at the defined stage (score=3). The development of a standardized and basic DHIS2 process at the national level, the development of a 10-year strategic plan to guide the implementation of digital health systems including DHIS2, and the presence of the required competencies at the facility level to accomplish specific DHIS2-related tasks are the major strength of the Ministry of Health of Ethiopia so far. The lack of workforce competency guidelines to support the implementation of DHIS2; the unavailability of core competencies (knowledge, skills, and abilities) required to accomplish DHIS2 tasks at all levels of the health system; and ICT infrastructures such as communication network and internet connectivity at the district, zonal, and regional levels are the major hindrances to effective DHIS2 implementation in the country. CONCLUSIONS: On the basis of the Stages of Continuous Improvement maturity model toolkit, the implementation status of DHIS2 in Ethiopia is at the defined stage, with the ICT infrastructure domain being at the lowest stage as compared to the other 4 domains. By 2025, the maturity status is planned to move from the defined stage to the managed stage by improving the identified gaps. Various action points are suggested to address the identified gaps and reach the stated maturity level. The responsible body, necessary resources, and methods of verification required to reach the specified maturity level are also listed.

RESUMEN

BACKGROUND: The COVID-19 pandemic had a profound impact on healthcare systems and services, including routine immunization (RI). To date, there is limited information on the effects of the COVID-19 pandemic on RI in West African countries such as Sierra Leone, which had already experienced public health emergencies that disrupted its healthcare system. Here, we describe the impact of the COVID-19 pandemic on the RI of key antigens in Sierra Leone. METHODS: We used vaccination data from the District Health Information System for BCG, measles-rubella 1 and 2, and pentavalent 1 and 3 antigens. We compared 2019, 2020, 2021, and 2022 annual coverage rates for the selected antigens at the national and district levels. We used the Pearson chi-square test to assess the difference between annual coverage rates between 2019 and 2020, 2020-2021, and 2021-2022. RESULTS: National coverage rates for all antigens declined in 2019-2020, notably measles-rubella 1 and pentavalent 3 (-5.4% and - 4.9%). Between 2020 and 2021, there was an overall increase in coverage (+ 0.2% to + 2.5%), except for measles-rubella 2 (-1.8%). Measles-rubella antigens rebounded in 2021-2022, while others decreased between - 0.5 and - 1.9% in coverage. Overall, all district-level coverage rates in 2022 were lower than those in 2019. Most districts decreased between 2019 and 2022, though a few had a continuous increase; some had an increase/recovery between 2020 and 2021; some districts had recovered 2019 levels by 2022. CONCLUSION: The COVID-19 pandemic impacted Sierra Leone's national BCG, measles-rubella, and pentavalent antigen immunization, which were not fully restored in 2022. Most districts experienced notable coverage declines during the pandemic, though a few reached or surpassed 2019 rates in 2022. Examining pandemic impact can benefit from a focus beyond the national level to identify vulnerable regions. Sierra Leone's post-pandemic RI reestablishment needs targeted strategies and continual investments for equitable access and coverage, as well as to prevent vaccine-preventable diseases.

Asunto(s)

RESUMEN

Licensed practical nurses (LPNs) are the second largest occupational group and the largest group in the social and healthcare sector in Finland, and they have an extensive working environment. Like other health and social care professionals, LPNs also use health information systems (HIS) and client information systems (CIS) in their daily work. The aim of this study was to describe LPNs' perceptions of the benefits of information systems in daily patient care. The information systems include the main HIS or CIS that the respondents mainly use in their work. The data comprised 3 866 LPNs' responses were collected via an online survey in 2022. Most of the LPNs work in social care using the Lifecare system. ESKO is used in public health care and was rated as the most popular system that LPNs use regarding the benefits of information systems. Highly experienced LPNs seem to rate the benefits of information systems higher than LPNs who have just started working.

Asunto(s)

RESUMEN

Background: The ongoing revolution in health care, driven by wearable technology, virtual reality, and the Internet of Things, is reshaping both health care operations and our daily lives. This digital transformation ensures broader access to health care options, fosters patient-centered care and affects both health care institutions and individuals. In Sweden, health care is undergoing a digital shift, with initiatives like personal health management, remote monitoring, and virtual care enhancing patient involvement. This article reviews Sweden's health care digital transformation and compares it with the United Arab Emirates (UAE's) initiatives to assess viability. Methods: Using systematic literature review methods, databases from 2011 to 2023 were searched, supplemented by reference lists. Results: Database searches identified 761 records. A total of 480 articles were screened on basis of title and abstract, yielding 184 that were assessed for eligibility, leading to 40 academic studies to be included and 12 grey literature. Conclusions: The findings highlight Sweden's success in empowering patients through enhanced connectivity with clinical teams, knowledge sharing, and care management. However, due to contextual differences, the UAE should not blindly replicate Sweden's strategy. In conclusion, Sweden's efforts have positively engaged patients in health care, but challenges such as emerging technologies, demographic shifts, and budget constraints persist. Proactive planning and adaptation are crucial, with lessons applicable to the UAE market. Establishing a clear regulatory framework for digital care is imperative for future resilience.

Asunto(s)

RESUMEN

BACKGROUND: Burnout among health care professionals is a significant concern, with detrimental effects on health care service quality and patient outcomes. The use of the electronic health record (EHR) system has been identified as a significant contributor to burnout among health care professionals. OBJECTIVE: This systematic review and meta-analysis aims to assess the prevalence of burnout among health care professionals associated with the use of the EHR system, thereby providing evidence to improve health information systems and develop strategies to measure and mitigate burnout. METHODS: We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for English-language peer-reviewed articles published between January 1, 2009, and December 31, 2022. Two independent reviewers applied inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Meta-analyses were performed using R (version 4.1.3; R Foundation for Statistical Computing), with EndNote X7 (Clarivate) for reference management. RESULTS: The review included 32 cross-sectional studies and 5 case-control studies with a total of 66,556 participants, mainly physicians and registered nurses. The pooled prevalence of burnout among health care professionals in cross-sectional studies was 40.4% (95% CI 37.5%-43.2%). Case-control studies indicated a higher likelihood of burnout among health care professionals who spent more time on EHR-related tasks outside work (odds ratio 2.43, 95% CI 2.31-2.57). CONCLUSIONS: The findings highlight the association between the increased use of the EHR system and burnout among health care professionals. Potential solutions include optimizing EHR systems, implementing automated dictation or note-taking, employing scribes to reduce documentation burden, and leveraging artificial intelligence to enhance EHR system efficiency and reduce the risk of burnout. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42021281173; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021281173.

RESUMEN

BACKGROUND: Digital health is being used as an accelerator to improve the traditional healthcare system, aiding countries in achieving their sustainable development goals. Burkina Faso aims to harmonize its digital health interventions to guide its digital health strategy for the coming years. The current assessment represents upstream work to steer the development of this strategic plan. METHODS: This was a quantitative, descriptive study conducted between September 2022 and April 2023. It involved a two-part survey: a self-administered questionnaire distributed to healthcare information managers in facilities, and direct interviews conducted with software developers. This was complemented by a documentary review of the country's strategic and standards documents on digital transformation. RESULTS: Burkina Faso possesses a relatively comprehensive collection of governance documents pertaining to digital transformation. The study identified a total of 35 digital health interventions. Analysis showed that 89% of funding originated from technical and financial partners as well as the private sector. While the use of open-source technologies for the development of the applications, software, or platforms used to implement these digital health interventions is well established (77%), there remains a deficiency in the integration of data from different platforms. Furthermore, the classification of digital health interventions revealed an uneven distribution between the different elements across domains: the health system, the classification of digital health interventions (DHI), and the subsystems of the National Health Information System (NHIS). Most digital health intervention projects are still in the pilot phase (66%), with isolated electronic patient record initiatives remaining incomplete. Within the public sector, these records typically take the form of electronic registers or isolated specialty records in a hospital. Within the private sector, tool implementation varies based on expressed needs. Challenges persist in adhering to interoperability norms and standards during tool design, with minimal utilization of the data generated by the implemented tools. CONCLUSION: This study provides an insightful overview of the digital health environment in Burkina Faso and highlights significant challenges regarding intervention strategies. The findings serve as a foundational resource for developing the digital health strategic plan. By addressing the identified shortcomings, this plan will provide a framework for guiding future digital health initiatives effectively.

Asunto(s)

RESUMEN

Purpose: Function and cosmesis may be improved by replantation following digital amputation in pediatric patients. However, accurate failure and complication rate estimates may be limited as most pertinent studies reflect single center/surgeon experience and therefore are limited by small sample sizes. The primary aim of this study was to assess the rate of failure (amputation) following pediatric digital replantation. Secondary aims include evaluating the rate of complications and associated resource utilization (intensive care unit stays, readmission rate, and hospital length of stay). Methods: Digital replantation patients were identified from 47 pediatric hospitals using the 2004 to 2020 Pediatric Health Information System nationwide database. Using applicable International Classification of Disease 9/10 and Current Procedural Terminology codes, we identified complications after replantation, including revision amputation, infection, surgical complications, medical complications, admission to intensive care unit (ICU), and length of stay. Results: Of the 348 patients who underwent replantation the mean age was 8.3 ± 5.1 years, and 27% were female. Mean hospital length of stay was 5.8 ± 4.7 (range, 1-28) days. Of the 53% of patients who required ICU admission, the mean ICU length of stay was 2.4 ± 3.3 days. Failure/amputation after replantation occurred in 71 (20.4%) patients, at a mean of 9.7 ± 27.2 days postoperatively. Surgical complications occurred in 58 (17%) patients, 30-day hospital readmissions occurred in 5.7% of patients, and 90-day readmissions occurred in 6.3% patients. Conclusion: The estimated rate of failure following pediatric digit replantation was 20%. Our data on failure and complication rates and associated resource utilization may be useful in counseling pediatric replantation patients and their families and provide an update on prior literature. Level of Evidence: IV, Prognosis.

RESUMEN

OBJECTIVES: To analyze the evolutionary trends concerning vasectomy over the last 8 years in order to better understand the situation and identify measures to be implemented to develop this activity. METHODS: The number of vasectomy procedures performed between 2015 and 2022 was extracted from the Open CCAM file compiled from the national database of the Programme de médicalisation du système d'informations français (PMSI). RESULTS: Over the period 2015-2022, the number of vasectomy procedures increased from 3743 in 2015 to 29,890 in 2022. This increase was observed in all French metropolitan and overseas regions. The number of minimally invasive vasectomies (notably without scalpel) rose sharply, from 313 to 7760. Almost all vasectomies were performed during outpatient hospitalization (0 nights), with fewer than 300 acts reported/year in outpatient care. CONCLUSION: In France, vasectomy is becoming an increasingly frequent contraceptive method. This analysis is in line with recent surveys carried out in France, and tends to prove that more and more couples of childbearing age are in favour of sharing the contraceptive burden.

Asunto(s)

RESUMEN

BACKGROUND: The National Health Service (NHS) Talking Therapies program treats people with common mental health problems in England according to "stepped care," in which lower-intensity interventions are offered in the first instance, where clinically appropriate. Limited resources and pressure to achieve service standards mean that program providers are exploring all opportunities to evaluate and improve the flow of patients through their service. Existing research has found variation in clinical performance and stepped care implementation across sites and has identified associations between service delivery and patient outcomes. Process mining offers a data-driven approach to analyzing and evaluating health care processes and systems, enabling comparison of presumed models of service delivery and their actual implementation in practice. The value and utility of applying process mining to NHS Talking Therapies data for the analysis of care pathways have not been studied. OBJECTIVE: A better understanding of systems of service delivery will support improvements and planned program expansion. Therefore, this study aims to demonstrate the value and utility of applying process mining to NHS Talking Therapies care pathways using electronic health records. METHODS: Routine collection of a wide variety of data regarding activity and patient outcomes underpins the Talking Therapies program. In our study, anonymized individual patient referral records from two sites over a 2-year period were analyzed using process mining to visualize the care pathway process by mapping the care pathway and identifying common pathway routes. RESULTS: Process mining enabled the identification and visualization of patient flows directly from routinely collected data. These visualizations illustrated waiting periods and identified potential bottlenecks, such as the wait for higher-intensity cognitive behavioral therapy (CBT) at site 1. Furthermore, we observed that patients discharged from treatment waiting lists appeared to experience longer wait durations than those who started treatment. Process mining allowed analysis of treatment pathways, showing that patients commonly experienced treatment routes that involved either low- or high-intensity interventions alone. Of the most common routes, >5 times as many patients experienced direct access to high-intensity treatment rather than stepped care. Overall, 3.32% (site 1: 1507/45,401) and 4.19% (site 2: 527/12,590) of all patients experienced stepped care. CONCLUSIONS: Our findings demonstrate how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships among performance issues, and highlight systemic issues, such as stepped care being relatively uncommon within a stepped care system. Integration of process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective. These insights will provide value to services by identifying areas for service improvement, providing evidence for capacity planning decisions, and facilitating better quality analysis into how health systems can affect patient outcomes.

Asunto(s)

RESUMEN

BACKGROUND: The primary healthcare system in Pakistan focuses on providing episodic, disease-based care. Health care for low-middle income communities is largely through a fee-for-service model that ignores preventive and health-promotive services. The growing burden of cardiovascular illnesses requires restructuring of the primary health care system allowing a community-to-clinic model of care to improve patient- and community-level health indicators. METHODS: We propose a model that integrates a Patient-Centered Medical Home (PCMH) with a Community-Based Health Information System (CBHIS) using hypertension (HTN) as an example. This protocol describes the integration and evaluation of the PCMH-CBHIS infrastructure through a population-based, observational, longitudinal study in a low-middle income, urban community in Pakistan. Participants are being enrolled in CBHIS and will be followed longitudinally over two years for HTN outcomes. A mixed-methods approach is adopted to evaluate the process of integrating PCMH with CBHIS. This involves building partnerships with the community through formal and informal meetings, focus group discussions, and a household health assessment survey (HAS). Community members identified with HTN are linked to PCMH for disease management. A customized electronic medical record system links community-level data with patient-level data to track changes in disease burden. The RE-AIM evaluation framework will be used to monitor community and individual-level metrics to guide implementation assessment, the potential for generalization, and the effectiveness of the PCMH in improving HTN-related health outcomes. Ethical clearance has been obtained from the Ethics Review Committee at Aga Khan University (2022-6723-20985). DISCUSSION: This study will evaluate the value of restructuring the primary care health system by ensuring systematic community engagement and measurement of health indicators at the patient- and community-level. While HTN is being used as a prototype to generate evidence for the effectiveness of this model, findings from this initiative will be leveraged towards strengthening the management of other acute and chronic conditions in primary care settings. If effective, the model can be used in Pakistan and other LMICs and resource-limited settings.

Asunto(s)

RESUMEN

BACKGROUND: Research has highlighted a need to improve the quality of clinical documentation and data within aged care and disability services in Australia to support improved regulatory reporting and ensure quality and safety of services. However, the specific causes of data quality issues within aged care and disability services and solutions for optimisation are not well understood. OBJECTIVES: This study explored aged care and disability workforce (referred to as 'data-users') experiences and perceived root causes of clinical data quality issues at a large aged care and disability services provider in Western Australia, to inform optimisation solutions. METHODS: A purposive sample of n = 135 aged care and disability staff (including community-based and residential-based) in clinical, care, administrative and/or management roles participated in semi-structured interviews and web-based surveys. Data were analysed using an inductive thematic analysis method, where themes and subthemes were derived. RESULTS: Eight overarching causes of data and documentation quality issues were identified: (1) staff-related challenges, (2) education and training, (3) external barriers, (4) operational guidelines and procedures, (5) organisational practices and culture, (6) technological infrastructure, (7) systems design limitations, and (8) systems configuration-related challenges. CONCLUSION: The quality of clinical data and documentation within aged care and disability services is influenced by a complex interplay of internal and external factors. Coordinated and collaborative effort is required between service providers and the wider sector to identify behavioural and technical optimisation solutions to support safe and high-quality care and improved regulatory reporting.

Asunto(s)