1
|
Lukkien DRM, Stolwijk NE, Ipakchian Askari S, Hofstede BM, Nap HH, Boon WPC, Peine A, Moors EHM, Minkman MMN. AI-Assisted Decision-Making in Long-Term Care: Qualitative Study on Prerequisites for Responsible Innovation. JMIR Nurs 2024; 7:e55962. [PMID: 39052315 DOI: 10.2196/55962] [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: 01/01/2024] [Revised: 04/16/2024] [Accepted: 05/24/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Although the use of artificial intelligence (AI)-based technologies, such as AI-based decision support systems (AI-DSSs), can help sustain and improve the quality and efficiency of care, their deployment creates ethical and social challenges. In recent years, a growing prevalence of high-level guidelines and frameworks for responsible AI innovation has been observed. However, few studies have specified the responsible embedding of AI-based technologies, such as AI-DSSs, in specific contexts, such as the nursing process in long-term care (LTC) for older adults. OBJECTIVE Prerequisites for responsible AI-assisted decision-making in nursing practice were explored from the perspectives of nurses and other professional stakeholders in LTC. METHODS Semistructured interviews were conducted with 24 care professionals in Dutch LTC, including nurses, care coordinators, data specialists, and care centralists. A total of 2 imaginary scenarios about AI-DSSs were developed beforehand and used to enable participants articulate their expectations regarding the opportunities and risks of AI-assisted decision-making. In addition, 6 high-level principles for responsible AI were used as probing themes to evoke further consideration of the risks associated with using AI-DSSs in LTC. Furthermore, the participants were asked to brainstorm possible strategies and actions in the design, implementation, and use of AI-DSSs to address or mitigate these risks. A thematic analysis was performed to identify the opportunities and risks of AI-assisted decision-making in nursing practice and the associated prerequisites for responsible innovation in this area. RESULTS The stance of care professionals on the use of AI-DSSs is not a matter of purely positive or negative expectations but rather a nuanced interplay of positive and negative elements that lead to a weighed perception of the prerequisites for responsible AI-assisted decision-making. Both opportunities and risks were identified in relation to the early identification of care needs, guidance in devising care strategies, shared decision-making, and the workload of and work experience of caregivers. To optimally balance the opportunities and risks of AI-assisted decision-making, seven categories of prerequisites for responsible AI-assisted decision-making in nursing practice were identified: (1) regular deliberation on data collection; (2) a balanced proactive nature of AI-DSSs; (3) incremental advancements aligned with trust and experience; (4) customization for all user groups, including clients and caregivers; (5) measures to counteract bias and narrow perspectives; (6) human-centric learning loops; and (7) the routinization of using AI-DSSs. CONCLUSIONS The opportunities of AI-assisted decision-making in nursing practice could turn into drawbacks depending on the specific shaping of the design and deployment of AI-DSSs. Therefore, we recommend considering the responsible use of AI-DSSs as a balancing act. Moreover, considering the interrelatedness of the identified prerequisites, we call for various actors, including developers and users of AI-DSSs, to cohesively address the different factors important to the responsible embedding of AI-DSSs in practice.
Collapse
Affiliation(s)
- Dirk R M Lukkien
- Vilans Centre of Expertise of Long Term Care, Utrecht, Netherlands
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, Netherlands
| | | | - Sima Ipakchian Askari
- Vilans Centre of Expertise of Long Term Care, Utrecht, Netherlands
- Human Technology Interaction, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Bob M Hofstede
- Vilans Centre of Expertise of Long Term Care, Utrecht, Netherlands
- Human Technology Interaction, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Henk Herman Nap
- Vilans Centre of Expertise of Long Term Care, Utrecht, Netherlands
- Human Technology Interaction, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Wouter P C Boon
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, Netherlands
| | - Alexander Peine
- Faculty of Humanities, Open University of The Netherlands, Heerlen, Netherlands
| | - Ellen H M Moors
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, Netherlands
| | - Mirella M N Minkman
- Vilans Centre of Expertise of Long Term Care, Utrecht, Netherlands
- TIAS School for Business and Society, Tilburg University, Tilburg, Netherlands
| |
Collapse
|
2
|
Nap HH, Stolwijk NE, Ipakchian Askari S, Lukkien DRM, Hofstede BM, Morresi N, Casaccia S, Amabili G, Bevilacqua R, Margaritini A, Barbarossa F, Lin CJ, Chieh HF, Su FC, Revel GM, Tesfay E, Bai D, Wirtjes C, Hsu YL. The evaluation of a decision support system integrating assistive technology for people with dementia at home. FRONTIERS IN DEMENTIA 2024; 3:1400624. [PMID: 39081617 PMCID: PMC11285597 DOI: 10.3389/frdem.2024.1400624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024]
Abstract
Introduction With a decreasing workforce of carers and a transition from care homes to home care, people with dementia (PwD) increasingly rely on informal caregivers (ICs) and assistive technologies (ATs). There is growing evidence that ATs in the home environment can reduce workload for formal carers (FCs) and ICs, reduce care costs, and can have a positive influence on quality of life (QoL) for PwD and their caregivers. In practice, using multiple ATs still often implies using different separate point solutions and applications. However, the integral, combined use of the data generated using various applications can potentially enhance the insight into the health and wellbeing status of PwD and can provide decision support for carers. The purpose of the current study was to evaluate the use of a DSS that integrated multiple ATs into one dashboard through a small-scale field study. Methods The current study presents the formative evaluation of a Decision Support System (DSS) connected to multiple ATs. This DSS has been developed by means of co-creation during an international project. The DSS provides an insight into the physical and cognitive status of a PwD, as well as an insight into sleep activity and general wellbeing. Semi-structured interview sessions were held in three countries (Netherlands, Italy, and Taiwan) with 41 participants to gain insight into the experiences of formal and informal carers and PwD with both the ATs and the DSS Alpha prototype dashboard. Results The results showed that participants using the DSS were satisfied and perceived added value and a fit with certain care demands from the PwD. In general, ICs and FCs have limited insight into the status of PwD living independently at home, and in these moments, the DSS dashboard and AT bundle can provide valuable insights. Participants experienced the DSS dashboard as well-organized and easy to navigate. The accuracy of the data displayed in the dashboard is important, the context, and (perceived) privacy issues should be tackled according to all users. Furthermore, based in the insight gained during the evaluation a set of design improvements was composed which can be used to further improve the DSS for the Beta evaluation. Discussion and conclusion The current paper evaluates a possible solution for excess AT usage and how the use of a DSS which integrated multiple AT into one single technology could support caregivers in providing care for PwD. The formative evaluation scrutinized the integration of the developed DSS and the composed bundle of ATs across diverse cultural contexts. Insights from multi-center observations shed light on user experiences, encompassing overall usability, navigational efficacy, and attitudes toward the system. FCs and ICs expressed positivity toward the DSS dashboard's design and functionalities, highlighting its utility in remote monitoring, tracking changes in the person's abilities, and managing urgent situations. There is a need for personalized solutions and the findings contribute to a nuanced understanding of DSS and AT integration, providing insights for future developments and research in the field of DSS for the care of PwD.
Collapse
Affiliation(s)
- Henk Herman Nap
- Vilans Centre of Expertise for Long-Term Care, Digital Care, Utrecht, Netherlands
| | - Nathalie E. Stolwijk
- Vilans Centre of Expertise for Long-Term Care, Digital Care, Utrecht, Netherlands
| | | | - Dirk R. M. Lukkien
- Vilans Centre of Expertise for Long-Term Care, Digital Care, Utrecht, Netherlands
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, Netherlands
| | - Bob M. Hofstede
- Vilans Centre of Expertise for Long-Term Care, Digital Care, Utrecht, Netherlands
| | - Nicole Morresi
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Sara Casaccia
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Giulio Amabili
- Scientific Direction, Istituto Nazionale Ricovero e Cura per Anziani (IRCCS INRCA), Ancona, Italy
| | - Roberta Bevilacqua
- Scientific Direction, Istituto Nazionale Ricovero e Cura per Anziani (IRCCS INRCA), Ancona, Italy
| | - Arianna Margaritini
- Scientific Direction, Istituto Nazionale Ricovero e Cura per Anziani (IRCCS INRCA), Ancona, Italy
| | - Federico Barbarossa
- Scientific Direction, Istituto Nazionale Ricovero e Cura per Anziani (IRCCS INRCA), Ancona, Italy
| | - Chien-Ju Lin
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Feng Chieh
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Gian Marco Revel
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Ephrem Tesfay
- Vilans Centre of Expertise for Long-Term Care, Digital Care, Utrecht, Netherlands
| | - Dorothy Bai
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Claire Wirtjes
- Vilans Centre of Expertise for Long-Term Care, Digital Care, Utrecht, Netherlands
| | - Yeh-Liang Hsu
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan, Taiwan
| |
Collapse
|
3
|
Yangming H, Sha L, Hui L, Yanda Y. Study on the measurement of coupling and coordinated development level between China's internet and elderly care services and its influencing factors. BMC Public Health 2024; 24:920. [PMID: 38553686 PMCID: PMC10979630 DOI: 10.1186/s12889-024-18291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND With the intensification of China's aging population, the demand for elderly care services has become increasingly prominent. At the same time, rapid development of internet technology provides more convenience and possibilities for the elderly. However, the coordinated development between the internet and elderly care services still faces challenges. This study aims to measure the level of coupling and coordinated development between the internet and elderly care services in China, and analyze the influencing factors, in order to provide reference for promoting elderly care services. METHODS In this paper, the entropy method and coupling coordination degree model were used to measure the coupling coordination development index of the internet and elderly care services in China from 2012 to 2021. In addition, considering that the coordinated development between the two is affected by many factors, the Tobit model was used to analyze the main factors affecting the integration of the internet and elderly care services. RESULTS (1) The coupling and coordination of the Internet and senior care services is in its infancy, but the coupling and coordination of the two is on the rise, and there is still a lot of room for development in the future. (2) In terms of time scale, the coupling coordination development level between the internet and elderly care services in China has gone through three stages of "disorder recession-transition coordination-coordinated development". (3) In terms of influencing factors, government management ability has a more positive impact on the development of the integration of the Internet and senior care services, financial support, scientific and technological investment and the level of innovation play a mild pulling role, while the level of informatization to a certain extent restricts the level of integration of the Internet and senior care services. CONCLUSION In order to promote the coordinated development of China's Internet and senior care services, it is necessary to comprehensively understand the current situation and development space of China's Internet and senior care services coupling coordination degree, accurately grasp the dynamic trend of China's Internet and senior care services coupling and coordinated development, promote the stage of leapfrogging, and fully consider the influencing factors, so as to realize the optimal allocation of policies and resources. These measures will help to promote a more coordinated and sustainable development of the internet and elderly care services in China.
Collapse
Affiliation(s)
- Hu Yangming
- College of Public Administration and Law, Hunan Agricultural University, Changsha, People's Republic of China
| | - Li Sha
- College of Public Administration and Law, Hunan Agricultural University, Changsha, People's Republic of China.
| | - Liu Hui
- College of Public Administration and Law, Hunan Agricultural University, Changsha, People's Republic of China
| | - Yang Yanda
- Animal Science and Technology College, Hunan Agricultural University, Changsha, People's Republic of China
| |
Collapse
|
4
|
Lee J, Park S, Cho MH, Kang JW, Kim M, Choi S, Kim SG, Choi JH, Han K, Kim CO, Moon IC, Choi M, Jang SN. Development of a web-based care networking system to support visiting healthcare professionals in the community. BMC Health Serv Res 2023; 23:1427. [PMID: 38104086 PMCID: PMC10725602 DOI: 10.1186/s12913-023-10434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The role of visiting health services has been proven to be effective in promoting the health of older populations. Hence, developing a web system for nurses may help improve the quality of visiting health services for community-dwelling frail older adults. This study was conducted to develop a web application that reflects the needs of visiting nurses. METHODS Visiting nurses of public health centers and community centers in South Korea participated in the design and evaluation process. Six nurses took part in the focus group interviews, and 21 visiting nurses and community center managers participated in the satisfaction evaluation. Focus group interviews were conducted to identify the needs of visiting nurses with respect to system function. Based on the findings, a web application that can support the effective delivery of home visiting services in the community was developed. An artificial intelligence (AI) algorithm was also developed to recommend health and welfare services according to each patient's health status. After development, a structured survey was conducted to evaluate user satisfaction with system features using Kano's model. RESULTS The new system can be used with mobile devices to increase the mobility of visiting nurses. The system includes 13 features that support the management of patient data and enhance the efficiency of visiting services (e.g., map, navigation, scheduler, protocol archives, professional advice, and online case conferencing). The user satisfaction survey revealed that nurses showed high satisfaction with the system. Among all features, the nurses were most satisfied with the care plan, which included AI-based recommendations for community referral. CONCLUSIONS The system developed from the study has attractive features for visiting nurses and supports their essential tasks. The system can help with effective case management for older adults requiring in-home care and reduce nurses' workload. It can also improve communication and networking between healthcare and long-term care institutions.
Collapse
Affiliation(s)
- Jakyung Lee
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
| | - Susan Park
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Mi-Hee Cho
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-Ro, Dongjak-Gu, Seoul, 06974, Republic of Korea
| | - Ji-Won Kang
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
| | - Minkyoung Kim
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Suhyeon Choi
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
| | - Seok-Gyu Kim
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
| | - Ji-Hee Choi
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
| | - Keumhee Han
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
| | - Chang-O Kim
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
| | - Il-Chul Moon
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Moon Choi
- Graduate School of Science and Technology Policy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Soong-Nang Jang
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea.
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-Ro, Dongjak-Gu, Seoul, 06974, Republic of Korea.
| |
Collapse
|
5
|
Nuzzi A, Latorre V, Semisa D, Scozzi B. Improving the mental health care process in response to Covid-19 pandemic: The case of a penitentiary mental health division. PLoS One 2023; 18:e0293492. [PMID: 37903102 PMCID: PMC10615294 DOI: 10.1371/journal.pone.0293492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023] Open
Abstract
Covid-19 outbreak led all organizations to reorganize their processes to prevent infection and contagion risk. All healthcare facilities, included penitentiary mental health services, had to redesign their processes to safely deliver care services. In this paper, the case of a Penitentiary Mental Health Division located in southern Italy is presented. Soft System Methodology and Business process management principles and techniques are adopted to analyse and redesign the detainees' mental health care process. The process, characterized by direct, close and prolonged contact with patients, exposes detainees and healthcare staff to a high Covid-19 infection risk. Through document analysis, interviews with the actors involved in the process and direct observation, the process's inefficiencies and criticalities are identified. The process is redesigned to make it compliant with Covid-19 prevention provisions and national penitentiary regulations and address the other criticalities. The proposed methodological approach-which innovatively combines Soft System Methodology and Business Process Management-constitutes a human-centered process-based redesign approach that can be used both in healthcare and other organizational settings.
Collapse
Affiliation(s)
- Angela Nuzzi
- Department of Mechanics, Mathematics, and Management, Polytechnic University of Bari, Bari, Italy
| | - Valeria Latorre
- Complex Organization Unit Psychiatric Diagnosis and Care Service UO San Paolo, ASL Bari, Bari, Italy
- Penitentiary Mental Health Service, Department of Mental Health, ASL Bari, Bari, Italy
| | - Domenico Semisa
- Complex Organization Unit Psychiatric Diagnosis and Care Service UO San Paolo, ASL Bari, Bari, Italy
| | - Barbara Scozzi
- Department of Mechanics, Mathematics, and Management, Polytechnic University of Bari, Bari, Italy
| |
Collapse
|
6
|
Paquet C, Whitehead J, Shah R, Adams AM, Dooley D, Spreng RN, Aunio AL, Dubé L. Social Prescription Interventions Addressing Social Isolation and Loneliness in Older Adults: Meta-Review Integrating On-the-Ground Resources. J Med Internet Res 2023; 25:e40213. [PMID: 37195738 PMCID: PMC10233446 DOI: 10.2196/40213] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Social prescription programs represent a viable solution to linking primary care patients to nonmedical community resources for improving patient well-being. However, their success depends on the integration of patient needs with local resources. This integration could be accelerated by digital tools that use expressive ontology to organize knowledge resources, thus enabling the seamless navigation of diverse community interventions and services tailored to the needs of individual users. This infrastructure bears particular relevance for older adults, who experience a range of social needs that impact their health, including social isolation and loneliness. An essential first step in enabling knowledge mobilization and the successful implementation of social prescription initiatives to meet the social needs of older adults is to incorporate the evidence-based academic literature on what works, with on-the-ground solutions in the community. OBJECTIVE This study aims to integrate scientific evidence with on-the-ground knowledge to build a comprehensive list of intervention terms and keywords related to reducing social isolation and loneliness in older adults. METHODS A meta-review was conducted using a search strategy combining terms related to older adult population, social isolation and loneliness, and study types relevant to reviews using 5 databases. Review extraction included intervention characteristics, outcomes (social [eg, loneliness, social isolation, and social support] or mental health [eg, psychological well-being, depression, and anxiety]), and effectiveness (reported as consistent, mixed, or not supported). Terms related to identified intervention types were extracted from the reviewed literature as well as descriptions of corresponding community services in Montréal, Canada, available from web-based regional, municipal, and community data sources. RESULTS The meta-review identified 11 intervention types addressing social isolation and loneliness in older adults by either increasing social interactions, providing instrumental support, promoting mental and physical well-being, or providing home and community care. Group-based social activities, support groups with educational elements, recreational activities, and training or use of information and communication technologies were the most effective in improving outcomes. Examples of most intervention types were found in community data sources. Terms derived from the literature that were the most commonly congruent with those describing existing community services were related to telehealth, recreational activities, and psychological therapy. However, several discrepancies were observed between review-based terms and those addressing the available services. CONCLUSIONS A range of interventions found to be effective at addressing social isolation and loneliness or their impact on mental health were identified from the literature, and many of these interventions were represented in services available to older residents in Montréal, Canada. However, different terms were occasionally used to describe or categorize similar services across data sources. Establishing an efficient means of identifying and structuring such sources is important to facilitate referrals and help-seeking behaviors of older adults and for strategic planning of resources.
Collapse
Affiliation(s)
- Catherine Paquet
- Département de Marketing, Faculté des Sciences de l'Administration, Université Laval, Québec, QC, Canada
- Centre de Recherche, Centre Hospitalier Universitaire de Québec - Université Laval, Quebec, QC, Canada
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Quebec, QC, Canada
| | - Jocelyne Whitehead
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
- McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Rishabh Shah
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
- McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Alayne Mary Adams
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Damion Dooley
- Centre for Infectious Disease Genomics and One Health, Simon Fraser University, Vancouver, BC, Canada
| | - R Nathan Spreng
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | | | - Laurette Dubé
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
- McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| |
Collapse
|
7
|
Trinkley KE, Ho PM, Glasgow RE, Huebschmann AG. How Dissemination and Implementation Science Can Contribute to the Advancement of Learning Health Systems. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1447-1458. [PMID: 35796045 PMCID: PMC9547828 DOI: 10.1097/acm.0000000000004801] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Many health systems are working to become learning health systems (LHSs), which aim to improve the value of health care by rapidly, continuously generating evidence to apply to practice. However, challenges remain to advance toward the aspirational goal of becoming a fully mature LHS. While some important challenges have been well described (i.e., building system-level supporting infrastructure and the accessibility of inclusive, integrated, and actionable data), other key challenges are underrecognized, including balancing evaluation rapidity with rigor, applying principles of health equity and classic ethics, focusing on external validity and reproducibility (generalizability), and designing for sustainability. Many LHSs focus on continuous learning cycles, but with limited consideration of issues related to the rapidity of these learning cycles, as well as the sustainability or generalizability of solutions. Some types of data have been consistently underrepresented, including patient-reported outcomes and preferences, social determinants, and behavioral and environmental data, the absence of which can exacerbate health disparities. A promising approach to addressing many challenges that LHSs face may be found in dissemination and implementation (D&I) science. With an emphasis on multilevel dynamic contextual factors, representation of implementation partner engagement, pragmatic research, sustainability, and generalizability, D&I science methods can assist in overcoming many of the challenges facing LHSs. In this article, the authors describe the current state of LHSs and challenges to becoming a mature LHS, propose solutions to current challenges, focusing on the contributions of D&I science with other methods, and propose key components and characteristics of a mature LHS model that others can use to plan and develop their LHSs.
Collapse
Affiliation(s)
- Katy E Trinkley
- K.E. Trinkley is associate professor, Departments of Clinical Pharmacy and Medicine and Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Center, and clinical informaticist, Department of Clinical Informatics, UCHealth, Aurora, Colorado; ORCID: http://orcid.org/0000-0003-2041-7404
| | - P Michael Ho
- P.M. Ho is professor, Department of Medicine, University of Colorado Anschutz Medical Campus, and professor, VA Eastern Colorado Health Care System, Aurora, Colorado; ORCID: http://orcid.org/0000-0002-7775-6266
| | - Russell E Glasgow
- R.E. Glasgow is research professor, Department of Family Medicine, and director, Dissemination and Implementation Science Program, ACCORDS, University of Colorado Anschutz Medical Center, Aurora, Colorado; ORCID: http://orcid.org/0000-0003-4218-3231
| | - Amy G Huebschmann
- A.G. Huebschmann is associate professor, Division of General Internal Medicine, ACCORDS and Ludeman Family Center for Women's Health Research, University of Colorado Anschutz Medical Center, Aurora, Colorado; ORCID: http://orcid.org/0000-0002-9329-3142
| |
Collapse
|
8
|
Turcotte PL, Holmes D, Perron A. L’outil d’évaluation multi-clientèle comme mécanisme de contrôle des soins à domicile : une analyse poststructuraliste. Rech Soins Infirm 2022; 146:7-18. [PMID: 35724025 DOI: 10.3917/rsi.146.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION AND BACKGROUND In Quebec (Canada), the Multi-clientele Assessment Tool (Outil d'évaluation multi-clientèle, OEMC) profoundly transformed the practice of home care professionals (HCP), including nurses. Since 2015, all home care patients with a completed OEMC have been counted to assess the performance of services. If performance targets are not reached, funding renewal is threatened, exerting pressure on HCPs. OBJECTIVE The objective of this article is to review the OEMC's implementation in order to understand its political nature and its impacts on the practice of HCPs and patients' lives. MATERIAL AND METHOD Drawing on the works of Michel Foucault and Gilles Deleuze, we propose a poststructuralist analysis of OEMC documents. RESULTS Shifting from disciplinary societies to societies of control, the OEMC insidiously contributes to the regulation of home care services as well as patients' lives. The will of HCPs to apply their field of expertise is in opposition with the OEMC's purposes. DISCUSSION AND CONCLUSION To not complete the OEMC when it is deemed unnecessary would require a negotiation by HCPs. However, HCPs' autonomy is compromised by discourses repressing all forms of resistance.
Collapse
Affiliation(s)
- Pier-Luc Turcotte
- Ergothérapeute, Ph.Dc, École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada
| | - Dave Holmes
- Infirmier, Ph.D, FAAN, professeur titulaire, Faculté des sciences de la santé, École des sciences infirmières, Université d’Ottawa, Ottawa, Canada
| | - Amélie Perron
- Infirmière, Ph.D, professeure titulaire, Faculté des sciences de la santé, École des sciences infirmières, Université d’Ottawa, Ottawa, Canada
| |
Collapse
|