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Zurynski Y, Herkes-Deane J, Holt J, McPherson E, Lamprell G, Dammery G, Meulenbroeks I, Halim N, Braithwaite J. How can the healthcare system deliver sustainable performance? A scoping review. BMJ Open 2022; 12:e059207. [PMID: 35613812 PMCID: PMC9125771 DOI: 10.1136/bmjopen-2021-059207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Increasing health costs, demand and patient multimorbidity challenge the sustainability of healthcare systems. These challenges persist and have been amplified by the global pandemic. OBJECTIVES We aimed to develop an understanding of how the sustainable performance of healthcare systems (SPHS) has been conceptualised, defined and measured. DESIGN Scoping review of peer-reviewed articles and editorials published from database inception to February 2021. DATA SOURCES PubMed and Ovid Medline, and snowballing techniques. ELIGIBILITY CRITERIA We included articles that discussed key focus concepts of SPHS: (1) definitions, (2) measurement, (3) identified challenges, (4) identified solutions for improvement and (5) scaling successful solutions to maintain SPHS. DATA EXTRACTION AND SYNTHESIS After title/abstract screening, full-text articles were reviewed, and relevant information extracted and synthesised under the five focus concepts. RESULTS Of 142 included articles, 38 (27%) provided a definition of SPHS. Definitions were based mainly on financial sustainability, however, SPHS was also more broadly conceptualised and included acceptability to patients and workforce, resilience through adaptation, and rapid absorption of evidence and innovations. Measures of SPHS were also predominantly financial, but recent articles proposed composite measures that accounted for financial, social and health outcomes. Challenges to achieving SPHS included the increasingly complex patient populations, limited integration because of entrenched fragmented systems and siloed professional groups, and the ongoing translational gaps in evidence-to-practice and policy-to-practice. Improvement strategies for SPHS included developing appropriate workplace cultures, direct community and consumer involvement, and adoption of evidence-based practice and technologies. There was also a strong identified need for long-term monitoring and evaluations to support adaptation of healthcare systems and to anticipate changing needs where possible. CONCLUSIONS To implement lasting change and to respond to new challenges, we need context-relevant definitions and frameworks, and robust, flexible, and feasible measures to support the long-term sustainability and performance of healthcare systems.
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Affiliation(s)
- Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
| | - Jessica Herkes-Deane
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Joanna Holt
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
| | - Elise McPherson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gina Lamprell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
| | - Isabelle Meulenbroeks
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
| | - Nicole Halim
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, North Ryde, New South Wales, Australia
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Bastarache L, Brown JS, Cimino JJ, Dorr DA, Embi PJ, Payne PR, Wilcox AB, Weiner MG. Developing real-world evidence from real-world data: Transforming raw data into analytical datasets. Learn Health Syst 2022; 6:e10293. [PMID: 35036557 PMCID: PMC8753316 DOI: 10.1002/lrh2.10293] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022] Open
Abstract
Development of evidence-based practice requires practice-based evidence, which can be acquired through analysis of real-world data from electronic health records (EHRs). The EHR contains volumes of information about patients-physical measurements, diagnoses, exposures, and markers of health behavior-that can be used to create algorithms for risk stratification or to gain insight into associations between exposures, interventions, and outcomes. But to transform real-world data into reliable real-world evidence, one must not only choose the correct analytical methods but also have an understanding of the quality, detail, provenance, and organization of the underlying source data and address the differences in these characteristics across sites when conducting analyses that span institutions. This manuscript explores the idiosyncrasies inherent in the capture, formatting, and standardization of EHR data and discusses the clinical domain and informatics competencies required to transform the raw clinical, real-world data into high-quality, fit-for-purpose analytical data sets used to generate real-world evidence.
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Affiliation(s)
- Lisa Bastarache
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jeffrey S. Brown
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMassachusettsUSA
| | - James J. Cimino
- Informatics Institute, University of Alabama at BirminghamBirminghamAlabamaUSA
| | - David A. Dorr
- Department of Medical Informatics and Clinical EpidemiologyOregon Health Sciences UniversityPortlandOregonUSA
| | - Peter J. Embi
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
| | - Philip R.O. Payne
- Institute for Informatics, Washington University in St. LouisSt. LouisMissouriUSA
| | - Adam B. Wilcox
- Institute for InformaticsWashington University in St. Louis School of MedicineSt. LouisMissouriUSA
| | - Mark G. Weiner
- Department of Population Health SciencesWeill Cornell MedicineNew YorkNew YorkUSA
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Aytur SA, Carlino S, Bernard F, West K, Dobrzycki V, Malik R. Social-ecological theory, substance misuse, adverse childhood experiences, and adolescent suicidal ideation: Applications for community-academic partnerships. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:265-284. [PMID: 33942321 PMCID: PMC9292564 DOI: 10.1002/jcop.22560] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
Suicide is the second leading cause of death among youth in the United States. Data from the 2015 Youth Risk Behavior Survey of 9th-12th grade students in New Hampshire (N = 14,837) were utilized. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression models to evaluate associations between suicidal ideation, adverse childhood experiences (ACEs), and other risk factors including using opioids/drugs without a prescription and food insecurity. We also examined whether potentially protective behaviors may attenuate the relationship between ACEs and suicidal ideation. The prevalence of suicidal ideation was 15.4% (girls 20.15; boys 10.67). In unadjusted models, the crude odds ratio reflecting the relationship between suicidal ideation and higher ACE scores was 1.85 (95% CI 1.76-1.94). In adjusted models, suicidal ideation remained positively associated with higher ACE scores (aOR 1.61, 95% CI 1.52-1.70). Risk and protective behavioral factors identified in relation to suicidal ideation and ACEs are discussed within the context of community-academic partnerships and policy.
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Affiliation(s)
- Semra A. Aytur
- Department of Health Management and PolicyUniversity of New HampshireDurhamNew HampshireUSA
| | - Sydney Carlino
- Department of Health Management and PolicyUniversity of New HampshireDurhamNew HampshireUSA
| | - Felicity Bernard
- Institute for Health Practice and Policy (IHPP), College of Health and Human ServicesUniversity of New HampshireConcordNew HampshireUSA
| | - Kelsi West
- Institute for Health Practice and Policy (IHPP), College of Health and Human ServicesUniversity of New HampshireConcordNew HampshireUSA
| | - Victoria Dobrzycki
- Department of Health Management and PolicyUniversity of New HampshireDurhamNew HampshireUSA
| | - Riana Malik
- Department of Health Management and PolicyUniversity of New HampshireDurhamNew HampshireUSA
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Schleyer T, Williams L, Gottlieb J, Weaver C, Saysana M, Azar J, Sadowski J, Frederick C, Hui S, Kara A, Ruppert L, Zappone S, Bushey M, Grout R, Embi PJ. The Indiana Learning Health System Initiative: Early experience developing a collaborative, regional learning health system. Learn Health Syst 2021; 5:e10281. [PMID: 34277946 PMCID: PMC8278436 DOI: 10.1002/lrh2.10281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Learning health systems (LHSs) are usually created and maintained by single institutions or healthcare systems. The Indiana Learning Health System Initiative (ILHSI) is a new multi-institutional, collaborative regional LHS initiative led by the Regenstrief Institute (RI) and developed in partnership with five additional organizations: two Indiana-based health systems, two schools at Indiana University, and our state-wide health information exchange. We report our experiences and lessons learned during the initial 2-year phase of developing and implementing the ILHSI. METHODS The initial goals of the ILHSI were to instantiate the concept, establish partnerships, and perform LHS pilot projects to inform expansion. We established shared governance and technical capabilities, conducted a literature review-based and regional environmental scan, and convened key stakeholders to iteratively identify focus areas, and select and implement six initial joint projects. RESULTS The ILHSI successfully collaborated with its partner organizations to establish a foundational governance structure, set goals and strategies, and prioritize projects and training activities. We developed and deployed strategies to effectively use health system and regional HIE infrastructure and minimize information silos, a frequent challenge for multi-organizational LHSs. Successful projects were diverse and included deploying a Fast Healthcare Interoperability Standards (FHIR)-based tool across emergency departments state-wide, analyzing free-text elements of cross-hospital surveys, and developing models to provide clinical decision support based on clinical and social determinants of health. We also experienced organizational challenges, including changes in key leadership personnel and varying levels of engagement with health system partners, which impacted initial ILHSI efforts and structures. Reflecting on these early experiences, we identified lessons learned and next steps. CONCLUSIONS Multi-organizational LHSs can be challenging to develop but present the opportunity to leverage learning across multiple organizations and systems to benefit the general population. Attention to governance decisions, shared goal setting and monitoring, and careful selection of projects are important for early success.
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Affiliation(s)
- Titus Schleyer
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Linda Williams
- Center for Health Services ResearchRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
- VA HSR&D EXTEND QUERIRichard L. Roudebush VA Medical CenterIndianapolisIndianaUSA
| | - Jonathan Gottlieb
- Department of Health AdministrationUniversity of ProvidenceGreat FallsMontanaUSA
| | - Christopher Weaver
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Physician AdministrationIndiana University HealthIndianapolisIndianaUSA
| | - Michele Saysana
- Physician AdministrationIndiana University HealthIndianapolisIndianaUSA
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jose Azar
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Division of Quality and Patient SafetyIndiana University HealthIndianapolisIndianaUSA
| | - Josh Sadowski
- Department of Infection PreventionIndiana University HealthIndianapolisIndianaUSA
| | - Chris Frederick
- AdministrationRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Siu Hui
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of Biostatistics & Health Data ScienceIndiana University School of MedicineIndianapolisIndianaUSA
| | - Areeba Kara
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Laura Ruppert
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Sarah Zappone
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Michael Bushey
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
- Department of PsychiatryIndiana University HealthIndianapolisIndianaUSA
| | - Randall Grout
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
- InformaticsEskenazi HealthIndianapolisIndianaUSA
| | - Peter J. Embi
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- AdministrationRegenstrief Institute, IncIndianapolisIndianaUSA
- AdministrationIndiana University HealthIndianapolisIndianaUSA
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Gozashti L, Corbett-Detig R. Shortcomings of SARS-CoV-2 genomic metadata. BMC Res Notes 2021; 14:189. [PMID: 34001211 PMCID: PMC8128092 DOI: 10.1186/s13104-021-05605-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The SARS-CoV-2 pandemic has prompted one of the most extensive and expeditious genomic sequencing efforts in history. Each viral genome is accompanied by a set of metadata which supplies important information such as the geographic origin of the sample, age of the host, and the lab at which the sample was sequenced, and is integral to epidemiological efforts and public health direction. Here, we interrogate some shortcomings of metadata within the GISAID database to raise awareness of common errors and inconsistencies that may affect data-driven analyses and provide possible avenues for resolutions. RESULTS Our analysis reveals a startling prevalence of spelling errors and inconsistent naming conventions, which together occur in an estimated ~ 9.8% and ~ 11.6% of "originating lab" and "submitting lab" GISAID metadata entries respectively. We also find numerous ambiguous entries which provide very little information about the actual source of a sample and could easily associate with multiple sources worldwide. Importantly, all of these issues can impair the ability and accuracy of association studies by deceptively causing a group of samples to identify with multiple sources when they truly all identify with one source, or vice versa.
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Affiliation(s)
- Landen Gozashti
- Department of Organismic and Evolutionary Biology and Museum of Comparative Zoology, Harvard University, Cambridge, MA, 02138, USA. .,Department of Biomolecular Engineering and Genomics Institute, University of California Santa Cruz, Santa Cruz, CA, 95064, USA.
| | - Russell Corbett-Detig
- Department of Biomolecular Engineering and Genomics Institute, University of California Santa Cruz, Santa Cruz, CA, 95064, USA
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McGrath SP. Improving the Odds of Success for Precision Medicine Using the Social Ecological Model. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2020; 2019:1149-1156. [PMID: 32308912 PMCID: PMC7153092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The concept of precision medicine aims to provide additional context to patient data for healthcare providers A decade after the HITECH act of 2009, the state of EHRs can be considered a mixed bag. Increased levels of physician burnout have been attributed to the impact EHRs have had on traditional patient and provider interactions. In order for precision medicine to be allowed to establish a foothold, it must demonstrate the ability to improve clinical outcomes. One path to achieving this is by improving health behavior, which is a difficult task. In this paper, the case is presented for using the social ecological model to help shift health behaviors with precision medicine.
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