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Liedberg F, Hagberg O, Aljabery F, Andrén O, Falini V, Gårdmark T, Ströck V, Jerlström T. Cystectomy for bladder cancer in Sweden - short-term outcomes after centralization. Scand J Urol 2024; 59:84-89. [PMID: 38685576 DOI: 10.2340/sju.v59.40120] [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: 02/15/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Radical cystectomy (RC) for bladder cancer is associated with an inherent risk of complications and even postoperative mortality. The number of hospitals performing RC has decreased in Sweden over time, and since a formal regional centralization in 2017 cystectomy care is currently provided by nine hospitals. MATERIAL AND METHODS In the Swedish National Urinary Bladder Cancer Register (SNRUBC) 90-day complications after RC have been registered with high coverage since 2012. Descriptive data and short-term outcomes were compared in relation to centralization of the cystectomy care by stratifying data before (2012-2016) and after (2017-2023). RESULTS Out of all 4,638 cystectomies, 2,738 (59%) were performed after the centralization in 2017 and onwards. The median age at RC increased from 71 (Inter Quartile Range [IQR] 65-76) to 73 (IQR 67-77) years, and the proportion of patients with comorbidity (American Society of Anesthesiologists [ASA] 3 or 4) increased from 32% to 37% after the centralization (p < 0.001). The number of patients suffering from high-grade complications within 90 days of surgery corresponding to Clavien grade three were 345 (18%) and 407 (15%), and corresponding to Clavien grade four 61 (3%) and 64 (2%) before and after centralization, respectively. Reoperations within 90 days of RC decreased from 234/1,900 (12%) to 208/2,738 (8%) (p < 0.001), and 90-day mortality decreased from 84/1,900 (4%) to 85/2,738 (3%) (p = 0.023) before and after centralization, respectively. CONCLUSION After the centralization of the cystectomy-care in Sweden, older patients and individuals with more extensive comorbidity were offered RC whereas 90-day mortality and the proportion of patients subjected to reoperations within 90 days of surgery decreased without increasing waiting times.
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Affiliation(s)
- Fredrik Liedberg
- Department of Urology Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden.
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Firas Aljabery
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping, University, Linköping, Sweden
| | - Ove Andrén
- Section of Urology, Department of Surgery, Skellefteå Hospital, Sweden
| | | | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Viveka Ströck
- Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Tomas Jerlström
- Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Siette J, Dodds L, Sharifi F, Nguyen A, Baysari M, Seaman K, Raban M, Wabe N, Westbrook J. Usability and Acceptability of Clinical Dashboards in Aged Care: Systematic Review. JMIR Aging 2023; 6:e42274. [PMID: 37335599 DOI: 10.2196/42274] [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: 08/29/2022] [Revised: 03/12/2023] [Accepted: 05/12/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The use of clinical dashboards in aged care systems to support performance review and improve outcomes for older adults receiving care is increasing. OBJECTIVE Our aim was to explore evidence from studies of the acceptability and usability of clinical dashboards including their visual features and functionalities in aged care settings. METHODS A systematic review was conducted using 5 databases (MEDLINE, Embase, PsycINFO, Cochrane Library, and CINAHL) from inception to April 2022. Studies were included in the review if they were conducted in aged care environments (home-based community care, retirement villages, and long-term care) and reported a usability or acceptability evaluation of a clinical dashboard for use in aged care environments, including specific dashboard visual features (eg, a qualitative summary of individual user experience or metrics from a usability scale). Two researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review, and the risk of bias was measured using the Mixed Methods Appraisal Tool. RESULTS In total, 14 articles reporting on 12 dashboards were included. The quality of the articles varied. There was considerable heterogeneity in implementation setting (home care 8/14, 57%), dashboard user groups (health professionals 9/14, 64%), and sample size (range 3-292). Dashboard features included a visual representation of information (eg, medical condition prevalence), analytic capability (eg, predictive), and others (eg, stakeholder communication). Dashboard usability was mixed (4 dashboards rated as high), and dashboard acceptability was high for 9 dashboards. Most users considered dashboards to be informative, relevant, and functional, highlighting the use and intention of using this resource in the future. Dashboards that had the presence of one or more of these features (bar charts, radio buttons, checkboxes or other symbols, interactive displays, and reporting capabilities) were found to be highly acceptable. CONCLUSIONS A comprehensive summary of clinical dashboards used in aged care is provided to inform future dashboard development, testing, and implementation. Further research is required to optimize visualization features, usability, and acceptability of dashboards in aged care.
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Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, Australia
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, Australia
| | - Laura Dodds
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, Australia
| | - Fariba Sharifi
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, Australia
| | - Amy Nguyen
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Melissa Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Karla Seaman
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, Australia
| | - Magdalena Raban
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, Australia
| | - Nasir Wabe
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, Australia
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Ferreira G, Lobo M, Richards B, Dinh M, Maher C. Hospital variation in admissions for low back pain following an emergency department presentation: a retrospective study. BMC Health Serv Res 2022; 22:835. [PMID: 35818074 PMCID: PMC9275239 DOI: 10.1186/s12913-022-08134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background One in 6 patients with low back pain (LBP) presenting to emergency departments (EDs) are subsequently admitted to hospital each year, making LBP the ninth most common reason for hospital admission in Australia. No studies have investigated and quantified the extent of clinical variation in hospital admission following an ED presentation for LBP. Methods We used routinely collected ED data from public hospitals within the state of New South Wales, Australia, to identify presentations of patients aged between 18 and 111 with a discharge diagnosis of LBP. We fitted a series of random effects multilevel logistic regression models adjusted by case-mix and hospital variables. The main outcome was the hospital-adjusted admission rate (HAAR). Data were presented as funnel plots with 95% and 99.8% confidence limits. Hospitals with a HAAR outside the 95% confidence limit were considered to have a HAAR significantly different to the state average. Results We identified 176,729 LBP presentations across 177 public hospital EDs and 44,549 hospital admissions (25.2%). The mean (SD) age was 51.8 (19.5) and 52% were female. Hospital factors explained 10% of the variation (ICC = 0.10), and the median odds ratio (MOR) was 2.03. We identified marked variation across hospitals, with HAAR ranging from 6.9 to 65.9%. After adjusting for hospital variables, there was still marked variation between hospitals with similar characteristics. Conclusion We found substantial variation in hospital admissions following a presentation to the ED due to LBP even after controlling by case-mix and hospital characteristics. Given the substantial costs associated with these admissions, our findings indicate the need to investigate sources of variation and to determine instances where the observed variation is warranted or unwarranted. Supplementary information The online version contains supplementary material available at 10.1186/s12913-022-08134-8.
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Affiliation(s)
- Giovanni Ferreira
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia. .,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,, Camperdown, Australia.
| | - Marina Lobo
- Center for Health Technology and Services Research (CINTESIS), Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bethan Richards
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Michael Dinh
- The RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney, Australia
| | - Chris Maher
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Park S, Bekemeier B, Flaxman A, Schultz M. Impact of data visualization on decision-making and its implications for public health practice: a systematic literature review. Inform Health Soc Care 2021; 47:175-193. [PMID: 34582297 DOI: 10.1080/17538157.2021.1982949] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Data visualization tools have the potential to support decision-making for public health professionals. This review summarizes the science and evidence regarding data visualization and its impact on decision-making behavior as informed by cognitive processes such as understanding, attitude, or perception.An electronic literature search was conducted using six databases, including reference list reviews. Search terms were pre-defined based on research questions.Sixteen studies were included in the final analysis. Data visualization interventions in this review were found to impact attitude, perception, and decision-making compared to controls. These relationships between the interventions and outcomes appear to be explained by mediating factors such as perceived trustworthiness and quality, domain-specific knowledge, basic beliefs shared by social groups, and political beliefs.Visualization appears to bring advantages by increasing the amount of information delivered and decreasing the cognitive and intellectual burden to interpret information for decision-making. However, understanding data visualization interventions specific to public health leaders' decision-making is lacking, and there is little guidance for understanding a participant's characteristics and tasks. The evidence from this review suggests positive effects of data visualization can be identified, depending on the control of confounding factors on attitude, perception, and decision-making.
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Affiliation(s)
- Seungeun Park
- Department of Social and Preventive Medicine, School of Medicine, Sungkyunkwan University, Suwon, Korea
| | - Betty Bekemeier
- Department of Child, Family, & Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
| | - Abraham Flaxman
- Institute for Health Metrics and Evaluation, Department of Global Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - Melinda Schultz
- Department of Child, Family, & Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
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Arvidsson E, Dahlin S, Anell A. Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care. BMC FAMILY PRACTICE 2021; 22:113. [PMID: 34126935 PMCID: PMC8201899 DOI: 10.1186/s12875-021-01462-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/18/2021] [Indexed: 12/24/2022]
Abstract
Background High quality primary care is expected to be the basis of many health care systems. Expectations on primary care are rising as societies age and the burden of chronic disease grows. To stimulate adherence to guidelines and quality improvement, audit and feedback to professionals is often used, but the effects vary. Even with carefully designed audit and feedback practices, barriers related to contextual conditions may prevent quality improvement efforts. The purpose of this study was to explore how professionals and health centre managers in Swedish primary care experience existing forms of audit and feedback, and conditions and barriers for quality improvement, and to explore views on the future use of clinical performance data for quality improvement. Methods We used an explorative qualitative design. Focus groups were conducted with health centre managers, physicians and other health professionals at seven health centres. The interviews were audio recorded, transcribed and analysed using qualitative content analysis. Results Four different types of audit and feedback that regularly occurred at the health centres were identified. The main part of the audit and feedback was “external”, from the regional purchasers and funders, and from the owners of the health centres. This audit and feedback focused on non-clinical measures such as revenues, utilisation of resources, and the volume of production. The participants in our study did not perceive that existing audit and feedback practices contributed to improved quality in general. This, along with lack of time for quality improvement, lack of autonomy and lack of quality improvement initiatives at the system (macro) level, were considered barriers to quality improvement at the health centres. Conclusions Professionals and health centre managers did not experience audit and feedback practices and existing conditions in Swedish primary care as supportive of quality improvement work. From a professional perspective, audit and feedback with a focus on clinical measures, as well as autonomy for professionals, are necessary to create motivation and space for quality improvement work. Such initiatives also need to be supported by quality improvement efforts at the system (macro) level, which favour transformation to a primary care based system.
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Affiliation(s)
- Eva Arvidsson
- Futurum, Region Jönköping County, Sweden; School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Sofia Dahlin
- Futurum, Region Jönköping County, Jönköping, Sweden
| | - Anders Anell
- Lund University School of Economics & Management, Lund, Sweden
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