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Rodríguez-Moranta F, Argüelles-Arias F, Hinojosa Del Val J, Iborra Colomino M, Martín-Arranz MD, Menchén Viso L, Muñoz Núñez F, Ricart Gómez E, Sánchez-Hernández JG, Valdés-Delgado T, Guardiola Capón J, Barreiro-de Acosta M, Mañosa Ciria M, Zabana Abdo Y, Gutiérrez Casbas A. Therapeutic drug monitoring in inflammatory bowel diseases. Position statement of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:522-552. [PMID: 38311005 DOI: 10.1016/j.gastrohep.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/31/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024]
Abstract
The treatment of inflammatory bowel disease has undergone a significant transformation following the introduction of biologic drugs. Thanks to these drugs, treatment goals have evolved from clinical response and remission to more ambitious objectives, such as endoscopic or radiologic remission. However, even though biologics are highly effective, a significant percentage of patients will not achieve an initial response or may lose it over time. We know that there is a direct relationship between the trough concentrations of the biologic and its therapeutic efficacy, with more demanding therapeutic goals requiring higher drug levels, and inadequate exposure being common. Therapeutic drug monitoring of biologic medications, along with pharmacokinetic models, provides us with the possibility of offering a personalized approach to treatment for patients with IBD. Over the past few years, relevant information has accumulated regarding its utility during or after induction, as well as in the maintenance of biologic treatment, in reactive or proactive strategies, and prior to withdrawal or treatment de-escalation. The aim of this document is to establish recommendations regarding the utility of therapeutic drug monitoring of biologics in patients with inflammatory bowel disease, in different clinical practice scenarios, and to identify areas where its utility is evident, promising, or controversial.
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Affiliation(s)
- Francisco Rodríguez-Moranta
- Servicio de Aparato Digestivo, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
| | - Federico Argüelles-Arias
- Servicio de Aparato Digestivo, Hospital Universitario Virgen Macarena, Sevilla, España; Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | | | - Marisa Iborra Colomino
- Servicio de Aparato Digestivo, Hospital Universitario y Politécnico de La Fe, Valencia, España
| | - M Dolores Martín-Arranz
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Facultad de Medicina de la UAM, Fundación para la investigación del Hospital Universitario la Paz (IDIPAZ), Madrid, España
| | - Luis Menchén Viso
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón-IiSGM, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Fernando Muñoz Núñez
- Servicio de Aparato Digestivo, Hospital Universitario de Salamanca, Salamanca, España
| | - Elena Ricart Gómez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), H. Clínic Barcelona, Barcelona, IDIBAPS, Barcelona, España
| | | | - Teresa Valdés-Delgado
- Servicio de Aparato Digestivo, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Jordi Guardiola Capón
- Servicio de Gastroenterología, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Manuel Barreiro-de Acosta
- Servicio de Gastroenterología, Hospital Clínico Universitario de Santiago, A Coruña, España; Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, España
| | - Míriam Mañosa Ciria
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Yamile Zabana Abdo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología, Hospital Mútua de Terrassa (HMT), Terrassa, Barcelona, España
| | - Ana Gutiérrez Casbas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
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Klymenko IA, Tolstanov OK. IMPROVING CLINICAL MANAGEMENT OF PATIENTS WITH THYROID CANCER. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1090-1094. [PMID: 35758483 DOI: 10.36740/wlek202205107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: Obtaining evidence for an interdisciplinary approach to the clinical management of patients with thyroid cancer, identifying weak areas and justifying opportunities for improvement. PATIENTS AND METHODS Materials and methods: Data from 410 medical records of inpatients with thyroid cancer and 17 units of formalized documents of the health care facility where the study was conducted. Methods: statistical, graphic, comparative analysis, descriptive modeling, generalization. RESULTS Results: Patients' need for interdisciplinary care were determined by cancer itself and by the presence of 234 cases of accompanying pathologies and complications in 147 (35.9%) patients. Interdisciplinary interaction is positioned as the provision of medical care by the medical staff of the unit where the patient stays and receives expert care. Treatment planning is carried out through the advisory participation of physicians of different specialties, rather than multidisciplinary consensus. Clinical management of the patient and discharge are carried out by the attending physician. Clinical pathways are designed for the department where the patient is hospitalized. Opportunities for pre- and postoperative rehabilitation are not used. Interaction with primary and secondary care facilities is limited. CONCLUSION Conclusions: The key directions of improving the clinical management of patients with thyroid cancer are identified: to improve the patient's clinical path, to strengthen interdisciplinary interaction of specialists through the use of digital technologies, to make clinical decision through the multidisciplinary consensus.
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Affiliation(s)
- Igor A Klymenko
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
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Noto G, Lo Verso AC, Barresi G. What is the performance in public hospitals? A longitudinal analysis of performance plans through topic modeling. BMC Health Serv Res 2021; 21:326. [PMID: 33836737 PMCID: PMC8033690 DOI: 10.1186/s12913-021-06332-4] [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] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/25/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Both the concept of performance and the role of hospitals in health systems evolved significantly in the last decades. Today, the performance in health could be defined as the ability to create 'population value,' and the hospitals' role is to support this aim by providing acute care and by integrating and coordinating their activity with other settings of care. This research aims to assess how and with what degree the management of public hospitals have embraced in practice the updated concept of performance and their new role. RESULT The paper analyses 181 performance plans of 48 Italian autonomous public hospitals over a nine-year period through the topic modeling algorithm called Latent Dirichlet Allocation (LDA). This is a method that allows for analysing large textual corpora that generates a representation of the latent topics discussed therein. The concept of performance in public hospitals was framed into 15 topics resulting from the analysis of the hospitals' performance plans. The prevalence of each topic was analysed through the period considered so as to understand the evolution of performance-related practices over the last decade. CONCLUSION In recent years, the concept of performance in hospitals evolved toward the adoption of an outcome-based and population-based perspective. Additional effort should be devoted toward improved collaboration and integration of care with other settings.
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Affiliation(s)
- Guido Noto
- Department of Economics, University of Messina, Messina, Italy.
| | | | - Gustavo Barresi
- Department of Economics, University of Messina, Messina, Italy
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Looman W, Struckmann V, Köppen J, Baltaxe E, Czypionka T, Huic M, Pitter J, Ruths S, Stokes J, Bal R, Rutten-van Mölken M. Drivers of successful implementation of integrated care for multi-morbidity: Mechanisms identified in 17 case studies from 8 European countries. Soc Sci Med 2021; 277:113728. [PMID: 33878666 DOI: 10.1016/j.socscimed.2021.113728] [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] [Revised: 12/26/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022]
Abstract
This paper provides a deeper understanding of the mechanisms underlying implementation strategies for integrated care. As part of the SELFIE project, 17 integrated care programmes addressing multi-morbidity from eight European countries were selected and studied. Data was extracted from 'thick descriptions' of the 17 programmes and analysed both inductively and deductively using implementation theory. The following ten mechanisms for successful implementation of integrated care were identified. With regards to service delivery, successful implementers (1) commonly adopted an incremental growth model rather than a disruptive innovation approach, and found (2) a balance between flexibility and formal structures of integration. For leadership & governance, they (3) applied collaborative governance by engaging all stakeholders, and (4) distributed leadership throughout all levels of the system. For the workforce, these implementers (5) were able to build a multidisciplinary team culture with mutual recognition of each other's roles, and (6) stimulated the development of new roles and competencies for integrated care. With respect to financing, (7) secured long-term funding and innovative payments were applied as means to overcome fragmented financing of health and social care. Implementers emphasised (8) the implementation of ICT that was specifically developed to support collaboration and communication rather than administrative procedures (technology & medical devices), and (9) created feedback loops and a continuous monitoring system (information & research). The overarching mechanism was that implementers (10) engaged in alignment work across the different components and levels of the health and social care system. These evidence-based mechanisms for implementation are applicable in different local, regional and national contexts.
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Affiliation(s)
- Willemijn Looman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands.
| | - Verena Struckmann
- Department of Health Care Management, Technische Universität Berlin, Berlin, H 80, Strasse des 17, Juni 135, D-10623, Berlin, Germany.
| | - Julia Köppen
- Department of Health Care Management, Technische Universität Berlin, Berlin, H 80, Strasse des 17, Juni 135, D-10623, Berlin, Germany.
| | - Erik Baltaxe
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain.
| | - Thomas Czypionka
- Institute for Advanced Studies, Vienna, Austria, Josefstädter Straße 39, 1080, Vienna, Austria.
| | - Mirjana Huic
- Ministry of Health, Zagreb, Croatia, Ksaver 200a HR, 10000, Zagreb, Croatia.
| | - Janos Pitter
- Syreon Research Institute, Budapest, Hungary, 1142, Budapest, Mexikoi str. 65/A, Budapest, Hungary.
| | - Sabine Ruths
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Research Unit for General Practice, NORCE Norwegian Research Centre, P.O. Box 7804, 5020 Bergen, Norway.
| | - Jonathan Stokes
- Centre for Primary Care and Health Services Research, University of Manchester, 7th Floor, Williamson Building, Oxford Road, M13 9PL, Manchester, United Kingdom.
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands.
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands.
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Martín-Gutiérrez N, Sánchez-Hernández JG, Rebollo N, Pordomingo AF, Muñoz F, Otero MJ. Long-term effectiveness and pharmacokinetics of the infliximab biosimilar CT-P13 after switching from the originator during the treatment of inflammatory bowel disease. Eur J Hosp Pharm 2020; 29:222-227. [PMID: 33115797 DOI: 10.1136/ejhpharm-2020-002410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/01/2020] [Accepted: 09/29/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Switching patients from the originator infliximab to a biosimilar is a measure to expand access to treatments and counteract its negative impact on healthcare budgets. However, industry-independent long-term studies on the effect of switching in real life to support the lack of switch-related problems in inflammatory bowel disease (IBD) patients are sparse, as are studies addressing infliximab pharmacokinetic behaviour. The objectives were to investigate the effectiveness and the pharmacokinetics of CT-P13 after switching from originator infliximab in a real-world population of IBD patients with a follow-up of 2 years. METHOD Prospective, single-centre, observational 2 year study conducted in IBD adult patients with stable disease treated with the originator infliximab who were switched to CT-P13. Four time points were defined for follow-up: prior to the switch, 4-8 weeks after the switch, 8 months later, and 2 years later. Outcome measures were the proportion of patients with clinical, endoscopic and biochemical remission, and changes in biochemical inflammation markers (albumin, C-reactive protein, faecal calprotectin) and infliximab clearance. RESULTS 42 IBD patients were switched, of which 36 (85.7%) remained on CT-P13 throughout the 2 year study period. Only two patients discontinued CT-P13 due to loss of response. The proportion of patients who displayed clinical, endoscopic and biochemical remission were unchanged during the follow-up (p<0.05) and no statistically significant changes were observed in the biochemical markers of disease activity. The median (IQR) clearance estimated for the infliximab originator before the change was 0.364 (0.321-0.415) L/day, and for the CT-P13 biosimilar it was 0.361 (0.323-0.415) L/day 4-8 weeks after the change, and 0.370 (0.334-0.419) L/day 2 years after (p=0.395). CONCLUSION Switching from originator infliximab to biosimilar CT-P13 did not affect the long-term clinical outcomes or the pharmacokinetic behaviour. This information provides the clinician more evidence for the success of switching and supports non-medical switching in adult IBD patients.
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Affiliation(s)
| | - José Germán Sánchez-Hernández
- Pharmacy Service, University Hospital of Salamanca, Salamanca, Spain .,Biomedical Research Institute of Salamanca, Salamanca, Salamanca, Spain
| | - Noemí Rebollo
- Pharmacy Service, University Hospital of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca, Salamanca, Salamanca, Spain
| | - Alejandra F Pordomingo
- Biomedical Research Institute of Salamanca, Salamanca, Salamanca, Spain.,Gastroenterology Service, University Hospital of Salamanca, Salamanca, Salamanca, Spain
| | - Fernando Muñoz
- Biomedical Research Institute of Salamanca, Salamanca, Salamanca, Spain.,Gastroenterology Service, University Hospital of Salamanca, Salamanca, Salamanca, Spain
| | - María José Otero
- Pharmacy Service, University Hospital of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca, Salamanca, Salamanca, Spain
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Trankle SA, Usherwood T, Abbott P, Roberts M, Crampton M, Girgis CM, Riskallah J, Chang Y, Saini J, Reath J. Key stakeholder experiences of an integrated healthcare pilot in Australia: a thematic analysis. BMC Health Serv Res 2020; 20:925. [PMID: 33028299 PMCID: PMC7542969 DOI: 10.1186/s12913-020-05794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally. METHODS We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n = 42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts. RESULTS Key themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting. CONCLUSIONS Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.
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Affiliation(s)
- Steven A Trankle
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Tim Usherwood
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
- George Institute for Global Health, Sydney, Australia
| | - Penelope Abbott
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Mary Roberts
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
| | | | - Christian M Girgis
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | - John Riskallah
- Western Sydney Local Health District (Blacktown Hospital), Sydney, Australia
| | - Yashu Chang
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
- Western Sydney Local Health District (Blacktown Hospital), Sydney, Australia
| | - Jaspreet Saini
- Western Sydney Primary Health Network, Sydney, Australia
| | - Jennifer Reath
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Sánchez-Hernández JG, Rebollo N, Martin-Suarez A, Calvo MV, Muñoz F. A 3-year prospective study of a multidisciplinary early proactive therapeutic drug monitoring programme of infliximab treatments in inflammatory bowel disease. Br J Clin Pharmacol 2020; 86:1165-1175. [PMID: 32022291 DOI: 10.1111/bcp.14229] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 01/10/2020] [Accepted: 01/18/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS Therapeutic drug monitoring (TDM) of trough serum infliximab concentrations has been mainly used in case of loss of response in patients with inflammatory bowel disease (IBD). The aim of this study was to evaluate the effectiveness and safety of a multidisciplinary early proactive TDM (mep-TDM) programme for dose adjustment. METHODS A 3-year prospective study was conducted based on a sample of 81 patients who started treatment and were subsequently subjected to mep-TDM with the first control at week 14. Data of a historical control group of 72 patients treated with infliximab and managed with empirical dosing were included. Effectiveness variables were treatment failure, IBD-related surgery and IBD-related hospitalization. Safety variables were serious infusion reactions (SIRs) and adverse reactions. Cox regression was used for survival analysis. RESULTS In the mep-TDM study group, compared to the control group, there was a significant reduction in the risk of treatment failure (hazard ratio [HR]: 0.51; 95% confidence interval [CI]: 0.27-0.92; P = .037), IBD-related surgery (HR: 0.14; 95% CI: 0.03-0.65; P = .012) and hospitalization (HR: 0.38; 95% CI: 0.17-0.87; P = .022). SIRs were lower in the mep-TDM group (2.5% vs 10.4%; P < .050); the incidence of adverse reactions was similar (3.7% vs 3.9%; p > .999). CONCLUSION This study found that compared to empirical dosing, mep-TDM is associated with improved efficacy and safety of infliximab therapy, reduced IBD-related hospitalization and surgery and incidence of SIRs, and increasing long-term durability of treatment effects.
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Affiliation(s)
- José Germán Sánchez-Hernández
- Pharmacy Service, University Hospital of Salamanca, Spain.,Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), Spain
| | - Noemí Rebollo
- Pharmacy Service, University Hospital of Salamanca, Spain.,Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), Spain
| | - Ana Martin-Suarez
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), Spain
| | - M Victoria Calvo
- Pharmacy Service, University Hospital of Salamanca, Spain.,Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), Spain
| | - Fernando Muñoz
- Biomedical Research Institute of Salamanca (IBSAL), Spain.,Gastroenterology Service, University Hospital of Salamanca, Spain
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Donnelly LF, Frush K, Shook J, Schein PA, Schein EH. The Importance of Both the Technical and Social Domains in Creating a Culture That Accelerates Improvement in Healthcare. Health (London) 2020. [DOI: 10.4236/health.2020.1212114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hacking teamwork in health care: Addressing adverse effects of ad hoc team composition in critical care medicine. Health Care Manage Rev 2019; 46:341-348. [PMID: 31804232 DOI: 10.1097/hmr.0000000000000265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The continued need for improved teamwork in all areas of health care is widely recognized. The present article reports on the application of a hackathon to the teamwork problems specifically associated with ad hoc team formation in rapid response teams. PURPOSES Hackathons-problem-solving events pioneered in computer science-are on the rise in health care management. The focus of these events tends to be on medical technologies, however, with calls for improvements in management practices as general recommendations. The hackathon reported here contributes to health care management practice by addressing improvements in teamwork as the focal problem. METHODOLOGY The hackathon event took place over 2.5 days in conjunction with an academic conference focused on group research. Three teams comprised of practicing healthcare professionals, academic researchers and students developed solutions to problems of ad hoc team formation in rapid response teams. FINDINGS The event fulfilled several goals. The teams produced three distinct, yet complementary solutions that were backed by both field-based experience and solid research evidence. The event provided the opportunity for two-way translation of research and practice through direct collaboration among key stakeholders. The hackathon produced long term effects through establishing or strengthening collaborations, dissemination of the ideas through presentations, workshops, and publications, and changes in participantsâ work practices. PRACTICE IMPLICATION The event demonstrated that hackathons, classically focused on technology, can also offer a spur to innovation around organizational processes. The article provides advice for organizing other hackathons focused on similar topics. The solutions offered by the participants in the event yields the clear insight that multipronged solutions for emergency-oriented teamwork are needed. The hackathon highlighted the scaled of collaboration and effort needed to tackle the many complexities in health care that impact outcomes for providers, patients, and health organizations.
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Alrabie N. Integrating professionals in French multi-professional health homes: Fostering collaboration beyond the walls. Health Serv Manage Res 2019; 33:86-95. [PMID: 31248282 DOI: 10.1177/0951484819858828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Current evidence of the effectiveness of multi-disciplinary co-location for healthcare integration is mixed. This case study investigates a territorial healthcare project that is implemented across four French rural healthcare practices that co-locate multi-disciplinary healthcare practitioners. Two levels of collaboration were identified: (i) local, intra-team collaboration (i.e., care and prevention) and (ii) territorial, inter-team collaboration (i.e., patient therapeutic education and knowledge sharing). An analysis of 50 interviews with healthcare professionals uncovers important aspects of successful multi-disciplinary collaboration, which is an intermediary between co-location and care integration. By highlighting the social dimension of care integration, with a specific focus on the professional component of interpersonal integration, this study expands the theory of care integration by identifying three antecedents of multi-disciplinary collaboration: (i) prior general practitioner joint-practice experience, (ii) professional impetus (i.e., initiated by practitioners) and (iii) general practitioner peer group membership. Successful multi-disciplinary co-location and, in turn, collaboration offer a range of benefits to both patients and practitioners and advance progress towards promising perspectives, such as local competence transfer and territorial contagion.
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Affiliation(s)
- Nour Alrabie
- TSM-Research, Université Toulouse Capitole, CNRS, Toulouse, France
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11
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Eljiz K, Greenfield D, Derrett A, Radmore S. Health system redesign: Changing thoughts, values, and behaviours for the co-production of a safety culture. Int J Health Plann Manage 2019; 34:1477-1484. [PMID: 31120155 DOI: 10.1002/hpm.2798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Simultaneous incremental and revolutionary systems change is a norm for many health care organisations. Organisational redesign, incorporating physical redevelopments and technological innovations, drives revolutionary transformations. Redesigning health facilities provides opportunities for improving and sustaining safe, high-quality patient care. There is a need for the creation of knowledge, based on empirical research, to inform how to effectively plan, implement, and evaluate health organisational redesign, underpinned by co-production principles. FINDINGS Using an Australian case study, we identify and discuss the opportunities and challenges, aligned with safety and quality requirements, to undertake redesign projects. Through an analysis of redesign and governance accountabilities, we identify five key foci for health leaders, and their communities, to plan, implement and evaluate organisational redesign. CONCLUSION By rebuilding and engaging with patients and consumers to organise, manage and deliver care, the redesign process allows us to change thoughts, values, and behaviours to achieve better patient outcomes.
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Affiliation(s)
- Kathy Eljiz
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
| | - David Greenfield
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
| | - Alison Derrett
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Simon Radmore
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
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Centauri F, Mazzocato P, Villa S, Marsilio M. System-wide lean implementation in health care: A multiple case study. Health Serv Manage Res 2018; 31:60-73. [PMID: 29681169 DOI: 10.1177/0951484818768226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis. FINDINGS The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.
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Affiliation(s)
| | - Pamela Mazzocato
- 2 Department of Learning, informatics, management and ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Stefano Villa
- 3 Department of Management, Catholic University, Rome, Italy; CERISMAS (Research Centre in Health Care Management), Catholic University, Milan, Italy
| | - Marta Marsilio
- 4 Department of economics and management, University of Milan, Italy
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Villa S, Restuccia JD, Anessi-Pessina E, Rizzo MG, Cohen AB. Quality improvement strategies and tools: A comparative analysis between Italy and the United States. Health Serv Manage Res 2018; 31:205-217. [PMID: 29486603 DOI: 10.1177/0951484818755534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Italian and American hospitals, in two different periods, have been urged by external circumstances to extensively redesign their quality improvement strategies. This paper, through the use of a survey administered to chief quality officers in both countries, aims to identify commonalities and differences between the two systems and to understand which approaches are effective in improving quality of care. In both countries chief quality officers report quality improvement has become a strategic priority, clinical governance approaches, and tools-such as disease-specific quality improvement projects and clinical pathways-are commonly used, and there is widespread awareness that clinical decision making must be supported by protocols and guidelines. Furthermore, the study clearly outlines the critical importance of adopting a system-wide approach to quality improvement. To this extent Italy seems lagging behind compared to US in fact: (i) responsibilities for different dimensions of quality are spread across different organizational units; (ii) quality improvement strategies do not typically involve administrative staff; and (iii) quality performance measures are not disseminated widely within the organization but are reported primarily to top management. On the other hand, in Italy chief quality officers perceive that the typical hospital organizational structure, which is based on clinical directories, allows better coordination between clinical specialties than in the United States. In both countries, the results of the study show that it is not the single methodology/model that makes the difference but how the different quality improvement strategies and tools interact to each other and how they are coherently embedded with the overall organizational strategy.
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Affiliation(s)
- Stefano Villa
- 1 Department of Management, Università Cattolica del Sacro Cuore, Rome, Italy.,2 CERISMAS (Research Centre in Healthcare Management), Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Eugenio Anessi-Pessina
- 2 CERISMAS (Research Centre in Healthcare Management), Università Cattolica del Sacro Cuore, Milan, Italy.,4 Department of Management, Università Cattolica del Sacro Cuore, Milano, Italy
| | - Marco Giovanni Rizzo
- 1 Department of Management, Università Cattolica del Sacro Cuore, Rome, Italy.,2 CERISMAS (Research Centre in Healthcare Management), Università Cattolica del Sacro Cuore, Milan, Italy
| | - Alan B Cohen
- 3 Questrom School of Business, Boston University, Boston, MA, USA
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