1
|
Muili AO, Tangmi A, Shariff S, Awad F, Oseili T. Exploring strategies for building a sustainable healthcare system in Africa: lessons from Japan and Switzerland. Ann Med Surg (Lond) 2024; 86:1563-1569. [PMID: 38463076 PMCID: PMC10923269 DOI: 10.1097/ms9.0000000000001767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024] Open
Abstract
Strengthening healthcare infrastructure is an important strategy for building a sustainable healthcare system in Africa. This involves investing in facilities, equipment, and supplies, as well as training and retaining skilled healthcare workers. Additionally, improving healthcare infrastructure and investing in healthcare education and training can lead to significant improvements in health outcomes, such as reducing maternal and child mortality. This is critical for building a sustainable healthcare system. Through a literature review, we assessed the approaches to building a sustainable healthcare system in Africa from the perspectives of Japan's and Switzerland's healthcare systems. It was discovered that Japan currently has the highest life expectancy, which can be attributed to insurance policies, healthcare policies, and the integration of emerging technologies and clinical research into their healthcare system. Lessons that Africa must emulate from the Japanese healthcare system include ensuring universal healthcare coverage, improving the workforce, improving primary healthcare, prioritizing the aging population, and investing in technology, infrastructure, and research. Japans healthcare system is also sustainable thanks to its stable workforce and primary healthcare. Switzerland also has an exceptional healthcare system globally, with technical and socioeconomic advancements leading to increased life expectancy and population aging through a worldwide health policy approach, programs tackling professional responsibilities and interprofessional cooperation, and initiatives to support family medicine. By learning from Japan's and Switzerland's approaches, Africa will gradually achieve the Sustainable Development Goals and build a sustainable healthcare system.
Collapse
Affiliation(s)
| | - Adrien Tangmi
- Faculty of Medicine, Université Technologique Bel Campus, Kinshasa, DRC
| | | | | | | |
Collapse
|
2
|
Scalvini S, Olivares A, Giardini A, Comini L, Zanelli E, Corica G, Tarro Genta F. ICF framework in cardiac rehabilitation: a real-life implementation in post-cardiac surgery and chronic heart failure patients. Eur J Phys Rehabil Med 2023; 59:605-614. [PMID: 37377129 PMCID: PMC10664764 DOI: 10.23736/s1973-9087.23.07666-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 04/26/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The International Classification of Functioning, Disability, and Health (ICF) is growing in importance in cardiac rehabilitation (CR) as the number of elderly comorbid patients increases. AIM To classify through the ICF framework a group of post-cardiac surgery (CS) and chronic heart failure (CHF) patients undergoing rehabilitation. Then, to compare the two groups and identify possible factors at admission that could affect ICF evaluations at discharge. DESIGN Observational retrospective real-life study. SETTING Two inpatient CR units. POPULATION Consecutive CS and CHF patients admitted for CR (January-December 2019). METHODS Clinical, anthropometric data and functional status at admission and discharge were extracted from patient health records. A set of 26 ICF codes regarding body functions (b) and activities (d) was analyzed to identify: 1) the qualifiers attributed (from 0=no impairment to 4=severe impairment) for each code, 2) the percent distribution of qualifiers (0/1/2/3/4) attributed per patient. We then evaluated changes in both (1) and (2 - defined as ICF Delta%) from admission to discharge. RESULTS All patients (55% males; mean age 73±12 years) showed an improvement post-rehabilitation in the ICF qualifiers attributed (P<0.0001 for all codes). CS patients (N.=150) were less functionally impaired at admission than CHF (N.=194) (P<0.05 for all codes), and at discharge showed greater Delta% in the qualifiers 0/1/2 attributed than CHF (P<0.0001 for b codes; P<0.05 for d codes). Delta% for qualifiers 3 and 4 was similar in the two groups. No impairment at admission (qualifier 0), CS group, and presence/complexity of comorbidities were identified as possible covariates influencing ICF qualifiers at discharge, impacting the rate of both no/mild impairment (ICF% aggregate 0+1 - adjusted R2=0.627; P<0.0001) and moderate impairment (ICF% qualifier 2 - adjusted R2=0.507; P<0.0001). CONCLUSIONS CHF patients showed a worse ICF picture at admission and less improvement at discharge than CS. The presence and complexity of comorbidities negatively influenced the ICF classification at discharge, especially in CHF patients. CLINICAL REHABILITATION IMPACT This study shows the utility of ICF classification in CR as a means for describing, measuring, and comparing patient functioning across the care continuum.
Collapse
Affiliation(s)
- Simonetta Scalvini
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Brescia, Italy
| | - Adriana Olivares
- Scientific Direction, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Brescia, Italy -
| | - Anna Giardini
- Department of Information Technology, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Laura Comini
- Scientific Direction, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Brescia, Italy
| | - Emanuela Zanelli
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Brescia, Italy
| | - Giacomo Corica
- Health Directorate, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Brescia, Italy
| | - Franco Tarro Genta
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, Turin, Italy
| |
Collapse
|
3
|
Nunes SR, Andrade FGD, Fernandes MR. Adhesive Capsulitis' Patients Report Improvement in Functionality Trough International Classification of Functioning, Disability and Health Checklist and Dash After Suprascapular Nerve Blocks. Rev Bras Ortop 2023; 58:487-494. [PMID: 37396072 PMCID: PMC10310426 DOI: 10.1055/s-0042-1751261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/27/2022] [Indexed: 10/16/2022] Open
Abstract
Objective To evaluate the functionality in patients with adhesive capsulitis undergoing suprascapular nerve block (SSNB). Methods A before-and-after clinical prospective study in a single center was conducted with patients with secondary adhesive capsulitis treated with four nerve blocks based on anatomical limits. The sample was non-probabilistic, and it was obtained after a routine appointment at a specialized outpatient clinic. The instruments used for evaluation were the International Classification of Functioning, Disability and Health (ICF) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, which were applied at baseline (T 0 ), one week after the fourth SSNB (T 4 ), and three months after the first SSNB (T 12 ). The paired t -test was used to compare the means of the ICF checklist items and DASH in the different: T 0 xT 4 ; T 4 xT 12 ; and T 0 xT 12 ). The probability of rejecting the null hypothesis was 5%. Results The sample was composed of 25 individuals with a mean age of 58.16 years; 16 of them were female. The duration of the pain symptoms ranged from 2 to 16 months, with a mean of 5.92 months. The ICF checklist showed that all domains had already improved in T 4, except for the environmental factors, which only improved at 03 months ( p = 0.037). The patients reported improvements in shoulder function in T 4 , which increased more in T 12 , at the end of data collection ( p = 0.019). Conclusion The SSNB technique is effective in patients with adhesive capsulitis after 4 weeks of application, with improvements in individual's functionality lasting for 12 weeks.
Collapse
Affiliation(s)
- Sara Ribeiro Nunes
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | - Fernanda Guimarães de Andrade
- Curso de Fisioterapia, Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Marcos Rassi Fernandes
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brasil
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brasil
| |
Collapse
|
4
|
Bölte S. A more holistic approach to autism using the International Classification of Functioning: The why, what, and how of functioning. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:3-6. [PMID: 36330803 DOI: 10.1177/13623613221136444] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
5
|
Pletschko T, Kaufmann L. Teilhabe in Schule und Studium trotz neuropsychologischer Funktionseinschränkungen. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2022. [DOI: 10.1024/1016-264x/a000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Thomas Pletschko
- Comprehensive Center for Pediatrics, Medizinische Universität Wien, Österreich
| | - Liane Kaufmann
- Institut für Psychologie, Universität Innsbruck, Österreich
| |
Collapse
|
6
|
van Leeuwen LM, Pronk M, Merkus P, Goverts ST, Terwee CB, Kramer SE. Operationalization of the Brief ICF Core Set for Hearing Loss: An ICF-Based e-Intake Tool in Clinical Otology and Audiology Practice. Ear Hear 2021; 41:1533-1544. [PMID: 33136629 PMCID: PMC7722460 DOI: 10.1097/aud.0000000000000867] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES According to the International Classification of Functioning, Disability and Health (ICF), functioning reflects the interplay between an individual's body structures and functions, activities, participation, environmental, and personal factors. To be useful in clinical practice, these concepts need to be operationalized into a practical and integral instrument. The Brief ICF Core Set for Hearing Loss (CSHL) provides a minimum standard for the assessment of functioning in adults with hearing loss. The objective of the present study was to operationalize the Brief CSHL into a digital intake tool that could be used in the otology-audiology practice for adults with ear and hearing problems as part of their intake assessment. DESIGN A three-step approach was followed: (1) Selecting and formulating questionnaire items and response formats, using the 27 categories of the Brief CSHL as a basis. Additional categories were selected based on relevant literature and clinical expertise. Items were selected from existing, commonly used disease-specific questionnaires, generic questionnaires, or the WHO's official descriptions of ICF categories. The response format was based on the existing item's response categories or on the ICF qualifiers. (2) Carrying out an expert survey and a pilot study (using the three-step test interview. Relevant stakeholders and patients were asked to comment on the relevance, comprehensiveness, and comprehensibility of the items. Results were discussed in the project group, and items were modified based on consensus. (3) Integration of the intake tool into a computer-based system for use in clinical routine. RESULTS The Brief CSHL was operationalized into 62 items, clustered into six domains: (1) general information, including reason for visit, sociodemographic, and medical background; (2) general body functions; (3) ear and hearing structures and functions; (4) activities and participation (A&P); (5) environmental factors (EF); and (6) personal factors (mastery and coping). Based on stakeholders' responses, the instructions of the items on A&P and EF were adapted. The three-step test interview showed that the tool had sufficient content validity but that some items on EF were redundant. Overall, the stakeholders and patients indicated that the intake tool was relevant and had a logical and clear structure. The tool was integrated in an online portal. CONCLUSIONS In the current study, an ICF-based e-intake tool was developed that aims to screen self-reported functioning problems in adults with an ear/hearing problem. The relevance, comprehensiveness, and comprehensibility of the originally proposed item list was supported, although the stakeholder and patient feedback resulted into some changes of the tool on item-level. Ultimately, the functioning information obtained with the tool could be used to promote patient-centered ear and hearing care taking a biopsychosocial perspective into account.
Collapse
Affiliation(s)
- Lisette M. van Leeuwen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, Amsterdam, Netherlands
| | - Marieke Pronk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, Amsterdam, Netherlands
| | - Paul Merkus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, Amsterdam, Netherlands
| | - S. Theo Goverts
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, Amsterdam, Netherlands
| | - Caroline B. Terwee
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam, Netherlands
| | - Sophia E. Kramer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, Amsterdam, Netherlands
| |
Collapse
|
7
|
Bickenbach J. Human Functioning: Developments and Grand Challenges. FRONTIERS IN REHABILITATION SCIENCES 2021; 1:617782. [PMID: 36570604 PMCID: PMC9782683 DOI: 10.3389/fresc.2020.617782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/04/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Jerome Bickenbach
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland,*Correspondence: Jerome Bickenbach
| |
Collapse
|
8
|
Thieu T, Maldonado JC, Ho PS, Ding M, Marr A, Brandt D, Newman-Griffis D, Zirikly A, Chan L, Rasch E. A comprehensive study of mobility functioning information in clinical notes: Entity hierarchy, corpus annotation, and sequence labeling. Int J Med Inform 2021; 147:104351. [PMID: 33401169 PMCID: PMC8104034 DOI: 10.1016/j.ijmedinf.2020.104351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/10/2020] [Accepted: 11/22/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Secondary use of Electronic Health Records (EHRs) has mostly focused on health conditions (diseases and drugs). Function is an important health indicator in addition to morbidity and mortality. Nevertheless, function has been overlooked in accessing patients' health status. The World Health Organization (WHO)'s International Classification of Functioning, Disability and Health (ICF) is considered the international standard for describing and coding function and health states. We pioneer the first comprehensive analysis and identification of functioning concepts in the Mobility domain of the ICF. RESULTS Using physical therapy notes at the National Institutes of Health's Clinical Center, we induced a hierarchical order of mobility-related entities including 5 entities types, 3 relations, 8 attributes, and 33 attribute values. Two domain experts manually curated a gold standard corpus of 14,281 nested entity mentions from 400 clinical notes. Inter-annotator agreement (IAA) of exact matching averaged 92.3 % F1-score on mention text spans, and 96.6 % Cohen's kappa on attributes assignments. A high-performance Ensemble machine learning model for named entity recognition (NER) was trained and evaluated using the gold standard corpus. Average F1-score on exact entity matching of our Ensemble method (84.90 %) outperformed popular NER methods: Conditional Random Field (80.4 %), Recurrent Neural Network (81.82 %), and Bidirectional Encoder Representations from Transformers (82.33 %). CONCLUSIONS The results of this study show that mobility functioning information can be reliably captured from clinical notes once adequate resources are provided for sequence labeling methods. We expect that functioning concepts in other domains of the ICF can be identified in similar fashion.
Collapse
Affiliation(s)
- Thanh Thieu
- Oklahoma State University, Stillwater, OK, United States.
| | | | - Pei-Shu Ho
- National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Min Ding
- National Institute of Standards and Technology, Gaithersburg, MD, United States
| | - Alex Marr
- National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Diane Brandt
- Social Security Advisory Board, Washington, DC, United States
| | - Denis Newman-Griffis
- National Institutes of Health Clinical Center, Bethesda, MD, United States; Ohio State University, Columbus, OH, United States
| | - Ayah Zirikly
- National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Leighton Chan
- National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Elizabeth Rasch
- National Institutes of Health Clinical Center, Bethesda, MD, United States
| |
Collapse
|
9
|
Newman-Griffis D, Fosler-Lussier E. Automated Coding of Under-Studied Medical Concept Domains: Linking Physical Activity Reports to the International Classification of Functioning, Disability, and Health. Front Digit Health 2021; 3:620828. [PMID: 33791684 PMCID: PMC8009547 DOI: 10.3389/fdgth.2021.620828] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
Linking clinical narratives to standardized vocabularies and coding systems is a key component of unlocking the information in medical text for analysis. However, many domains of medical concepts, such as functional outcomes and social determinants of health, lack well-developed terminologies that can support effective coding of medical text. We present a framework for developing natural language processing (NLP) technologies for automated coding of medical information in under-studied domains, and demonstrate its applicability through a case study on physical mobility function. Mobility function is a component of many health measures, from post-acute care and surgical outcomes to chronic frailty and disability, and is represented as one domain of human activity in the International Classification of Functioning, Disability, and Health (ICF). However, mobility and other types of functional activity remain under-studied in the medical informatics literature, and neither the ICF nor commonly-used medical terminologies capture functional status terminology in practice. We investigated two data-driven paradigms, classification and candidate selection, to link narrative observations of mobility status to standardized ICF codes, using a dataset of clinical narratives from physical therapy encounters. Recent advances in language modeling and word embedding were used as features for established machine learning models and a novel deep learning approach, achieving a macro-averaged F-1 score of 84% on linking mobility activity reports to ICF codes. Both classification and candidate selection approaches present distinct strengths for automated coding in under-studied domains, and we highlight that the combination of (i) a small annotated data set; (ii) expert definitions of codes of interest; and (iii) a representative text corpus is sufficient to produce high-performing automated coding systems. This research has implications for continued development of language technologies to analyze functional status information, and the ongoing growth of NLP tools for a variety of specialized applications in clinical care and research.
Collapse
Affiliation(s)
- Denis Newman-Griffis
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States
- Epidemiology & Biostatistics Section, Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Eric Fosler-Lussier
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
10
|
Ernst J, Petry H, Luethi N, Naef R. Acute care delivery to persons with cognitive impairment: a mixed method study of health professionals' care provision and associated challenges. Aging Ment Health 2020; 24:1726-1735. [PMID: 31119943 DOI: 10.1080/13607863.2019.1616162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: Cognitive impairment is common among older persons admitted to hospital and associated with adverse outcomes. Inadequate care has been widely reported, with health professionals tending to be ill-equipped to meet the specific needs of this patient group. This study aimed to investigate health professionals' care provision to persons with cognitive impairment and associated challenges.Design and Setting: A concurrent, cross-sectional mixed method study was conducted at two university-affiliated hospitals.Participants: A total of 339 health professionals participated in the study.Measurements: An online survey (n = 312) determined the extent to which health professionals perceived their care provision to be person-centered and evidence-based (POPAC-R), and experience distress in looking after this patient group (NPI-D). Four focus group interviews (n = 27) explored health professionals' experience of care provision.Results: More than half of the health professionals reported to act always or very frequently in person-centered and evidence-based ways, and two third experienced challenging behaviors as moderately to very distressing. Health professionals working in acute geriatric wards demonstrated statistically significant higher levels of person-centered and evidence-based care provision, and lower distress. Their caring practices pertained to building a relationship, addressing specific needs, involving family members, and working collaboratively.Conclusions: Findings suggest that geriatric models of care delivery support staff in meeting the needs of persons with cognitive impairment. Health professionals require an acute care culture that values relational, collaborative and coordinated care as essential to patient safety and quality of care, and supports the consistent implementation of evidence-based practices for this patient group.
Collapse
Affiliation(s)
- Jutta Ernst
- Center for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Heidi Petry
- Center for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Nadja Luethi
- Clinic for Acute Geriatrics, Waid City Hospital, Zurich, Switzerland
| | - Rahel Naef
- Center for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
11
|
Newman-Griffis D, Porcino J, Zirikly A, Thieu T, Camacho Maldonado J, Ho PS, Ding M, Chan L, Rasch E. Broadening horizons: the case for capturing function and the role of health informatics in its use. BMC Public Health 2019; 19:1288. [PMID: 31615472 PMCID: PMC6794808 DOI: 10.1186/s12889-019-7630-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background Human activity and the interaction between health conditions and activity is a critical part of understanding the overall function of individuals. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) models function as all aspects of an individual’s interaction with the world, including organismal concepts such as individual body structures, functions, and pathologies, as well as the outcomes of the individual’s interaction with their environment, referred to as activity and participation. Function, particularly activity and participation outcomes, is an important indicator of health at both the level of an individual and the population level, as it is highly correlated with quality of life and a critical component of identifying resource needs. Since it reflects the cumulative impact of health conditions on individuals and is not disease specific, its use as a health indicator helps to address major barriers to holistic, patient-centered care that result from multiple, and often competing, disease specific interventions. While the need for better information on function has been widely endorsed, this has not translated into its routine incorporation into modern health systems. Purpose We present the importance of capturing information on activity as a core component of modern health systems and identify specific steps and analytic methods that can be used to make it more available to utilize in improving patient care. We identify challenges in the use of activity and participation information, such as a lack of consistent documentation and diversity of data specificity and representation across providers, health systems, and national surveys. We describe how activity and participation information can be more effectively captured, and how health informatics methodologies, including natural language processing (NLP), can enable automatically locating, extracting, and organizing this information on a large scale, supporting standardization and utilization with minimal additional provider burden. We examine the analytic requirements and potential challenges of capturing this information with informatics, and describe how data-driven techniques can combine with common standards and documentation practices to make activity and participation information standardized and accessible for improving patient care. Recommendations We recommend four specific actions to improve the capture and analysis of activity and participation information throughout the continuum of care: (1) make activity and participation annotation standards and datasets available to the broader research community; (2) define common research problems in automatically processing activity and participation information; (3) develop robust, machine-readable ontologies for function that describe the components of activity and participation information and their relationships; and (4) establish standards for how and when to document activity and participation status during clinical encounters. We further provide specific short-term goals to make significant progress in each of these areas within a reasonable time frame.
Collapse
Affiliation(s)
- Denis Newman-Griffis
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA. .,Department of Computer Science and Engineering, The Ohio State University, 2015 Neil Avenue, DL 395, Columbus, OH, 43210, USA.
| | - Julia Porcino
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Ayah Zirikly
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Thanh Thieu
- Department of Computer Science, Oklahoma State University, 116-A MSCS, Stillwater, OK, 74078, USA
| | - Jonathan Camacho Maldonado
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Pei-Shu Ho
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Min Ding
- Information Technology Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD, 20899, USA
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Elizabeth Rasch
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| |
Collapse
|
12
|
Meier C, Boes S, Gemperli A, Gmünder HP, Koligi K, Metzger S, Schaefer DJ, Schmitt K, Schwegmann W, Wettstein R, Scheel-Sailer A. Treatment and cost of pressure injury stage III or IV in four patients with spinal cord injury: the Basel Decubitus Concept. Spinal Cord Ser Cases 2019; 5:30. [PMID: 31632697 PMCID: PMC6462022 DOI: 10.1038/s41394-019-0173-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/14/2019] [Accepted: 02/21/2019] [Indexed: 11/29/2022] Open
Abstract
Study design Retrospective chart analyses as part of a quality improvement project. Objectives To demonstrate treatment of pressure injury (PI) in patients with spinal cord injuries (SCI) and analyse costs using the "modified Basel Decubitus Concept". Setting Inpatient setting of a specialised acute care and rehabilitation clinic for SCI. Methods Complex treatment courses of four patients with chronic SCI and PI stage III or IV were described and costs were recorded. The total healthcare services' costs per patient and different profession's involvement were analysed in relation to patient characteristics, treatment phases and milestones demonstrated. Results The treatment of PI stage III and IV in patients with SCI included input from plastic surgery, rehabilitation medicine, nursing and other involved professions. Recommended interventions were chosen according to the "modified Basel Decubitus Concept". The cost course of PI treatment in patients with SCI depicted the multimodal treatment concept, including three clinically and financially relevant milestones (debridement, flap surgery and mobilisation to wheelchair) as well as the highest costs in the functionally highly dependent patient. Acute care and rehabilitation overlapped with different intensities during the whole treatment process. Conclusion Multimodal treatment concepts connecting acute and rehabilitation care were applied in these complex health conditions. Cost-explication models including treatment phases and milestones helped to understand resources more easily and integrate aspects of process-based management and quality of care. Scientific evidence is needed to create a recommended quality standard in line with adequate financing of this health condition.
Collapse
Affiliation(s)
- Christine Meier
- Swiss Paraplegic Centre (SPC), Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research (SPF), Nottwil, Switzerland
| | | | | | | | - Dirk J. Schaefer
- Swiss Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | | | | | - Reto Wettstein
- Swiss Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | - Anke Scheel-Sailer
- Swiss Paraplegic Centre (SPC), Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| |
Collapse
|
13
|
Standardised assessment of functioning in ADHD: consensus on the ICF Core Sets for ADHD. Eur Child Adolesc Psychiatry 2018; 27:1261-1281. [PMID: 29435654 DOI: 10.1007/s00787-018-1119-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 02/03/2018] [Indexed: 01/29/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is associated with significant impairments in social, educational, and occupational functioning, as well as specific strengths. Currently, there is no internationally accepted standard to assess the functioning of individuals with ADHD. WHO's International Classification of Functioning, Disability and Health-child and youth version (ICF) can serve as a conceptual basis for such a standard. The objective of this study is to develop a comprehensive, a common brief, and three age-appropriate brief ICF Core Sets for ADHD. Using a standardised methodology, four international preparatory studies generated 132 second-level ICF candidate categories that served as the basis for developing ADHD Core Sets. Using these categories and following an iterative consensus process, 20 ADHD experts from nine professional disciplines and representing all six WHO regions selected the most relevant categories to constitute the ADHD Core Sets. The consensus process resulted in 72 second-level ICF categories forming the comprehensive ICF Core Set-these represented 8 body functions, 35 activities and participation, and 29 environmental categories. A Common Brief Core Set that included 38 categories was also defined. Age-specific brief Core Sets included a 47 category preschool version for 0-5 years old, a 55 category school-age version for 6-16 years old, and a 52 category version for older adolescents and adults 17 years old and above. The ICF Core Sets for ADHD mark a milestone toward an internationally standardised functional assessment of ADHD across the lifespan, and across educational, administrative, clinical, and research settings.
Collapse
|
14
|
Hopfe M, Stucki G, Bickenbach JE, Prodinger B. Accounting for What Matters to Patients in the G-DRG System: A Stakeholder's Perspective on Integrating Functioning Information. Health Serv Insights 2018; 11:1178632918796776. [PMID: 30202209 PMCID: PMC6122243 DOI: 10.1177/1178632918796776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 11/23/2022] Open
Abstract
Functioning information constitutes a relevant component for determining
patients’ service needs and respective resource use. Diagnosis-Related Group
(DRG) systems can be optimized by integrating functioning information. First
steps toward accounting for functioning information in the German DRG (G-DRG)
system have been made; yet, there is no systematic integration of functioning
information. The G-DRG system is part of the health system; it is embedded in
and as such dependent on various stakeholders and vested interests. This study
explores the stakeholder’s perspective on integrating functioning information in
the G-DRG system. A qualitative interview study was conducted with national
stakeholders in 4 groups of the G-DRG system (health policy, administration,
development, and consultations). Interviews were analyzed using inductive
thematic analysis. In total, 14 interviews were conducted (4 administration and
10 consultation group). Three main themes were identified: (1) functioning
information in the G-DRG system: opportunities and obstacles, (2) general
aspects concerning optimizing G-DRG systems by integrating additional
information, and (3) ideas and requirements on how to proceed. The study offers
insights into the opportunities and obstacles of integrating functioning
information in the G-DRG system. The relevance of functioning information was
evident. However, the value of functioning information for the G-DRG system was
seen critically. Integrating functioning information alone does not seem to be
sufficient and a systems approach is needed.
Collapse
Affiliation(s)
- Maren Hopfe
- Swiss Paraplegic Research, Guido A. Zäch Institute (GZI), Nottwil, Switzerland.,Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Institute (GZI), Nottwil, Switzerland.,Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Jerome E Bickenbach
- Swiss Paraplegic Research, Guido A. Zäch Institute (GZI), Nottwil, Switzerland.,Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Birgit Prodinger
- Swiss Paraplegic Research, Guido A. Zäch Institute (GZI), Nottwil, Switzerland.,Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland.,Fakultät für Angewandte Gesundheits- und Sozialwissenschaften, Hochschule Rosenheim, Rosenheim, Germany
| |
Collapse
|
15
|
Bölte S, Mahdi S, de Vries PJ, Granlund M, Robison JE, Shulman C, Swedo S, Tonge B, Wong V, Zwaigenbaum L, Segerer W, Selb M. The Gestalt of functioning in autism spectrum disorder: Results of the international conference to develop final consensus International Classification of Functioning, Disability and Health core sets. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:449-467. [PMID: 29378422 PMCID: PMC6376609 DOI: 10.1177/1362361318755522] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder is associated with diverse social, educational, and
occupational challenges. To date, no standardized, internationally accepted
tools exist to assess autism spectrum disorder–related functioning. World Health
Organization’s International Classification of Functioning, Disability and
Health can serve as foundation for developing such tools. This study aimed to
identify a comprehensive, a common brief, and three age-appropriate brief autism
spectrum disorder Core Sets. Four international preparatory studies yielded in
total 164 second-level International Classification of Functioning, Disability
and Health candidate categories. Based on this evidence, 20 international autism
spectrum disorder experts applied an established iterative decision-making
consensus process to select from the candidate categories the most relevant ones
to constitute the autism spectrum disorder Core Sets. The consensus process
generated 111 second-level International Classification of Functioning,
Disability and Health categories in the Comprehensive Core Set for autism
spectrum disorder—one body structure, 20 body functions, 59 activities and
participation categories, and 31 environmental factors. The Common Brief Core
Set comprised 60 categories, while the age-appropriate core sets included 73
categories in the preschool version (0- to 5-year-old children), 81 in the
school-age version (6- to 16-year-old children and adolescents), and 79 in the
older adolescent and adult version (⩾17-year-old individuals). The autism
spectrum disorder Core Sets mark a milestone toward the standardized assessment
of autism spectrum disorder–related functioning in educational, administrative,
clinical, and research settings.
Collapse
Affiliation(s)
- Sven Bölte
- 1 Karolinska Institutet, Sweden.,2 Stockholm County Council, Sweden
| | - Soheil Mahdi
- 1 Karolinska Institutet, Sweden.,2 Stockholm County Council, Sweden
| | | | | | | | | | | | | | | | | | | | - Melissa Selb
- 11 Swiss Paraplegic Research, Switzerland.,12 ICF Research Branch, Switzerland
| |
Collapse
|
16
|
Fehrmann E, Kotulla S, Fischer L, Kienbacher T, Tuechler K, Mair P, Ebenbichler G, Paul B. The impact of age and gender on the ICF-based assessment of chronic low back pain. Disabil Rehabil 2018; 41:1190-1199. [DOI: 10.1080/09638288.2018.1424950] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Elisabeth Fehrmann
- Karl Landsteiner Institute, Institute for Outpatient Rehabilitation Research, Vienna, Austria
- Department of Psychology, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Simone Kotulla
- Essen University Hospital, Institute of Medical Psychology and Behavioral Immunobiology, Essen, Germany
| | - Linda Fischer
- Karl Landsteiner Institute, Institute for Outpatient Rehabilitation Research, Vienna, Austria
| | - Thomas Kienbacher
- Karl Landsteiner Institute, Institute for Outpatient Rehabilitation Research, Vienna, Austria
| | - Kerstin Tuechler
- Karl Landsteiner Institute, Institute for Outpatient Rehabilitation Research, Vienna, Austria
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Gerold Ebenbichler
- Department of Physical Medicine and Rehabilitation, Medical University Vienna, Vienna, Austria
| | - Birgit Paul
- Karl Landsteiner Institute, Institute for Outpatient Rehabilitation Research, Vienna, Austria
| |
Collapse
|
17
|
Maritz R, Aronsky D, Prodinger B. The International Classification of Functioning, Disability and Health (ICF) in Electronic Health Records. A Systematic Literature Review. Appl Clin Inform 2017. [PMID: 28933506 DOI: 10.4338/aci2017050078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The International Classification of Functioning, Disability and Health (ICF) is the World Health Organization's standard for describing health and health-related states. Examples of how the ICF has been used in Electronic Health Records (EHRs) have not been systematically summarized and described yet. OBJECTIVES To provide a systematic review of peer-reviewed literature about the ICF's use in EHRs, including related challenges and benefits. METHODS Peer-reviewed literature, published between January 2001 and July 2015 was retrieved from Medline®, CINAHL®, Scopus®, and ProQuest® Social Sciences using search terms related to ICF and EHR concepts. Publications were categorized according to three groups: Requirement specification, development and implementation. Information extraction was conducted according to a qualitative content analysis method, deductively informed by the evaluation framework for Health Information Systems: Human, Organization and Technology-fit (HOT-fit). RESULTS Of 325 retrieved articles, 17 publications were included; 4 were categorized as requirement specification, 7 as development, and 6 as implementation publications. Information regarding the HOT-fit evaluation framework was summarized. Main benefits of using the ICF in EHRs were its unique comprehensive perspective on health and its interdisciplinary focus. Main challenges included the fact that the ICF is not structured as a formal terminology as well as the need for a reduced number of ICF codes for more feasible and practical use. CONCLUSION Different approaches and technical solutions exist for integrating the ICF in EHRs, such as combining the ICF with other existing standards for EHR or selecting ICF codes with natural language processing. Though the use of the ICF in EHRs is beneficial as this review revealed, the ICF could profit from further improvements such as formalizing the knowledge representation in the ICF to support and enhance interoperability.
Collapse
Affiliation(s)
- Roxanne Maritz
- Roxanne Maritz, Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland, Tel. +41419396578,
| | | | | |
Collapse
|
18
|
Maritz R, Aronsky D, Prodinger B. The International Classification of Functioning, Disability and Health (ICF) in Electronic Health Records. A Systematic Literature Review. Appl Clin Inform 2017; 8:964-980. [PMID: 28933506 DOI: 10.4338/aci-2017050078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/15/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The International Classification of Functioning, Disability and Health (ICF) is the World Health Organization's standard for describing health and health-related states. Examples of how the ICF has been used in Electronic Health Records (EHRs) have not been systematically summarized and described yet. OBJECTIVES To provide a systematic review of peer-reviewed literature about the ICF's use in EHRs, including related challenges and benefits. METHODS Peer-reviewed literature, published between January 2001 and July 2015 was retrieved from Medline®, CINAHL®, Scopus®, and ProQuest® Social Sciences using search terms related to ICF and EHR concepts. Publications were categorized according to three groups: Requirement specification, development and implementation. Information extraction was conducted according to a qualitative content analysis method, deductively informed by the evaluation framework for Health Information Systems: Human, Organization and Technology-fit (HOT-fit). RESULTS Of 325 retrieved articles, 17 publications were included; 4 were categorized as requirement specification, 7 as development, and 6 as implementation publications. Information regarding the HOT-fit evaluation framework was summarized. Main benefits of using the ICF in EHRs were its unique comprehensive perspective on health and its interdisciplinary focus. Main challenges included the fact that the ICF is not structured as a formal terminology as well as the need for a reduced number of ICF codes for more feasible and practical use. CONCLUSION Different approaches and technical solutions exist for integrating the ICF in EHRs, such as combining the ICF with other existing standards for EHR or selecting ICF codes with natural language processing. Though the use of the ICF in EHRs is beneficial as this review revealed, the ICF could profit from further improvements such as formalizing the knowledge representation in the ICF to support and enhance interoperability.
Collapse
Affiliation(s)
- Roxanne Maritz
- Roxanne Maritz, Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland, Tel. +41419396578,
| | | | | |
Collapse
|