1
|
García-Alonso CR, Almeda N, Salinas-Pérez JA, Gutiérrez-Colosía MR, Iruin-Sanz Á, Salvador-Carulla L. Use of a decision support system for benchmarking analysis and organizational improvement of regional mental health care: Efficiency, stability and entropy assessment of the mental health ecosystem of Gipuzkoa (Basque Country, Spain). PLoS One 2022; 17:e0265669. [PMID: 35316302 PMCID: PMC8939819 DOI: 10.1371/journal.pone.0265669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022] Open
Abstract
Decision support systems are appropriate tools for guiding policymaking processes, especially in mental health (MH), where care provision should be delivered in a balanced and integrated way. This study aims to develop an analytical process for (i) assessing the performance of an MH ecosystem and (ii) identifying benchmark and target-for-improvement catchment areas. MH provision (inpatient, day and outpatient types of care) was analysed in the Mental Health Network of Gipuzkoa (Osakidetza, Basque Country, Spain) using a decision support system that integrated data envelopment analysis, Monte Carlo simulation and artificial intelligence. The unit of analysis was the 13 catchment areas defined by a reference MH centre. MH ecosystem performance was assessed by the following indicators: relative technical efficiency, stability and entropy to guide organizational interventions. Globally, the MH system of Gipuzkoa showed high efficiency scores in each main type of care (inpatient, day and outpatient), but it can be considered unstable (small changes can have relevant impacts on MH provision and performance). Both benchmark and target-for-improvement areas were identified and described. This article provides a guide for evidence-informed decision-making and policy design to improve the continuity of MH care after inpatient discharges. The findings show that it is crucial to design interventions and strategies (i) considering the characteristics of the area to be improved and (ii) assessing the potential impact on the performance of the global MH care ecosystem. For performance improvement, it is recommended to reduce admissions and readmissions for inpatient care, increase workforce capacity and utilization of day care services and increase the availability of outpatient care services.
Collapse
Affiliation(s)
| | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
- * E-mail:
| | | | | | - Álvaro Iruin-Sanz
- Instituto Biodonostia, Red de Salud Mental Extrahospitalaria de Gipuzkoa, Donostia-San Sebastián, Spain
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| |
Collapse
|
2
|
Munir K, Oner O, Kerala C, Rustamov I, Boztas H, Juszkiewicz K, Wloszczak-Szubzda A, Kalmatayeva Z, Iskandarova A, Zeynalli S, Cibrev D, Kosherbayeva L, Miriyeva N, Jarosz MJ, Kurakbayev K, Soroka E, Mancevska S, Novruzova N, Emin M, Olajossy M, Bajraktarov S, Raleva M, Roy A, Waqar Azeem M, Bertelli M, Salvador-Carulla L, Javed A. Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries. Psychiatry Res 2022; 309:114409. [PMID: 35121341 DOI: 10.1016/j.psychres.2022.114409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 02/02/2023]
Abstract
The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.
Collapse
Affiliation(s)
- Kerim Munir
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; World Psychiatric Association, Geneva, Switzerland.
| | - Ozgur Oner
- World Psychiatric Association, Geneva, Switzerland; Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Coskun Kerala
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | | | | | - Konrad Juszkiewicz
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; Al-Farabi Kazakh National Medical University, Almaty, Kazakhstan
| | | | | | | | | | - Dragan Cibrev
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Lyazzat Kosherbayeva
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; Al-Farabi Kazakh National Medical University, Almaty, Kazakhstan
| | | | | | | | | | - Sanja Mancevska
- Faculty of Human Sciences, University of Economics and Innovation, Lublin, Poland
| | | | - Melda Emin
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | | | - Stojan Bajraktarov
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Marija Raleva
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Ashok Roy
- World Psychiatric Association, Geneva, Switzerland; Coventry and Warwickshire Partnership NHS Trust, Birmingham, UK
| | - Muhammad Waqar Azeem
- World Psychiatric Association, Geneva, Switzerland; Department of Psychiatry, Sidra Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Marco Bertelli
- World Psychiatric Association, Geneva, Switzerland; CREA (Centro Ricerca E Ambulatori), Fondazione San Sebastiano, Florence, Italy
| | - Luis Salvador-Carulla
- World Psychiatric Association, Geneva, Switzerland; Health Research Institute, Faculty of Health, University of Canberra, Australia
| | - Afzal Javed
- World Psychiatric Association, Geneva, Switzerland; Warwick Medical School, University of Warwick, UK
| |
Collapse
|
3
|
Sturmberg JP, Martin CM. How to cope with uncertainty? Start by looking for patterns and emergent knowledge. J Eval Clin Pract 2021; 27:1168-1171. [PMID: 34216085 DOI: 10.1111/jep.13596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 06/22/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Joachim P Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,International Society for Systems and Complexity Sciences for Health, Waitsfield, Vermont, USA
| | - Carmel M Martin
- Department of Medicine, Nursing and Allied Health Monash Health Clayton, Clayton, Australia
| |
Collapse
|
4
|
Hussain R, Parmenter T, Wark S, Janicki M, Knox M, Hayhoe N. Mitigating the impact of the 'silos' between the disability and aged-care sectors in Australia: Development of a Best Practice Framework. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1477-1488. [PMID: 34046986 DOI: 10.1111/jar.12890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/23/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although a 'person-centred focus' is a legislated objective for both aged-care and disability services sectors in Australia, evidence suggests limited translation into systems and practices due to entrenched silos. This paper proposes a Best Practice Framework to mitigate these silos. METHODS Mixed-methods research comprising key informant interviews with major stakeholders across both sectors; a survey of people with/without intellectual disability aged 60+ years; qualitative in-depth interviews; and survey of health professionals. RESULTS There is an urgent need to develop inter-sectoral 'integrated care systems'. Key components include choice in accommodation; regular assessment of health and well-being indicators; development and adoption of nationally consistent policies/standards across integrated aged- and disability-care sectors; improved strategies for workforce planning; and upskilling of existing staff including place-based collaboration. CONCLUSIONS An integrated service model requires collaboration on broader public policy instruments, appropriate planning and resourcing. A strategic shift is required to ensure better quality person-centred support systems.
Collapse
Affiliation(s)
- Rafat Hussain
- Australian National University, Canberra, ACT, Australia
| | | | - Stuart Wark
- University of New England, Armidale, NSW, Australia
| | | | - Marie Knox
- University of Sydney, Sydney, NSW, Australia
| | - Nicola Hayhoe
- Nicola Hayhoe, The Housing Connection, Sydney, NSW, Australia
| |
Collapse
|
5
|
Romero-Lopez-Alberca C, Alonso-Trujillo F, Almenara-Abellan JL, Salinas-Perez JA, Gutierrez-Colosia MR, Gonzalez-Caballero JL, Pinzon Pulido S, Salvador-Carulla L. A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study. J Med Internet Res 2021; 23:e24930. [PMID: 33720035 PMCID: PMC8074989 DOI: 10.2196/24930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/19/2020] [Accepted: 12/17/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND DESDE-LTC (Description and Evaluation of Services and DirectoriEs for Long-Term Care) is an international classification system that allows standardized coding and comparisons between different territories and care sectors, such as health and social care, in defined geographic areas. We adapted DESDE-LTC into a computer tool (DESDE-AND) for compiling a directory of care services in Andalucia, Spain. OBJECTIVE The aim of this study was to evaluate the maturity of DESDE-AND. A secondary objective of this study is to show the practicality of a new combined set of standard evaluation tools for measuring the maturity of health technology products. METHODS A system for semiautomated coding of service provision has been co-designed. A panel of 23 domain experts and a group of 68 end users participated in its maturity assessment that included its technology readiness level (TRL), usability, validity, adoption (Adoption Impact Ladder [AIL]), and overall degree of maturity [implementation maturity model [IMM]). We piloted the prototype in an urban environment (Seville, Spain). RESULTS The prototype was demonstrated in an operational environment (TRL 7). Sixty-eight different care services were coded, generating fact sheets for each service and its geolocation map. The observed agreement was 90%, with moderate reliability. The tool was partially adopted by the regional government of Andalucia (Spain), reaching a level 5 in adoption (AIL) and a level 4 in maturity (IMM) and is ready for full implementation. CONCLUSIONS DESDE-AND is a usable and manageable system for coding and compiling service directories and it can be used as a core module of decision support systems to guide planning in complex cross-sectoral areas such as combined social and health care.
Collapse
Affiliation(s)
- Cristina Romero-Lopez-Alberca
- Department of Psychology, Universidad de Cádiz, Cádiz, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Federico Alonso-Trujillo
- Agencia de Servicios Sociales y Dependencia de Andalucía, Junta de Andalucía, Sevilla, Spain
- Health Information Systems Group (SICA-CTS-553), Universidad de Cádiz, Cádiz, Spain
| | - Jose Luis Almenara-Abellan
- Health Information Systems Group (SICA-CTS-553), Universidad de Cádiz, Cádiz, Spain
- Hospital Universitario Reina Sofía, Servicio Andaluz de Salud, Córdoba, Spain
| | - Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | | | | | - Sandra Pinzon Pulido
- Escuela Andaluza de Salud Pública, Gobierno Regional de la Junta de Andalucía, Granada, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| |
Collapse
|
6
|
Salvador-Carulla L, Rosenberg S, Mendoza J, Tabatabaei-Jafari H. Rapid response to crisis: Health system lessons from the active period of COVID-19. HEALTH POLICY AND TECHNOLOGY 2020; 9:578-586. [PMID: 32874862 PMCID: PMC7450947 DOI: 10.1016/j.hlpt.2020.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This paper outlines the need for a health systems approach and rapid response strategy for gathering information necessary for policy decisions during pandemics and similar crises. It suggests a new framework for assessing the phases of the pandemic. METHOD The paper draws its information and conclusions from a rapid synthesis and translation process (RSTP) of a series of webinars and online discussions from the Pandemic-Mental Health International Network (Pan-MHIN) - policy experts from across 16 locations in Australia, Denmark, Italy, Spain, Taiwan, the UK and the USA. While the initial focus of this research was on mental health, COVID-19 has raised much broader issues and questions for health planners. RESULTS We identified gaps affecting the capacity to respond effectively and quickly, including in relation to system indicators, the inadequacy of the prior classification of the phases of the pandemic, the absences of a healthcare ecosystem approach, and the quick shift to digital technologies. The strengths and weaknesses of COVID-19 responses across different systems, services, sites and countries been identified and compared, including both low and high impacted areas. CONCLUSIONS There is an urgent need for managerial epidemiology based on healthcare ecosystem research encompassing multidisciplinary teams, visualization tools and decision analytics for rapid response. Policy and healthcare context played a key role in the response to COVID-19. Its severity, the containment measures and the societal response varied greatly across sites and countries. Understanding this variation is vital to assess the impact of COVID-19 in specific areas such as ageing or mental health.
Collapse
Affiliation(s)
- Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd, Acton ACT 2601 Australia
| | - Sebastian Rosenberg
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd, Acton ACT 2601 Australia
- Mental Health Policy Unit, Brain & Mind Centre, University of Sydney, Australia
| | - John Mendoza
- Faculty of Medicine, University of Sydney, Australia
- Mental Health Centre, Adelaide Local Health Network, Australia
| | - Hossein Tabatabaei-Jafari
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd, Acton ACT 2601 Australia
| |
Collapse
|
7
|
Abstract
Kurt Schneider introduced in the definition of the first-rank symptoms (FRS) the criterion that, where unequivocally present, the FRS are always psychological primaries and irreducible. This criterion, grounded on 'phenomenology' (description of subjective experiences), cannot be applied, according to Schneider, to delusions, either two-stage FRS delusional perception, or second-rank delusional notions. The Schneider's key criterion was neglected since the initial adoption of the 'Schneider's FRS' in the subsequent international literature (e.g. PSE, RDC, DSM, and ICD). The 'Schneider's FRS' (e.g. thought insertion, thought withdrawal, passivity, and influence) were persistently equivocated as 'delusions', in spite of the Schneider's FRS exclusion criterion. The internationally equivocated 'Schneider's FRS' (only homonymous of the original 'Schneider's FRS'), were eliminated in the DSM-5 and de-emphasized in ICD-11. However, the diagnostic value of the original 'Schneider's FRS', assessed on the basis of the strict compliance with the Schneider's criterion for their definition, was never determined. The 'damnatio memoriae' of the original Schneider's FRS may be premature. The definition and assessment of the 'experienced' symptoms of schizophrenia, only directly observed and reported by the patients, represent a specific, crucial, irreplaceable domain of psychopathology, to be carefully distinguished from the domain of the 'behavioral' symptoms observed by the clinician. Contemporary psychopathology research is aware of the absolute need for psychiatry to enhance precision and exactness in the definition of the experienced symptoms of schizophrenia, through the formulation of unequivocal inclusion and exclusion criteria (descriptive micro-psychopathology), in order to determine their value in research and care.
Collapse
|
8
|
Furst MA, Bagheri N, Salvador-Carulla L. An ecosystems approach to mental health services research. BJPsych Int 2020; 18:23-25. [PMID: 34287396 PMCID: PMC8274404 DOI: 10.1192/bji.2020.24] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/24/2020] [Accepted: 03/24/2020] [Indexed: 11/23/2022] Open
Abstract
Mental health ecosystems research is an emerging discipline which takes a whole-systems approach to mental healthcare, facilitating analysis of the complex environment and context of mental health systems, and translation of this knowledge into policy and practice. Evidence from the local context is needed in the analysis of complex interventions and of geographic variations in the outcomes of care. Technical tools and support have been developed to gather and interpret evidence from the local context and translate it in a meaningful and relevant manner for planners and policy makers to guide their decision-making.
Collapse
Affiliation(s)
- Mary Anne Furst
- Australian National University College of Health and Medicine.
| | - Nasser Bagheri
- Australian National University College of Health and Medicine.
| | | |
Collapse
|
9
|
Fortune N, Badland H, Clifton S, Emerson E, Rachele J, Stancliffe RJ, Zhou Q, Llewellyn G. The Disability and Wellbeing Monitoring Framework: data, data gaps, and policy implications. Aust N Z J Public Health 2020; 44:227-232. [PMID: 32311191 DOI: 10.1111/1753-6405.12983] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To develop a framework and indicators to monitor inequalities in health and the social determinants of health for Australians with disability. METHODS The development drew on existing frameworks and input from people with lived experience of disability. RESULTS The Disability and Wellbeing Monitoring Framework has 19 domains. Australian national data are available for 73% of the 128 indicators in these domains. Data gaps and limitations include the absence of national data and the absence of disability identifiers in some data sources. CONCLUSIONS The framework will be used to report baseline data for people with and without disability and to monitor inequalities over time in Australia. It will also be used to locate policy priorities and focus efforts to address data gaps. Implications for public health: Inequality between people with and without disability in relation to health and the social determinants of health is a public health issue that warrants greater attention than it has received to date. The framework provides a robust, evidence-informed tool to address the health inequalities of people with disability, inform the development of effective policy and practice responses, and monitor change over time.
Collapse
Affiliation(s)
- Nicola Fortune
- Centre for Disability Research and Policy, University of Sydney, New South Wales
| | | | - Shane Clifton
- Centre for Disability Research and Policy, University of Sydney, New South Wales
| | - Eric Emerson
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, UK
| | - Jerome Rachele
- Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | - Roger J Stancliffe
- Centre for Disability Research and Policy, University of Sydney, New South Wales
| | - Qingsheng Zhou
- Centre for Disability Research and Policy, University of Sydney, New South Wales
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, University of Sydney, New South Wales
| |
Collapse
|
10
|
A scoping review to characterize bridging tasks in the literature on aging with disability. BMC Health Serv Res 2020; 20:170. [PMID: 32131826 PMCID: PMC7057667 DOI: 10.1186/s12913-020-5046-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/26/2020] [Indexed: 01/16/2023] Open
Abstract
Background Bridging involves improving knowledge sharing and collaboration across different fields, such as aging and disability. The objectives of this review were to describe: 1) the contexts where bridging has occurred in relation to delivery of health services for adults aging with neurological or developmental conditions; and 2) characterize and map bridging tasks, stakeholders involved, and outcomes discussed in peer-reviewed literature. Methods Seven databases were searched around the core concepts of “bridging,” “aging,” and “disability.” In total, 10,819 articles were screened with 49 meeting the inclusion criteria of discussing aging with developmental or neurological disability, explicitly describing bridging tasks, published in English and a peer-reviewed publication. Bibliographic information, sample characteristics, and data on bridging was extracted and included in the qualitative synthesis. Results Intellectual and/or Developmental disabilities were the most studied population (76% of articles), and most articles were published in the United States (57%). Twenty-two bridging tasks were identified, and categorized into three domains: health and social service delivery (e.g., care coordination tasks), policy (e.g., policy change), and research and training (e.g., mentoring). Stakeholders involved ranged from health care professionals to policy makers and organizations in aging and disability services. Conclusions The resulting matrix will assist in the specification of bridging in research and practice. Future work should evaluate specific models of bridging and their effects on health service delivery.
Collapse
|
11
|
Sturmberg JP. Evidence-based medicine-Not a panacea for the problems of a complex adaptive world. J Eval Clin Pract 2019; 25:706-716. [PMID: 30887648 DOI: 10.1111/jep.13122] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/13/2019] [Indexed: 12/26/2022]
Abstract
The recent sacking of Peter Gøtzsche from the Cochrane Collaboration Board raised strong responses and highlights the neglected issue about priorities-maintaining the reputation of the organization or vigorously debating the merits of scientific approaches to find answers to complex problems? The Cochrane approach hales the randomized trial (RCT) as the gold standard research approach and affirms that meta-analysis provides the ultimate proof (or platinum standard) to settle contentious issues confronting the clinician. However, most published medical research is wrong, and critics coined the acronym GIGO (garbage in, garbage out) as a meme to highlight the risks of blind faith in the hyped-up procedures of the EBM movement. This paper firstly explores the differences between the prevailing scientific method arising from the linear cause-and-effect assumption and the complex adaptive systems science methods arising from observations that most phenomena emerge from nonlinearity in networked systems. Most medical conditions are characterized by necessary features that by themselves are not sufficient to explain their nature and behaviour. Such nonlinear phenomena require modelling approaches rather than linear statistical and/or meta-analysis approaches to be understood. These considerations also highlight that research is largely stuck at the data and information levels of understanding which fails clinicians who depend on knowledge-the synthesis of information-to apply in an adaptive way in the clinical encounter. Clinicians are constantly confronted with the linked challenges of doing things right and doing the right thing for their patients. EBM and Cochrane with their restrictive approaches are the antithesis to a practice of medicine that is responsive to constantly changing patient needs. As such, the EBM/Cochrane crisis opens a window of opportunity to re-examine the nature of health, illness and disease, and the nature of health care and its systems for the benefits of its professionals and their patients. We are at the cusp of a paradigmatic shift towards an understanding a praxis of health care that takes account of its complexities.
Collapse
Affiliation(s)
- Joachim P Sturmberg
- School of Medicine and Public Health, University of Newcastle, Wamberal, NSW, Australia
| |
Collapse
|
12
|
Chung Y, Salvador-Carulla L, Salinas-Pérez JA, Uriarte-Uriarte JJ, Iruin-Sanz A, García-Alonso CR. Use of the self-organising map network (SOMNet) as a decision support system for regional mental health planning. Health Res Policy Syst 2018; 16:35. [PMID: 29695248 PMCID: PMC5922302 DOI: 10.1186/s12961-018-0308-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Decision-making in mental health systems should be supported by the evidence-informed knowledge transfer of data. Since mental health systems are inherently complex, involving interactions between its structures, processes and outcomes, decision support systems (DSS) need to be developed using advanced computational methods and visual tools to allow full system analysis, whilst incorporating domain experts in the analysis process. In this study, we use a DSS model developed for interactive data mining and domain expert collaboration in the analysis of complex mental health systems to improve system knowledge and evidence-informed policy planning. Methods We combine an interactive visual data mining approach, the self-organising map network (SOMNet), with an operational expert knowledge approach, expert-based collaborative analysis (EbCA), to develop a DSS model. The SOMNet was applied to the analysis of healthcare patterns and indicators of three different regional mental health systems in Spain, comprising 106 small catchment areas and providing healthcare for over 9 million inhabitants. Based on the EbCA, the domain experts in the development team guided and evaluated the analytical processes and results. Another group of 13 domain experts in mental health systems planning and research evaluated the model based on the analytical information of the SOMNet approach for processing information and discovering knowledge in a real-world context. Through the evaluation, the domain experts assessed the feasibility and technology readiness level (TRL) of the DSS model. Results The SOMNet, combined with the EbCA, effectively processed evidence-based information when analysing system outliers, explaining global and local patterns, and refining key performance indicators with their analytical interpretations. The evaluation results showed that the DSS model was feasible by the domain experts and reached level 7 of the TRL (system prototype demonstration in operational environment). Conclusions This study supports the benefits of combining health systems engineering (SOMNet) and expert knowledge (EbCA) to analyse the complexity of health systems research. The use of the SOMNet approach contributes to the demonstration of DSS for mental health planning in practice. Electronic supplementary material The online version of this article (10.1186/s12961-018-0308-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Younjin Chung
- Faculty of Engineering & Information Technologies, The University of Sydney, 1 Cleveland Street, Darlington, NSW, 2008, Australia. .,ANU College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia.
| | - Luis Salvador-Carulla
- Faculty of Health Sciences, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.,ANU College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia
| | - José A Salinas-Pérez
- PSICOST Research Association, Universidad Loyola Andalucía, C/Energía Solar, 1 Edificio G, 41014, Sevilla, Spain
| | - Jose J Uriarte-Uriarte
- Bizkaia Mental Health Services, Osakidetza-Basque Health Service, Biocruces Health Research Institute, Calle Maria Diaz de Haro, 58, 48010, Bilbao, Spain
| | - Alvaro Iruin-Sanz
- Gipuzkoa Mental Health Services, Osakidetza - Basque Health Service, Biocruces Health Research Institute, Paseo Doctor Beguiristain, 115, 20014, San Sebastian, Spain
| | - Carlos R García-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, C/Escritor Castilla Aguayo, 4, 14004, Córdoba, Spain
| |
Collapse
|
13
|
Serrano-Blanco A, Rubio-Valera M, Aznar-Lou I, Baladón Higuera L, Gibert K, Gracia Canales A, Kaskens L, Ortiz JM, Salvador-Carulla L. In-patient costs of agitation and containment in a mental health catchment area. BMC Psychiatry 2017; 17:212. [PMID: 28583103 PMCID: PMC5460463 DOI: 10.1186/s12888-017-1373-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. METHODS A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability. RESULTS During 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area. CONCLUSIONS Agitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.
Collapse
Affiliation(s)
- Antoni Serrano-Blanco
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Rubio-Valera
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Ignacio Aznar-Lou
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luisa Baladón Higuera
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
| | - Karina Gibert
- Statistics and Operations Research Department, Knowledge Engineering and Machine Learning group, Universitat Politècnica de Catalunya-Barcelona Tech, Barcelona, Spain
| | | | | | - José Miguel Ortiz
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Medicine, Biology & Environment, The Australian National University, Canberra, Australia
| |
Collapse
|
14
|
Salvador-Carulla L, Lukersmith S, Sullivan W. From the EBM pyramid to the Greek temple: a new conceptual approach to Guidelines as implementation tools in mental health. Epidemiol Psychiatr Sci 2017; 26:105-114. [PMID: 28290273 PMCID: PMC6998697 DOI: 10.1017/s2045796016000767] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Guideline methods to develop recommendations dedicate most effort around organising discovery and corroboration knowledge following the evidence-based medicine (EBM) framework. Guidelines typically use a single dimension of information, and generally discard contextual evidence and formal expert knowledge and consumer's experiences in the process. In recognition of the limitations of guidelines in complex cases, complex interventions and systems research, there has been significant effort to develop new tools, guides, resources and structures to use alongside EBM methods of guideline development. In addition to these advances, a new framework based on the philosophy of science is required. Guidelines should be defined as implementation decision support tools for improving the decision-making process in real-world practice and not only as a procedure to optimise the knowledge base of scientific discovery and corroboration. A shift from the model of the EBM pyramid of corroboration of evidence to the use of broader multi-domain perspective graphically depicted as 'Greek temple' could be considered. This model takes into account the different stages of scientific knowledge (discovery, corroboration and implementation), the sources of knowledge relevant to guideline development (experimental, observational, contextual, expert-based and experiential); their underlying inference mechanisms (deduction, induction, abduction, means-end inferences) and a more precise definition of evidence and related terms. The applicability of this broader approach is presented for the development of the Canadian Consensus Guidelines for the Primary Care of People with Developmental Disabilities.
Collapse
Affiliation(s)
- L. Salvador-Carulla
- Mental Health Policy Unit, Brain and Mind Centre, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - S. Lukersmith
- Mental Health Policy Unit, Brain and Mind Centre, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - W. Sullivan
- Department of Family & Community Medicine, Medical Services, Surrey Place Centre, St. Michael's Hospital, Toronto, Canada
| |
Collapse
|
15
|
Lukersmith S, Hopman K, Vine K, Krahe L, McColl A. A new framing approach in guideline development to manage different sources of knowledge. J Eval Clin Pract 2017; 23:66-72. [PMID: 27198591 DOI: 10.1111/jep.12566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/17/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022]
Abstract
RATIONALE Contemporary guideline methodology struggles to consider context and information from different sources of knowledge besides quantitative research. Return to work programmes involve multiple components and stakeholders. If the guideline is to be relevant and practical for a complex intervention such as return to work, it is essential to use broad sources of knowledge. AIMS AND OBJECTIVE This paper reports on a new method in guideline development to manage different sources of knowledge. METHODS The method used framing for the return-to-work guidance within the Clinical Practice Guidelines for the Management of Rotator Cuff Syndrome in the Workplace. The development involved was a multi-disciplinary working party of experts including consumers. The researchers considered a broad range of research, expert (practice and experience) knowledge, the individual's and workplace contexts, and used framing with the International Classification of Functioning, Disability and Health. Following a systematic database search on four clinical questions, there were seven stages of knowledge management to extract, unpack, map and pack information to the ICF domains framework. Companion graded recommendations were developed. RESULTS The results include practical examples, user and consumer guides, flow charts and six graded or consensus recommendations on best practice for return to work intervention. CONCLUSIONS Our findings suggest using framing in guideline methodology with internationally accepted frames such as the ICF is a reliable and transparent framework to manage different sources of knowledge. Future research might examine other examples and methods for managing complexity and using different sources of knowledge in guideline development.
Collapse
Affiliation(s)
| | | | - Kristina Vine
- University of New South Wales Rural Clinical School, Port Macquarie, Australia
| | - Lee Krahe
- University of New South Wales Rural Clinical School, Port Macquarie, Australia
| | - Alexander McColl
- University of New South Wales Rural Clinical School, Port Macquarie, Australia
| |
Collapse
|
16
|
Gupta VK, Wander P, Gupta M. Is evidence-based medicine a gold standard or can it be influenced? Indian Heart J 2016; 68:747-748. [PMID: 27773419 PMCID: PMC5079202 DOI: 10.1016/j.ihj.2016.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 05/31/2016] [Indexed: 11/23/2022] Open
Affiliation(s)
- Vitull K Gupta
- Kishori Ram Hospital and Diabetes Care Centre, India; AIMSR, India.
| | - Praneet Wander
- Department of Medicine, Mount Sinai St Lukes Roosevelt Hospital, New York, United States
| | - Meghna Gupta
- Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| |
Collapse
|
17
|
Abstract
The description of case management in research and clinical practice is highly variable which impedes quality analysis, policy and planning. Case management makes a unique contribution towards the integration of health care, social services and other sector services and supports for people with complex health conditions. There are multiple components and variations of case management depending on the context and client population. This paper aims to scope and map case management in the literature to identify how case management is described in the literature for key complex health conditions (e.g., brain injury, diabetes, mental health, spinal cord injury). Following literature searches in multiple databases, grey literature and exclusion by health condition, community-based and adequate description, there were 661 potential papers for data extraction. Data from 79 papers (1988–2013) were analysed to the point of saturation (no new information) and mapped to the model, components and activities. The results included 22 definitions, five models, with 69 activities or tasks of case managers mapped to 17 key components (interventions). The results confirm the significant terminological variance in case management which produces role confusion, ambiguity and hinders comparability across different health conditions and contexts. There is an urgent need for an internationally agreed taxonomy for the coordination, navigation and management of care.
Collapse
|
18
|
Bertelli MO, Munir K, Harris J, Salvador-Carulla L. "Intellectual developmental disorders": reflections on the international consensus document for redefining "mental retardation-intellectual disability" in ICD-11. Adv Ment Health Intellect Disabil 2016; 10:36-58. [PMID: 27066217 PMCID: PMC4822711 DOI: 10.1108/amhid-10-2015-0050] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The debate as to whether intellectual disability (ID) should be conceptualized as a health condition or as a disability has intensified as the revision of World Health Organization's (WHO's) International Classification of Diseases (ICD) is being finalized. Defining ID as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. The purpose of this paper is to include some reflections on the consensus document produced by the first WHO Working Group on the Classification of MR (WHO WG-MR) and on the process that was followed to realize it. The consensus report was the basis for the development of official recommendations sent to the WHO Advisory Group for ICD-11. DESIGN/METHODOLOGY/APPROACH A mixed qualitative approach was followed in a series of meetings leading to the final consensus report submitted to the WHO Advisory group. These recommendations combined prior expert knowledge with available evidence; a nominal approach was followed throughout with face-to-face conferences. FINDINGS The WG recommended a synonym set ("synset") ontological approach to the conceptualisation of this health condition underlying a clinical rationale for its diagnosis. It proposed replacing MR with Intellectual Developmental Disorders (IDD) in ICD-11, defined as "a group of developmental conditions characterized by a significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills". The WG further advised that IDD be included under the parent category of neurodevelopmental disorders, that current distinctions (mild, moderate, severe and profound) be continued as severity qualifiers, and that problem behaviours removed from its core classification structure and instead described as associated features. ORIGINALITY/VALUE Within the ID/IDD synset two different names combine distinct aspects under a single construct that describes its clinical as well as social, educational and policy utilities. The single construct incorporates IDD as a clinical meta-syndrome, and ID as its functioning and disability counterpart. IDD and ID are not synonymous or mirror concepts as they have different scientific, social and policy applications. New diagnostic criteria for IDD should be based on a developmental approach, which accounts for the complex causal factors known to impact the acquisition of specific cognitive abilities and adaptive behaviours. The paper focuses on a new clinical framework for the diagnosis of IDD that also includes and complements the existing social, educational and policy components inherent in ID.
Collapse
Affiliation(s)
- Marco O Bertelli
- Scientific Director at CREA, Research and Clinical Centre, San Sebastiano Foundation, Florence, Italy and President at EAMHID, European Association for Mental Health in Intellectual Disability, Florence, Italy
| | - Kerim Munir
- Developmental Medicine Center, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James Harris
- School of Medicine, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland. USA
| | - Luis Salvador-Carulla
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia and Mental Health Policy Unit, Brain and Mind Institute, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| |
Collapse
|
19
|
Health services use and costs in people with intellectual disability: building a context knowledge base for evidence-informed policy. Curr Opin Psychiatry 2016; 29:89-94. [PMID: 26808613 DOI: 10.1097/yco.0000000000000237] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We summarize the research published between 2011 and 2015 in healthcare utilization and costs for persons with intellectual disabilities/intellectual developmental disorders with a particular focus on context studies for evidence-informed policy. RECENT FINDINGS Persons with intellectual disability show higher unmet needs and lower use of promotion and prevention services and generic health services. Use of generic psychiatric services varies across countries. Persons with intellectual disability and comorbid mental disorders have the highest rates of specialized service use, costs, and unmet needs. International and national cost-of-illness studies show the high impact of intellectual disability in the total direct health costs of mental disorders at least in Europe. On the contrary, the burden-of-illness studies show conflicting results in intellectual disability. SUMMARY Contextual studies of healthcare and costs have improved the knowledge base for evidence-informed planning in intellectual disability in a number of countries. However, only two of these studies have used local atlases of healthcare for improving decision making. The paucity of information on prevalence, comorbidity, and demographic indicators hampers the advance of evidence-informed policy in intellectual disability.
Collapse
|
20
|
Fernandez A, Sturmberg J, Lukersmith S, Madden R, Torkfar G, Colagiuri R, Salvador-Carulla L. Evidence-based medicine: is it a bridge too far? Health Res Policy Syst 2015; 13:66. [PMID: 26546273 PMCID: PMC4636779 DOI: 10.1186/s12961-015-0057-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 10/29/2015] [Indexed: 01/28/2023] Open
Abstract
AIMS This paper aims to describe the contextual factors that gave rise to evidence-based medicine (EBM), as well as its controversies and limitations in the current health context. Our analysis utilizes two frameworks: (1) a complex adaptive view of health that sees both health and healthcare as non-linear phenomena emerging from their different components; and (2) the unified approach to the philosophy of science that provides a new background for understanding the differences between the phases of discovery, corroboration, and implementation in science. RESULTS The need for standardization, the development of clinical epidemiology, concerns about the economic sustainability of health systems and increasing numbers of clinical trials, together with the increase in the computer's ability to handle large amounts of data, have paved the way for the development of the EBM movement. It was quickly adopted on the basis of authoritative knowledge rather than evidence of its own capacity to improve the efficiency and equity of health systems. The main problem with the EBM approach is the restricted and simplistic approach to scientific knowledge, which prioritizes internal validity as the major quality of the studies to be included in clinical guidelines. As a corollary, the preferred method for generating evidence is the explanatory randomized controlled trial. This method can be useful in the phase of discovery but is inadequate in the field of implementation, which needs to incorporate additional information including expert knowledge, patients' values and the context. CONCLUSION EBM needs to move forward and perceive health and healthcare as a complex interaction, i.e. an interconnected, non-linear phenomenon that may be better analysed using a variety of complexity science techniques.
Collapse
Affiliation(s)
- Ana Fernandez
- Brain and Mind Centre, Faculty of Health Sciences, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Joachim Sturmberg
- Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.
| | - Sue Lukersmith
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Rosamond Madden
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Ghazal Torkfar
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Ruth Colagiuri
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Luis Salvador-Carulla
- Centre for Disability Research and Policy-Brain and Mind Centre, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| |
Collapse
|
21
|
Lukersmith S, Fernandez A, Millington M, Salvador-Carulla L. The brain injury case management taxonomy (BICM-T); a classification of community-based case management interventions for a common language. Disabil Health J 2015; 9:272-80. [PMID: 26616541 DOI: 10.1016/j.dhjo.2015.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 07/08/2015] [Accepted: 09/21/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Case management is a complex intervention. Complexity arises from the interaction of different components: the model (theoretical basis), implementation context (service), population and health condition, focus for the intervention (client and/or their family), case manager's actions (interventions) and the target of case management (integrated care and support, client's community participation). There is a lack of understanding and a common language. To our knowledge there is no classification (taxonomy) for community-based case management. OBJECTIVE To develop a community-based case management in brain injury taxonomy (BICM-T), as a common language and understanding of case management for use in quality analysis, policy, planning and practice. METHODS The mixed qualitative methods used multiple sources of knowledge including scoping, framing and a nominal group technique to iteratively develop the Beta version (draft) of the taxonomy. A two part developmental evaluation involving case studies and mapping to international frameworks assessed the applicability and acceptability (feasibility) before finalization of the BICM-T. RESULTS The BICM-T includes a definition of community-based case management, taxonomy trees, tables and a glossary. The interventions domain tree has 9 main actions (parent category): engagement, holistic assessment, planning, education, training and skills development, emotional and motivational support, advising, coordination, monitoring; 17 linked actions (children category); 8 related actions; 63 relevant terms defined in the glossary. CONCLUSIONS The BICM-T provides a knowledge map with the definitions and relationships between the core actions (interventions domain). Use of the taxonomy as a common language will benefit practice, quality analysis, evaluation, policy, planning and resource allocation.
Collapse
Affiliation(s)
- Sue Lukersmith
- Faculty of Health Sciences, Centre for Disability Research and Policy, University of Sydney, Australia; Lifetime Care & Support Authority, Australia.
| | - Ana Fernandez
- Faculty of Health Sciences, Centre for Disability Research and Policy, Brain and Mind Research Institute, University of Sydney, Australia
| | - Michael Millington
- Faculty of Health Sciences, Centre for Disability Research and Policy, University of Sydney, Australia
| | - Luis Salvador-Carulla
- Faculty of Health Sciences, Centre for Disability Research and Policy, Brain and Mind Research Institute, University of Sydney, Australia
| |
Collapse
|