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McKnight L, Schultz A, Vidic N, Palmer EE, Jaffe A. Learning to make a difference for chILD: Value creation through network collaboration and team science. Pediatr Pulmonol 2024; 59:2257-2266. [PMID: 36855907 DOI: 10.1002/ppul.26377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/20/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
Addressing the recognized challenges and inequalities in providing high quality healthcare for rare diseases such as children's interstitial lung disease (chILD) requires collaboration across institutional, geographical, discipline, and system boundaries. The Children's Interstitial Lung Disease Respiratory Network of Australia and New Zealand (chILDRANZ) is an example of a clinical network that brings together multidisciplinary health professionals for collaboration, peer learning, and advocacy with the goal of improving the diagnosis and management of this group of rare and ultra-rare conditions. This narrative review explores the multifaceted benefits arising from social learning spaces within rare disease clinical networks by applying the value creation framework. The operation of the chILDRANZ network is used as an example across the framework to highlight how value is generated, realized, and transferred within such collaborative clinical and research networks. The community of practice formed in the chILDRANZ multidisciplinary meetings provides a strong example of social learning that engages with the uncertainty inherent in rare disease diagnosis and management and pays attention to generate new knowledge and best practice to make a difference for children and families living with chILD. This review underscores international calls for further investment in, and support of, collaborative clinical networks and virtual centers of excellence for rare disease.
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Affiliation(s)
- Lauren McKnight
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - André Schultz
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Nada Vidic
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Respiratory Department, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Vočanec D, Džakula A. Beyond the business-to-client model: how the business-to-business model can transform the complex patient care. Croat Med J 2024; 65:400-402. [PMID: 39219205 PMCID: PMC11399726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Affiliation(s)
- Dorja Vočanec
- Dorja Vočanec, Department of Social Medicine and Organization of Health Care, Andrija Štampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia,
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Bammert P, Franke S, Flemming R, Iashchenko I, Brittner M, Gerlach R, Voß K, Sundmacher L. Comparing the quality of care in physician networks to usual care for elderly patients in three German regions: a quasi-experimental cohort study. Public Health 2024; 232:161-169. [PMID: 38788492 DOI: 10.1016/j.puhe.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVES Patients in Germany have free choice of physicians in the ambulatory care sector and can consult them as often as they wish without a referral. This can lead to inefficiencies in treatment pathways. In response, some physicians have formed networks to improve the coordination and quality of care. This study aims to investigate whether the care provided by these networks results in better health and process outcomes than usual care. STUDY DESIGN This was a quasi-experimental cohort study. METHODS We analysed claims data from 2017 to 2018 in Bavaria, Brandenburg, and Westphalia-Lippe. Our study population includes patients aged 65 years or older with heart failure (n = 267,256), back pain (n = 931,672), or depression (n = 483,068). We compared condition-specific and generic quality indicators between patients treated in physician networks and usual care. Ambulatory care-sensitive emergency department cases were used as a primary outcome measure. Imbalances between the groups were minimized using propensity score matching. RESULTS Rates of ambulatory care-sensitive emergency department cases yielded insignificant differences between networks and usual care in the depression and heart failure subgroups. For back pain patients, rates were 0.17 percentage points higher (P < 0.01) in network patients compared with usual care. Among network patients, generic indicators for prevention and coordination showed significantly better performance. For instance, the rate of completed vaccination against influenza is 3.03 percentage points higher (P < 0.01), and the rate of specialist visits after referral is 1.6 percentage points higher (P < 0.01) in heart failure patients, who are treated in physician networks. This is accompanied by higher rates of polypharmacy. Furthermore, the results for condition-specific indicators suggest that for most indicators, a greater proportion of the care provided by physician networks adhered to national treatment guidelines. CONCLUSIONS Our findings suggest that physician networks in Germany do not reduce rates of ambulatory care-sensitive emergency department cases but perform better than usual care in terms of care coordination and prevention. Further research is needed to confirm our findings and explore the implications of the potentially higher rates of polypharmacy seen in physician networks.
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Affiliation(s)
- P Bammert
- School of Medicine and Health, Technical University of Munich, Munich, Germany.
| | - S Franke
- School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - R Flemming
- School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - I Iashchenko
- School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - M Brittner
- Association of Statutory Health Insurance Physicians Westphalia-Lippe, Dortmund, Germany
| | - R Gerlach
- Association of Statutory Health Insurance Physicians Bavaria, Munich, Germany
| | - K Voß
- Association of Statutory Health Insurance Physicians Brandenburg, Potsdam, Germany
| | - L Sundmacher
- School of Medicine and Health, Technical University of Munich, Munich, Germany
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Röwer HAA, Herbst FA, Schwabe S. Regional hospice and palliative care networks worldwide: scoping review. BMJ Support Palliat Care 2024:spcare-2024-004974. [PMID: 38936971 DOI: 10.1136/spcare-2024-004974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Regional hospice and palliative care networks (RHPCNs) are increasingly being established to improve integrative care for patients with life-limiting illnesses. This scoping review aimed at identifying and synthesising international literature on RHPCNs, focusing on structures, outcomes, benefits, success factors and good practices. METHOD Following Arksey and O'Malley's (2005) framework, a search of four electronic databases (CINAHL, Google Scholar, PubMed, Web of Science Core Collection) was conducted on 7 July 2023. Additionally, a manual search of reference lists of the identified articles was performed. Original research, qualification theses and descriptive reports on RHPCNs at a structural level were included. FINDINGS Two researchers analysed 777 article abstracts, screened 104 full texts and selected 24 articles. The included studies predominantly used qualitative designs. RHPCNs self-identify as local stakeholders, employ coordination offices and steering committees, and actively recruit network partners. Outcomes included improved professional practices, enhanced quality of care, increased patient utilisation of regional care offerings and improved patient transitions between care providers. Success factors included clear coordination, transparent communication, strategic planning and resource-securing strategies. CONCLUSIONS The analysis identified key RHPCN success factors such as effective communication and adaptive leadership. Despite the need for further research, the findings emphasise RHPCNs' potential to improve palliative care and encourage policymaker support. OTHER This scoping review is part of the research project HOPAN, which aims at assessing and analysing RHPCNs in Germany. The project is funded by the German Innovation Fund of the Federal Joint Committee (G-BA) (Grant N° 01VSF22042; funding period: 01/2023-12/2024).
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Affiliation(s)
- Hanna A A Röwer
- Institute for General Practice and Palliative Care, Hanover Medical School, Hanover, Germany
| | - Franziska A Herbst
- Institute for General Practice and Palliative Care, Hanover Medical School, Hanover, Germany
| | - Sven Schwabe
- Institute for General Practice and Palliative Care, Hanover Medical School, Hanover, Germany
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Gernert M, Fohr G, Schaller A. Network development in workplace health promotion - empirically based insights from a cross-company network promoting physical activity in Germany. BMC Public Health 2024; 24:1560. [PMID: 38858699 PMCID: PMC11165875 DOI: 10.1186/s12889-024-19025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/31/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND In the field of health promotion, interorganisational networks are of growing relevance. However, systematic and target-oriented network management is of utmost importance for network development. The aim of this article is to report on the development of a cross-company network promoting physical activity, and to identify necessary activities and competencies for a systematic network management. METHODS The network was systematically planned and implemented in a German technology park comprising different companies. To assess and describe the development of the network, quantitative social network analysis was conducted. To answer the question on the activities and competencies for systematic network development semi-structured interviews with participating stakeholders, and a focus group discussion with health promotion experts were conducted. The interviews were analysed deductively and inductively with the structuring content analysis method and the focus group discussion was analysed deductively by summarising key aspects of the discussion. RESULTS Network metrics showed that the network became larger and denser during the planning phase, and stagnated during the implementation phase. As key facilitators for network development, participation of all stakeholders, a kick-off event, and the driving role of a network manager were identified. Necessary activities of the network manager were related to structural organisation, workplace health promotion offers, and cross-sectional tasks. The results suggested that not only professional and methodological competencies, but also social and self-competencies were required by the manager. CONCLUSIONS Our study provides initial guidance regarding the activities and required competencies of an interorganisational network manager. The results are of particular relevance for the context of workplace health promotion, since a network manager can be considered as a driving role for planning and implementing a cross-company network. TRIAL REGISTRATION The study is registered in the German Clinical Trials Register (DRKS00020956, 18/06/2020).
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Affiliation(s)
- Madeleine Gernert
- Department of Neurology, Psychosomatic Medicine, and Psychiatry, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany.
| | - Gabriele Fohr
- Institut für qualifizierende Innovationsforschung und -beratung GmbH, Bad Neuenahr-Ahrweiler, Germany
| | - Andrea Schaller
- Institute of Sport Science, Department of Human Sciences, University of the Bundeswehr Munich, Neubiberg, Germany
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Kornelsen J, Cameron A, Stoll K, Skinner T, Humber N, Williams K, Ebert S. A mixed-methods descriptive study on the role of continuous quality improvement in rural surgical and obstetrical stability: Considering enablers, challenges and impact. PLoS One 2024; 19:e0300977. [PMID: 38843178 PMCID: PMC11156343 DOI: 10.1371/journal.pone.0300977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/07/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION The Rural Surgical Obstetrical Networks (RSON) initiative in BC was developed to stabilize and grow low volume rural surgical and obstetrical services. One of the wrap-around supportive interventions was funding for Continuous Quality Improvement (CQI) initiatives, done through a local provider-driven lens. This paper reviews mixed-methods findings on providers' experiences with CQI and the implications for service stability. BACKGROUND Small, rural hospitals face barriers in implementing quality improvement initiatives due primarily to lack of resource capacity and the need to prioritize clinical care when allocating limited health human resources. Given this, funding and resources for CQI were key enablers of the RSON initiative and seen as an essential part of a response to assuaging concerns of specialists at higher volume sites regarding quality in lower volume settings. METHODS Data were derived from two datasets: in-depth, qualitative interviews with rural health care providers and administrators over the course of the RSON initiative and through a survey administered at RSON sites in 2023. FINDINGS Qualitative findings revealed participants' perceptions of the value of CQI (including developing expanded skillsets and improved team function and culture), enablers (the organizational infrastructure for CQI projects), challenges in implementation (complications in protecting/prioritizing CQI time and difficulty with staff engagement) and the importance of local leadership. Survey findings showed high ratings for elements of team function that relate directly to CQI (team process and relationships). CONCLUSION Attention to effective mechanisms of CQI through a rural lens is essential to ensure that initiatives meet the contextual realities of low-volume sites. Instituting pathways for locally-driven quality improvement initiatives enhances team function at rural hospitals through creating opportunities for trust building and goal setting, improving communication and increasing individual and team-wide motivation to improve patient care.
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Affiliation(s)
- Jude Kornelsen
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Audrey Cameron
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathrin Stoll
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom Skinner
- Rural Coordination Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Humber
- Rural Coordination Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Kim Williams
- Rural Coordination Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Ebert
- Rural Coordination Centre of British Columbia, Vancouver, British Columbia, Canada
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Steinert Y, Fontes K, Mortaz-Hejri S, Quaiattini A, Yousefi Nooraie R. Social Network Analysis in Undergraduate and Postgraduate Medical Education: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:452-465. [PMID: 38166322 DOI: 10.1097/acm.0000000000005620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
PURPOSE Social network analysis (SNA) is a theoretical framework and analytical approach used to study relationships among individuals and groups. While SNA has been employed by many disciplines to understand social structures and dynamics of interpersonal relationships, little is known about its use in medical education. Mapping and synthesizing the scope of SNA in undergraduate and postgraduate medical education can inform educational practice and research. METHOD This scoping review was based on searches conducted in Medline, Embase, Scopus, and ERIC in December 2020 and updated in March 2022. After removal of duplicates, the search strategy yielded 5,284 records, of which 153 met initial inclusion criteria. Team members conducted full-text reviews, extracted relevant data, and conducted descriptive and thematic analyses to determine how SNA has been used as a theoretical and analytical approach in undergraduate and postgraduate medical education. RESULTS Thirty studies, from 11 countries, were retained. Most studies focused on undergraduate medical students, primarily in online environments, and explored students' friendships, information sharing, and advice seeking through SNA. Few studies included residents and attending staff. Findings suggested that SNA can be a helpful tool for monitoring students' interactions in online courses and clinical clerkships. SNA can also be used to examine the impact of social networks on achievement, the influence of social support and informal learning outside the classroom, and the role of homophily in learning. In clinical settings, SNA can help explore team dynamics and knowledge exchange among medical trainees. CONCLUSIONS While SNA has been underutilized in undergraduate and postgraduate medical education, findings indicate that SNA can help uncover the structure and impact of social networks in the classroom and the clinical setting. SNA can also be used to help design educational experiences, monitor learning, and evaluate pedagogical interventions. Future directions for SNA research in medical education are described.
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Yousefi Nooraie R, Qin Q, Wagg A, Berta W, Estabrooks C. Building a communication and support network among quality improvement teams in nursing homes: a longitudinal study of the SCOPE trial. Implement Sci Commun 2024; 5:19. [PMID: 38438921 PMCID: PMC10913450 DOI: 10.1186/s43058-024-00559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND We applied a longitudinal network analysis approach to assess the formation of knowledge sharing and collaboration networks among care aide-led quality improvement (QI) teams in Canadian nursing homes participating in the Safer Care for Older Persons (in residential) Environments (SCOPE) trial which aimed to support unregulated front-line staff to lead unit-based quality improvement (QI) teams in nursing homes. We hypothesized that SCOPE's communicative and participatory nature would provide opportunities for peer support, knowledge sharing, and collaboration building among teams. METHODS Fourteen QI teams in Alberta (AB) and seventeen QI teams in British Columbia (BC) participated in the study. Communications across nursing homes occurred through a series of 4 collaborative Learning Congresses (training sessions) over a 1-year period. The senior leaders of QI teams participated in two online network surveys about the communication/collaboration between teams in their province, 1 month after the first, and 6 months later, after the fourth Learning Congress. We developed communication and collaboration network maps pertaining to three time points: before SCOPE, at 2 months, and at 9 months. RESULTS Over time, teams made significantly more new connections and strengthened existing ones, within and across regions. Geographic proximity and co-membership in organizational chains were important predictors of connectivity before and during SCOPE. Teams whose members were well connected at baseline disproportionately improved connectivity over time. On the other hand, teams that did not have prior opportunities to connect appeared to use SCOPE to build new ties. CONCLUSIONS Our findings suggest the importance of network-altering activities to the formation of collaboration networks among QI teams across nursing homes. Active strategies could be used to better connect less connected teams and facilitate collaboration among geographically proximate teams. These findings may inform the development of interventions to leverage existing networks and provide new networking opportunities to develop and sustain organizational improvements.
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Affiliation(s)
- Reza Yousefi Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.
| | - Qiuyuan Qin
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Adrian Wagg
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Whitney Berta
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Biscione FM, Domingues da Silva J. Representation of the hierarchical and functional structure of an ambulatory network of medical consultations through Social Network Analysis, with an emphasis on the role of medical specialties. PLoS One 2024; 19:e0290596. [PMID: 38359023 PMCID: PMC10868750 DOI: 10.1371/journal.pone.0290596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/16/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Ambulatory Health Care Networks (Amb-HCN) are circuits of patient referral and counter-referral that emerge, explicitly or spontaneously, between doctors who provide care in their offices. Finding a meaningful analytical representation for the organic and hierarchical functioning of an Amb-HCN may have managerial and health policymaking implications. We aimed to characterize the structural and functional topology of an Amb-HCN of a private health insurance provider (PHIP) using objective metrics from graph theory. METHODS This is a cross-sectional quantitative study with a secondary data analysis study design. A Social Network Analysis (SNA) was conducted using office visits performed between April 1, 2021 and May 15, 2022, retrieved from secondary administrative claim databases from a PHIP in Belo Horizonte, Southeastern Brazil. Included were beneficiaries of a healthcare plan not restricting the location or physician caring for the patient. A directional and weighted network was constructed, where doctors were the vertices and patient referrals between doctors, within 7-45 days, were the network edges. Vertex-level SNA measures were calculated and grouped into three theoretical constructs: patient follow-up (aimed at assessing the doctor's pattern of patient follow-up); relationship with authorities (which assessed whether the doctor is an authority or contributes to his or her colleague's authority status); and centrality (aimed at positioning the doctor relative to the network graph). To characterize physician profiles within each dimension based on SNA metrics results, a K-means cluster analysis was conducted. The resulting physician clusters were assigned labels that sought to be representative of the observed values of the vertex metrics within the clusters. FINDINGS Overall, 666,263 individuals performed 3,863,222 office visits with 4,554 physicians. A total of 577 physicians (12.7%) had very low consultation productivity and contributed very little to the network (i.e., about 1.1% of all referrals made or received), being excluded from subsequent doctor profiles analysis. Cluster analysis found 951 (23.9%) doctors to be central in the graph and 1,258 (31.6%) to be peripheral; 883 (22.2%) to be authorities and 266 (6.7%) as seeking authorities; 3,684 (92.6%) mostly shared patients with colleagues, with patient follow-up intensities ranging from weak to strong. Wide profile dispersion was observed among specialties and, more interestingly, within specialties. Non-primary-care medical specialties (e.g., cardiology, endocrinology etc.) were associated with central profile in the graph, while surgical specialties predominated in the periphery, along with pediatrics. Only pediatrics was associated with strong and prevalent (i.e., low patient sharing pattern) follow-up. Many doctors from internal medicine and family medicine had unexpectedly weak and shared patient follow-up profiles. Doctor profiles exhibited pairwise relationships with each other and with the number of chronic comorbidities of the patients they treated. For example, physicians identified as authorities were frequently central and treated patients with more comorbidities. Ten medical communities were identified with clear territorial and specialty segregation. CONCLUSIONS Viewing the Amb-HCN as a social network provided a topological and functional representation with potentially meaningful and actionable emerging insights into the most influential actors and specialties, functional hierarchies, factors that lead to self-constituted medical communities, and dispersion from expected patterns within medical specialties.
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Affiliation(s)
- Fernando Martín Biscione
- Department of Data Science in Healthcare, Healthcare Superintendence, Unimed-Belo Horizonte Healthcare Plan, Belo Horizonte, Minas Gerais State, Brazil
| | - Juliano Domingues da Silva
- Department of Administration, Center for Socioeconomic Studies, State University of Maringá, Maringá, Paraná State, Brazil
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Hanskamp-Sebregts M, van Gurp PJ, Braspenning J. Design and Validation of a Questionnaire to Measure Interprofessional Collaborative Practice for Auditing Integrated Hospital Care: Empirical Research. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:00005141-990000000-00103. [PMID: 38015499 PMCID: PMC11338029 DOI: 10.1097/ceh.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Interprofessional teamwork is the key issue of delivering integrated hospital care; however, measuring interprofessional collaboration for auditing is fragmented. In this study, a questionnaire to measure InterProfessional collaborative Practice for Integrated Hospital care (IPPIH) has been developed and validated. METHODS A four-step iterative process was conducted: (1) literature search to find suitable questionnaires; (2) semistructured stakeholder interviews (individual and in focus groups) to discuss the topics and questions (face validity), (3) pretesting the prototype of the questionnaire in two different integrated care pathways for feasibility, usability, and internal consistency, and (4) testing (content and construct validity and responsiveness) of the revised questionnaire in eight integrated care pathways; the validation and responsiveness was tested by means of exploratory factor analysis, calculation of Cronbach alpha, item analysis, and linear mixed model analysis. RESULTS Based on six questionnaires and the opinion of direct stakeholders, the questionnaire IPPIH comprised 27 items. Five different domains could be distinguished: own skills, culture, coordination and collaboration, practical support, and appreciation with the Cronbach alpha varied from 0.91 to 0.48. The self-reported intensity of the collaboration within a specific care pathway significantly influenced the outcome ( P = .000). DISCUSSION The product is a questionnaire, IPPIH, which can measure the degree of interprofessional collaborative practice in integrated hospital care pathways. The IPPIH was initially developed for quality assurance. However, the IPPIH also seems to be suitable as a self-assessment tool for directors to monitor and improve the interprofessional collaboration and the quality of their integrated care pathway.
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Affiliation(s)
- Mirelle Hanskamp-Sebregts
- Dr. Hanskamp-Sebregts: Radboud University Medical Center, Institute of Quality Assurance and Patient Safety, Nijmegen, The Netherlands. Prof. van Gurp: Radboud University Medical Center, Institute of Quality Assurance and Patient Safety, Nijmegen, The Netherlands, and Department of General Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. Prof. Braspenning: IQ Healthcare, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Petra J. van Gurp
- Dr. Hanskamp-Sebregts: Radboud University Medical Center, Institute of Quality Assurance and Patient Safety, Nijmegen, The Netherlands. Prof. van Gurp: Radboud University Medical Center, Institute of Quality Assurance and Patient Safety, Nijmegen, The Netherlands, and Department of General Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. Prof. Braspenning: IQ Healthcare, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Jozé Braspenning
- Dr. Hanskamp-Sebregts: Radboud University Medical Center, Institute of Quality Assurance and Patient Safety, Nijmegen, The Netherlands. Prof. van Gurp: Radboud University Medical Center, Institute of Quality Assurance and Patient Safety, Nijmegen, The Netherlands, and Department of General Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. Prof. Braspenning: IQ Healthcare, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
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Checkland K, Bramwell D, Warwick-Giles L, Bailey S, Hammond J. Primary care networks as a means of supporting primary care: findings from qualitative case study-based evaluation in the English NHS. BMJ Open 2023; 13:e075111. [PMID: 37989389 PMCID: PMC10668191 DOI: 10.1136/bmjopen-2023-075111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/22/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate primary care networks (PCNs) in the English National Health Service. We ask: How are PCNs constituted to meet their defined goals? What factors can be discerned as affecting their ability to deliver benefits to the community, the network as a whole and individual members? What outcomes or outputs are associated with PCNs so far? We draw policy lessons for PCN design and oversight, and consider the utility of the chosen evaluative framework. DESIGN AND SETTING Qualitative case studies in seven PCN in England, chosen for maximum variety around geography, rurality and population deprivation. Study took place between May 2019 and December 2022. PARTICIPANTS PCN members, staff employed in additional roles and local managers. Ninety-one semistructured interviews and approximately 87 hours of observations were undertaken remotely. Interview transcripts and observational field notes were analysed together using a framework approach. Initial codes were derived from our evaluation framework, with inductive coding of new concepts during the analysis. RESULTS PCNs have been successfully established across England, with considerable variation in structure and operation. Progress is variable, with a number of factors affecting this. Good managerial support was helpful for PCN development. The requirement to work together to meet the specific threat of the global pandemic did, in many cases, generate a virtuous cycle by which the experience of working together built trust and legitimacy. The internal dynamics of networks require attention. Pre-existing strong relationships provided a significant advantage. While policy cannot legislate to create such relationships, awareness of their presence/absence is important. CONCLUSIONS Networked approaches to service delivery are popular in many health systems. Our use of an explicit evaluation framework supports the extrapolation of our findings to networks elsewhere. We found the framework to be useful in structuring our study but suggest some modifications for future use.
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Affiliation(s)
- Kath Checkland
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Donna Bramwell
- School of Health Sciences, The University of Manchester, Manchester, UK
| | | | - Simon Bailey
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Jonathan Hammond
- School of Health Sciences, The University of Manchester, Manchester, UK
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Menzies JC, Brand S, Bench S, Bramley L, Smith V, Henshall C. Increasing nursing and midwifery research leadership: impact evaluation of the National Institute for Health and Care Research Senior Nurse and Midwife Research Leader Programme at 1 year. J Res Nurs 2023; 28:516-528. [PMID: 38144950 PMCID: PMC10741258 DOI: 10.1177/17449871231201550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
Background Although nurses and midwives make up the largest sector of the National Health Service (NHS) workforce, studies have identified a lack of knowledge, skills and confidence to engage and lead research. In 2018, the National Institute for Health and Care Research (NIHR) invested in the development of a 3-year Senior Nurse Midwife Research Leader (SNMRL) Programme aimed at developing nursing and midwifery research capacity and capability. This review was conducted at the end of year one as part of an ongoing impact evaluation of the programme. Aim To evaluate the impact of activities undertaken by NIHR SNMRL at the end of year one of the programme. Method The content of anonymised end-of-year one activity, self-reported by SNMRL, was coded independently and deductively analysed by a project team using the modified Visible ImpaCT Of Research framework (VICTOR). Exemplar case studies were selected by the team to illustrate activity within domains. Working group members coded two reports independently then compared them in pairs to increase inter-rater reliability and the quality and consistency of coding. Results Reports from 63 of 66 SNMRL were submitted and included for analysis. Reporting reflected progress towards NIHR programme objectives. These included acting as a programme ambassador, creating a vibrant research culture, supporting staff recruitment and retention, enhancing organisational reputation and clinical academic outputs. Networking and collaboration locally, regionally and nationally were widely reported. Conclusions The SNMRL cohort reported initiating multiple initiatives aimed at influencing organisational research culture, service provision and supporting nursing/midwifery engagement with research. Evaluation indicated progress to address barriers to research engagement within NHS Trusts.
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Affiliation(s)
- Julie C Menzies
- Clinical Academic/Nurse Researcher, Bristol Royal Hospital for Children, United Hospitals Bristol and Weston NHS Foundation Trust, UK
- Honorary Senior Research Fellow, University of Birmingham, UK
| | - Sarah Brand
- Assistant Divisional Nurse, Cancer and Associated Specialities, Nottingham University Hospital NHS Trust, UK
| | - Suzanne Bench
- Director of Nursing for Nurse and Midwife Led Research, Guys and St Thomas NHS Trust, UK
- Professor of Critical Care Nursing, London South Bank University, UK
| | - Louise Bramley
- Assistant Director of Nursing, Nottingham University Hospitals NHS Trust, UK
- Honorary Associate Professor, University of Nottingham, UK
| | - Vikki Smith
- Clinical Academic Midwife, Northumbria University, Department of Nursing, Midwifery and Health, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Catherine Henshall
- Reader in Nursing, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, UK
- Associate Director of Nursing and Midwifery, National Institute for Health and Care Research (NIHR), UK
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Mukinda FK, Djellouli N, Akter K, Sarker M, Tufa AA, Mwandira K, Seruwagi G, Kyamulabi A, Mwaba K, Marchant T, Shawar YR, English M, Namakula H, Gonfa G, Colbourn T, Kinney MV. Individual interactions in a multi-country implementation-focused quality of care network for maternal, newborn and child health: A social network analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001769. [PMID: 37733733 PMCID: PMC10513266 DOI: 10.1371/journal.pgph.0001769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) was established to build a cross-country platform for joint-learning around quality improvement implementation approaches to reduce mortality. This paper describes and explores the structure of the QCN in four countries and at global level. Using Social Network Analysis (SNA), this cross-sectional study maps the QCN networks at global level and in four countries (Bangladesh, Ethiopia, Malawi and Uganda) and assesses the interactions among actors involved. A pre-tested closed-ended structured questionnaire was completed by 303 key actors in early 2022 following purposeful and snowballing sampling. Data were entered into an online survey tool, and exported into Microsoft Excel for data management and analysis. This study received ethical approval as part of a broader evaluation. The SNA identified 566 actors across the four countries and at global level. Bangladesh, Malawi and Uganda had multiple-hub networks signifying multiple clusters of actors reflecting facility or district networks, whereas the network in Ethiopia and at global level had more centralized networks. There were some common features across the country networks, such as low overall density of the network, engagement of actors at all levels of the system, membership of related committees identified as the primary role of actors, and interactions spanning all types (learning, action and information sharing). The most connected actors were facility level actors in all countries except Ethiopia, which had mostly national level actors. The results reveal the uniqueness and complexity of each network assessed in the evaluation. They also affirm the broader qualitative evaluation assessing the nature of these networks, including composition and leadership. Gaps in communication between members of the network and limited interactions of actors between countries and with global level actors signal opportunities to strengthen QCN.
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Affiliation(s)
| | - Nehla Djellouli
- Institute for Global Health, University College London, London, United Kingdom
| | - Kohenour Akter
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Mithun Sarker
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | | | - Gloria Seruwagi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Agnes Kyamulabi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Kasonde Mwaba
- Institute for Global Health, University College London, London, United Kingdom
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yusra R. Shawar
- Department of International Health, School of Public Health, John Hopkins University, Baltimore, MD, United States of America
- School of Advanced International Studies, John Hopkins University, Baltimore, MD, United States of America
| | - Mike English
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Hilda Namakula
- School of Public Health, Makerere University, Kampala, Uganda
| | - Geremew Gonfa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | - Mary V. Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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14
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Kaminski P, Perry BL, Green HD. Comparing professional communities: Opioid prescriber networks and Public Health Preparedness Districts. Harm Reduct J 2023; 20:120. [PMID: 37658379 PMCID: PMC10474636 DOI: 10.1186/s12954-023-00840-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/22/2023] [Indexed: 09/03/2023] Open
Abstract
Problem opioid use and opioid-related drug overdoses remain a major public health concern despite attempts to reduce and monitor opioid prescriptions and increase access to office-based opioid treatment. Current provider-focused interventions are implemented at the federal, state, regional, and local levels but have not slowed the epidemic. Certain targeted interventions aimed at opioid prescribers rely on populations defined along geographic, political, or administrative boundaries; however, those boundaries may not align well with actual provider-patient communities or with the geographic distribution of high-risk opioid use. Instead of relying exclusively on commonly used geographic and administrative boundaries, we suggest augmenting existing strategies with a social network-based approach to identify communities (or clusters) of providers that prescribe to the same set of patients as another mechanism for targeting certain interventions. To test this approach, we analyze 1 year of prescription data from a commercially insured population in the state of Indiana. The composition of inferred clusters is compared to Indiana's Public Health Preparedness Districts (PHPDs). We find that in some cases the correspondence between provider networks and PHPDs is very high, while in other cases the overlap is low. This has implications for whether an intervention is reaching its intended provider targets efficiently and effectively. Assessing the best intervention targeting strategy for a particular outcome could facilitate more effective interventions to tackle the ongoing opioid use epidemic.
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Affiliation(s)
- Patrick Kaminski
- Department of Sociology, Indiana University, Bloomington, IN, USA.
- Luddy School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, USA.
| | - Brea L Perry
- Department of Sociology, Indiana University, Bloomington, IN, USA
| | - Harold D Green
- Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
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15
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Kirby L, Payne KL. Knowledge of autism gained by learning from people through a local UK Autism Champion Network: A health and social care professional perspective. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:13623613231167902. [PMID: 37131289 PMCID: PMC10576896 DOI: 10.1177/13623613231167902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
LAY ABSTRACT The Autism Act 10 Years On found few autistic adults thought health and social care professionals had a good understanding of autism. Autism training has been made law in the United Kingdom for health and social care staff to tackle health inequality. The county wide Autism Champion Network evaluated here is an equal partnership of interested staff across sectors (Autism Champions) and autistic experts by virtue of lived experience (Autism Advisory Panel). With knowledge flowing both ways, the Autism Champions take learning back to teams to support continuous development of services to meet autistic need. Seven health and social sector professionals from the Network participated in semi-structured interviews on sharing knowledge of autism gained with their teams. All participants provide care and support for autistic people, some working in specialist positions. Results showed that developing new relationships with people outside their own team to signpost to, answer questions and share resources, and informal learning from autistic people, was more valued and used in practice than information gained from presentations. These results have implications in developing learning for those who need above a basic knowledge of autism and may be useful for others considering setting up an Autism Champion Network.
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16
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Bowen JM, Ouimet M, Lawarée J, Bielecki J, Rhéaume A, Greenberg C, Rac VE. Describing the state of a research network: A mixed methods approach to network evaluation. RESEARCH EVALUATION 2023; 32:188-199. [PMID: 37799115 PMCID: PMC10550251 DOI: 10.1093/reseval/rvac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 08/03/2021] [Accepted: 09/05/2021] [Indexed: 10/07/2023]
Abstract
Diabetes Action Canada Strategy for Patient-Oriented Research (SPOR) Network in Chronic Disease was formed in 2016 and is funded primarily through the Canadian Institutes of Health Research (CIHR). We propose a novel mixed-methods approach to a network evaluation integrating the State of Network Evaluation framework and the Canadian Academy of Health Sciences (CAHS) preferred framework and indicators. We measure key network themes of connectivity, health and results, and impact and return on investment associated with health research networks. Our methods consist of a longitudinal cross-sectional network survey of members and social network analysis to examine Network Connectivity and assess the frequency of interactions, the topics discussed during them, and how networking effectively facilitates interactions and collaboration among members. Network Health will be evaluated through semistructured interviews, a membership survey inquiring about satisfaction and experience with the Network, and a review of documentary sources related to funding and infrastructure to evaluate Network Sustainability. Finally, we will examine Network Results and Impact using the CAHS preferred framework and indicators to measure returns on investment in health research across the five domains of the CAHS framework, which include: advancing knowledge, capacity building, informing decision making, health impact, and economic and social impact. Indicators will be assessed with various methods, including bibliometric analyses, review of relevant documentary sources (annual reports), member activities informing health and research policy, and Patient Partner involvement. The Network Evaluation will provide members and stakeholders with information for planning, improvements, and funding future Network endeavors.
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Affiliation(s)
- James M Bowen
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), Toronto, ON M5G 2C4, Canada
- THETA Collaborative, University Health Network, 10th Floor Eaton North, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- Health Technology Assessment and Network Analytics, Diabetes Action Canada, Toronto, ON M5G 2C4,Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6,Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mathieu Ouimet
- Health Technology Assessment and Network Analytics, Diabetes Action Canada, Toronto, ON M5G 2C4,Canada
- Département de Science Politique, Faculté des Science Social, Université Laval, Québec, QC G1V 0A6, Canada
| | - Justin Lawarée
- Département de Science Politique, Faculté des Science Social, Université Laval, Québec, QC G1V 0A6, Canada
| | - Joanna Bielecki
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), Toronto, ON M5G 2C4, Canada
- THETA Collaborative, University Health Network, 10th Floor Eaton North, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Ashley Rhéaume
- Département de Science Politique, Faculté des Science Social, Université Laval, Québec, QC G1V 0A6, Canada
| | - Caylee Greenberg
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), Toronto, ON M5G 2C4, Canada
- THETA Collaborative, University Health Network, 10th Floor Eaton North, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Valeria E Rac
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), Toronto, ON M5G 2C4, Canada
- THETA Collaborative, University Health Network, 10th Floor Eaton North, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- Health Technology Assessment and Network Analytics, Diabetes Action Canada, Toronto, ON M5G 2C4,Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6,Canada
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17
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Larrain N, Wang S, Stargardt T, Groene O. Cooperation Improvement in an Integrated Healthcare Network: A Social Network Analysis. Int J Integr Care 2023; 23:32. [PMID: 37396781 PMCID: PMC10312245 DOI: 10.5334/ijic.6519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Background Cooperation is a core feature of integrated healthcare systems and an important link in their value-creating mechanism. The premise is that providers who cooperate can promote more efficient use of health services while improving health outcomes. We studied the performance of an integrated healthcare system in improving regional cooperation. Methods Using claims data and social network analysis, we constructed the professional network from 2004 to 2017. Cooperation was studied by analyzing the evolution of network properties at network and physician practice (node) level. The impact of the integrated system was studied with a dynamic panel model that compared practices that participated in the integrated system versus nonparticipants. Results The regional network evolved favourably towards cooperation. Network density increased 1.4% on average per year, while mean distance decreased 0.78%. At the same time, practices participating in the integrated system became more cooperative compared to other practices in the region: Degree (1.64e-03, p = 0.07), eigenvector (3.27e-03, p = 0.06) and betweenness (4.56e-03, p < 0.001) centrality increased more for participating practices. Discussion Findings can be explained by the holistic approach to patients' care needs and coordination efforts of integrated healthcare. The paper provides a valuable design for performance assessment of professional cooperation. Highlights Using claims data and social network analysis, we identify a regional cooperation network and conduct a panel analysis to measure the impact of an integrated care initiative on enhancing professional cooperation.Physician practices participating in the integrated system became more cooperative and improved their influence in the regional network more than non-participating practices.Integrated healthcare systems effectively incentivize cooperation through a holistic approach to patient care needs and coordination efforts.
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Affiliation(s)
- Nicolás Larrain
- OptiMedis AG, Hamburg, DE
- Hamburg Centre for Health Economics (HCHE), University of Hamburg, Hamburg, DE
| | - Sophie Wang
- OptiMedis AG, Hamburg, DE
- Hamburg Centre for Health Economics (HCHE), University of Hamburg, Hamburg, DE
| | - Tom Stargardt
- Hamburg Centre for Health Economics (HCHE), University of Hamburg, Hamburg, DE
| | - Oliver Groene
- OptiMedis AG, Hamburg, DE
- University of Witten/Herdecke, Witten, DE
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18
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Towards Inclusive Diagnostics for Neglected Tropical Diseases: User Experience of a New Digital Diagnostic Device in Low-Income Settings. Trop Med Infect Dis 2023; 8:tropicalmed8030176. [PMID: 36977176 PMCID: PMC10056790 DOI: 10.3390/tropicalmed8030176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
Designing new and inclusive diagnostic tools to detect Neglected Tropical Diseases (NTDs) to achieve rational disease control requires a co-design process where end-users’ input is important. Failure to involve all potential end-users in new diagnostics for NTDs can result in low use and adoption failure, leading to persistent infection hot spots and ineffective disease control. There are different categories of potential end-users of new diagnostic tools for NTD control, and it is unclear if there are differences between the user efficiency, effectiveness, perception, and acceptability across these end-user categories. This study evaluated the usability, user perception, contextual factors affecting the user’s experience, and acceptability of a new digital optical diagnostic device for NTDs across three types of potential end users. A total of 21 participants were tested. Laboratory scientists, technicians, and Community Health Extension Workers (CHEWs) in training achieved similar scores on the usability and user perception questionnaires with no statistically significant difference between end-user categories. All participants also have high scores for the user perception domains which strongly correlate with the acceptability of the AiDx NTDx Assist device. This study indicates that, by providing digital diagnostic tools in combination with minimal training and support, CHEWs undergoing training and, by extension, CHEWs post-training, can be involved in the diagnoses of NTDs, potentially enhancing a community’s capabilities to diagnose, treat, and control NTDs.
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19
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Forstner J, Koetsenruijjter J, Arnold C, Laux G, Wensing M. The Influence of Provider Connectedness on Continuity of Care and Hospital Readmissions in Patients With COPD: A Claims Data Based Social Network Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2023; 10:77-88. [PMID: 36516332 PMCID: PMC9995233 DOI: 10.15326/jcopdf.2022.0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Hospital readmission rates are very high in patients with chronic obstructive pulmonary disease (COPD). Continuity of care (CoC) with general practitioners (GPs) and ambulatory specialists can impact readmission rates. This study aimed to identify shared patient networks of ambulatory care physicians and to examine the effect of provider connectedness on CoC and hospital readmissions. Methods A retrospective observational study was conducted in claims data from the years 2016 to 2018 in patients with COPD (aged 40 years or older; hospital stay in 2017). Linkages between GPs, pneumologists, and cardiologists were determined on the basis of shared patients. Multilevel regression models were used to analyze the impact of provider connectedness, operationalized by several social network characteristics, on continuity of care (sequential continuity [SECON] index) and hospital readmission rates. Results A total of 7294 patients linked to 3673 GPs were available for analysis. Closeness centrality (β=- 0.029) and the external-internal (EI)-index (β =0.037) impacted on the SECON index. The EI-index (odds ratio [OR]=1.25) and degree centrality (OR=1.257) impacted 30-day readmission. Network density (OR=0.811) and the SECON index (OR=1.121) affected the likelihood of a 90-day readmission. None of the predictors had a significant impact on 180-day and 365-day readmissions. Conclusions Ambulatory care providers' connectedness showed some effects on hospital readmissions and CoC in patients with COPD up to 90 days after hospital discharge, but the additional predictive power is limited.
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Affiliation(s)
- Johanna Forstner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany
| | - Jan Koetsenruijjter
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany
| | - Christine Arnold
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany
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20
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Moss JL, Stoltzfus KC, Popalis ML, Calo WA, Kraschnewski JL. Assessing the use of constructs from the consolidated framework for implementation research in U.S. rural cancer screening promotion programs: a systematic search and scoping review. BMC Health Serv Res 2023; 23:48. [PMID: 36653800 PMCID: PMC9846667 DOI: 10.1186/s12913-022-08976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer screening is suboptimal in rural areas, and interventions are needed to improve uptake. The Consolidated Framework for Implementation Research (CFIR) is a widely-used implementation science framework to optimize planning and delivery of evidence-based interventions, which may be particularly useful for screening promotion in rural areas. We examined the discussion of CFIR-defined domains and constructs in programs to improve cancer screening in rural areas. METHODS We conducted a systematic search of research databases (e.g., Medline, CINAHL) to identify studies (published through November 2022) of cancer screening promotion programs delivered in rural areas in the United States. We identified 166 records, and 15 studies were included. Next, two reviewers used a standardized abstraction tool to conduct a critical scoping review of CFIR constructs in rural cancer screening promotion programs. RESULTS Each study reported at least some CFIR domains and constructs, but studies varied in how they were reported. Broadly, constructs from the domains of Process, Intervention, and Outer setting were commonly reported, but constructs from the domains of Inner setting and Individuals were less commonly reported. The most common constructs were planning (100% of studies reporting), followed by adaptability, cosmopolitanism, and reflecting and evaluating (86.7% for each). No studies reported tension for change, self-efficacy, or opinion leader. CONCLUSIONS Leveraging CFIR in the planning and delivery of cancer screening promotion programs in rural areas can improve program implementation. Additional studies are needed to evaluate the impact of underutilized CFIR domains, i.e., Inner setting and Individuals, on cancer screening programs.
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Affiliation(s)
- Jennifer L Moss
- Penn State College of Medicine, Hershey, PA, USA.
- Department of Family and Community Medicine, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, 90 Hope Drive, #2120E, MC A172, P.O. Box 855, Hershey, PA, 17033, USA.
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Murray S, Langdahl B, Casado E, Brooks K, Libanati C, Di Lecce L, Lazure P. Preparing the Leaders of Tomorrow: Learnings from a Two-Year Community of Practice in Fragility Fractures. J Eur CME 2022; 11:2142405. [DOI: 10.1080/21614083.2022.2142405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Suzanne Murray
- Department of Research, AXDEV Group Inc, Brossard, QC, Canada
| | - Bente Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Enrique Casado
- Department of Rheumatology, University Hospital Parc Taulí, I3PT Research Institute, Sabadell, Barcelona, Spain
| | | | | | | | - Patrice Lazure
- Department of Research, AXDEV Group Inc, Brossard, QC, Canada
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22
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Arnold C, Hennrich P, Wensing M. Information exchange networks for chronic diseases in primary care practices in Germany: a cross-sectional study. BMC PRIMARY CARE 2022; 23:56. [PMID: 35346050 PMCID: PMC8958478 DOI: 10.1186/s12875-022-01649-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Coordination of care requires information exchange between health workers. The structure of their information exchange networks may influence the quality and efficiency of healthcare delivery. The aim of this study was to explore and classify information exchange networks in primary care for patients with chronic diseases in Germany.
Methods
A cross-sectional study was carried out between 2019 and 2021. As part of a larger project on coordination of care, this study focused on information exchange in practice teams regarding patients with type 2 diabetes (DM), coronary heart disease (CHD) and chronic heart failure (CHF). Social network analysis was applied to determine the number of connections, density and centralization for each of the health conditions for each of the practices. On the basis of the descriptive findings, we developed typologies of information exchange networks in primary care practices.
Results
We included 153 health workers from 40 practices, of which 25 practices were included in the social network analysis. Four types of information exchange structures were identified for the three chronic diseases: highly connected networks with low hierarchy, medium connected networks with medium hierarchy, medium connected networks with low hierarchy and lowly connected networks. Highly connected networks with low hierarchy were identified most frequently (18 networks for DM, 17 for CHD and 14 for CHF). Of the three chronic conditions, information sharing about patients with DM involved the most team members. Information exchange outside the family practice took place mainly with nurses and pharmacists.
Conclusions
This study identified four types of information exchange structures, which provides a practical tool for management and improvement in primary care. Some practices had few information transfer connections and could hardly be considered a network.
Trial registration
We registered the study prospectively on 7 November 2019 at the German Clinical Trials Register (DRKS, www.drks.de) under ID no. DRKS00019219.
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Decision-Making Dilemmas within Integrated Care Service Networks: A Systematic Literature Review. Int J Integr Care 2022; 22:11. [DOI: 10.5334/ijic.6458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
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Graessner H, Storf H, Schaefer F. [Healthcare networks for people with rare diseases: integrating data and expertise]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:1164-1169. [PMID: 36167994 PMCID: PMC9636292 DOI: 10.1007/s00103-022-03592-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022]
Abstract
In the European Union (EU), rare diseases (RDs) are diseases that affect no more than 5 in 10,000 people. Due to their rarity, clinical expertise and quality-assured care structures are scarce, and research is more difficult compared to other diseases. However, these problems can be overcome by means of national and transnational RD care networks. Data and expertise are pooled in these networks.In the EU, the European Reference Networks (ERNs) for Rare and Complex Diseases cooperate across borders. Important services provided by ERNs using health data include diagnostic coding of RDs, conducting virtual cross-border case conferences, and establishing European registries that are used to measure and improve the quality of care. In ERNs, local data generation and documentation combine with network-wide data infrastructures. This paper describes the data-based services in and for RD healthcare networks: (1) diagnostic coding, (2) cross-border case conferences, and (3) ERN registries for RD patient care. The final section discusses the integration of the networks into national healthcare systems.In order to achieve the best possible benefit for SE patients, ERN activities and structures need to be better integrated into national healthcare systems. In Germany, the Medical Informatics Initiative and the German Reference Networks play a central role in this regard.
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Affiliation(s)
- Holm Graessner
- Zentrum für Seltene Erkrankungen (ZSE) Tübingen, Institut für Medizinische Genetik und Angewandte Genomik, Universitätsklinikum Tübingen, Calwerstr. 7, 72076, Tübingen, Deutschland.
| | - Holger Storf
- Institut für Medizininformatik, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Franz Schaefer
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Cunningham FC, Potts BA, Ramanathan SA, Bailie J, Bainbridge RG, Searles A, Laycock AF, Bailie RS. Network evaluation of an innovation platform in continuous quality improvement in Australian Indigenous primary healthcare. Health Res Policy Syst 2022; 20:119. [PMID: 36316678 PMCID: PMC9620635 DOI: 10.1186/s12961-022-00909-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
Background From 2014 to 2019, the Centre for Research Excellence in Integrated Quality Improvement (CRE-IQI) was evaluated as an innovation platform focusing on continuous quality improvement in Indigenous Australian primary healthcare. Although social network analysis (SNA) is a recognized method for evaluating the functioning, collaboration and effectiveness of innovation platforms, applied research is limited. This study applies SNA to evaluate the CRE-IQI’s functioning as an innovation platform. Methods Two surveys (2017, 2019) were conducted using social survey and network methods. Survey items covered respondent characteristics, their perceptions of the CRE-IQI’s performance, and its impact and sociometric relationships. Members’ relationship information was captured for the CRE-IQI at three time points, namely start (retrospectively), midpoint and final year, on three network types (knew, shared information, collaborated). SNA software was used to compute standard network metrics including diameter, density and centrality, and to develop visualizations. Survey and network results were addressed in a workshop held by members to develop improvement strategies. Results The response rate was 80% in 2017 and 65% in 2019 (n = 49 and 47, respectively). Between 2017 and 2019, respondents’ mean ratings of the CRE-IQI’s functioning and achievements in meeting its goals were sustained. They perceived the CRE-IQI as multidisciplinary, having effective management and governance, and incorporating Indigenous research leadership, representation and ways of working. Respondents recognized high levels of trust amongst members, rated “good communication and coordination with participants” highly, and “facilitating collaboration” as the CRE’s most strongly recognized achievement. In collaboration and information-sharing networks, average path length remained low in 2017 and 2019, indicating good small-world network properties for relaying information. On average, respondents shared information and collaborated with more CRE members in 2017 than 2019. However, in both 2017 and 2019 there were new collaborations and information-sharing outside of direct collaborations. CRE-IQI outcomes included: evidence generation; knowledge transfer and skills development in quality improvement; research capacity-building, career development; mentoring; grant support; development of new projects; health service support; and policy impact. Conclusions This study shows the utility of network analysis in evaluating the functioning, and collaboration, at the individual, organizational and health system levels, of an innovation platform, and adds to our understanding of factors enabling successful innovation platforms. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00909-z.
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Affiliation(s)
- Frances Clare Cunningham
- grid.271089.50000 0000 8523 7955Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Brisbane, QLD Australia
| | - Boyd Alexander Potts
- grid.271089.50000 0000 8523 7955Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Brisbane, QLD Australia
| | - Shanthi Ann Ramanathan
- grid.413648.cHealth Research Economics, Hunter Medical Research Institute, Newcastle, NSW Australia ,grid.266842.c0000 0000 8831 109XCollege of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW Australia
| | - Jodie Bailie
- grid.1013.30000 0004 1936 834XUniversity Centre for Rural Health, The University of Sydney, Lismore, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Roxanne Gwendalyn Bainbridge
- grid.1003.20000 0000 9320 7537Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD Australia
| | - Andrew Searles
- grid.413648.cHealth Research Economics, Hunter Medical Research Institute, Newcastle, NSW Australia ,grid.266842.c0000 0000 8831 109XCollege of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW Australia
| | - Alison Frances Laycock
- grid.1013.30000 0004 1936 834XUniversity Centre for Rural Health, The University of Sydney, Lismore, NSW Australia
| | - Ross Stewart Bailie
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
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Purvis T, Middleton S, Alexandrov AW, Kilkenny MF, Coote S, Kuhle S, Cadilhac DA. Exploring barriers to stroke coordinator roles in Australia: A national survey. Collegian 2022. [DOI: 10.1016/j.colegn.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lawarée J, Bowen JM, Dogba J, Rac VE, Ouimet M. Inter-individual relationships within a Canadian SPOR research network: a social network study. BMC Health Serv Res 2022; 22:955. [PMID: 35897005 PMCID: PMC9326433 DOI: 10.1186/s12913-022-08343-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Efforts have been made by health research granting agencies to bring research closer to patients’ concerns. In Canada, such efforts were formalized in 2011 with the funding of the Strategy for Patient-Oriented Research (SPOR)’s research networks to address research priorities identified by patients and accelerate the translation of research findings into patient care and health care policy. Among these networks, SPOR Diabetes Action Canada (DAC) has created patient-partner circles to facilitate their integration within the network. The nature of the relationships within this atypical patient-oriented research network is systematically explored in this paper. Methods A cross-sectional social network study was conducted among the SPOR DAC’s network members to examine inter-individual interactions, and the topics discussed the most between members. Descriptive data analyses were conducted to explore which discussion topics were discussed most among members whose primary roles were research, administration, governance, and patient representation. Results The response rate was 51.9%, providing data on 76.5% of the maximum number of connections in the network. The survey captured 2763 inter-individual relationships. Responses to a sub-question inserted in the survey show that 482 of these relationships (17,4%) existed before joining the network in collaboration on a research project. Most ties captured in the survey were yearly or quarterly, while few relationships were monthly, weekly, or daily. In measured relationships, members discussed several topics, the most frequent being scientific research, patient engagement, network coordination and governance, and operations and management. The topics associated with the most significant proportion of relationships captured in the survey were scientific research (45.4%) and patient engagement (40.7%). Management & operations and governance & coordination follow, corresponding to 24.3 and 23.9% of the captured relationships. All discussion topic subnetworks were either somewhat or highly centralized, meaning that relationships were not equally distributed among members involved in these discussions. Of the 1256 relationships involving exchanges about scientific research, 647 (51.5%) involved a researcher, 419 (33.3%) an administrator, 182 (14.5%) a patient partner, and 82 (6.5%) a member whose primary role is network governance. Conclusions Scientific research and patient engagement were the most common topics discussed, consistent with the patient-centered research at the heart of the SPOR Diabetes Action Canada network. The study identified several relationships where a patient partner has discussed scientific research with a researcher. However, relationships involving research discussions were three times more common between a researcher and an administrator than between a researcher and a patient partner, although twice as many patient partners as administrators participated in the survey. The institutionalization of patient-partner involvement in large research networks is an evolving practice for which optimal engagement methods are still being explored. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08343-1.
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Affiliation(s)
- Justin Lawarée
- École nationale d'administration publique, Quebec, Canada
| | - James M Bowen
- Diabetes Action Canada, Toronto, Canada.,Program for Health System and Technology Evaluation, Toronto, Canada
| | - Joyce Dogba
- Diabetes Action Canada, Toronto, Canada.,Université Laval, Quebec, Canada
| | - Valeria E Rac
- Diabetes Action Canada, Toronto, Canada.,Program for Health System and Technology Evaluation, Toronto, Canada
| | - Mathieu Ouimet
- Diabetes Action Canada, Toronto, Canada. .,Université Laval, Quebec, Canada.
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Total Quality and Innovation Management in Healthcare (TQIM-H) for an Effective Innovation Development: A Conceptual Framework and Exploratory Study. APPLIED SYSTEM INNOVATION 2022. [DOI: 10.3390/asi5040070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To thrive, an organization must adapt to the fast and constant change in the economic environment caused by an aging society, technological changes, and the pandemic crisis. Innovation becomes important for the adaptation of industries. Healthcare is one of them. Innovation development in hospitals is effective and acceptable when its management is effective and aligns with the healthcare quality context since quality is a philosophy of work in life-related settings. To the best of our knowledge, quality management and innovation management in healthcare have never been integrated. Therefore, this research aimed to create an integrated framework of quality and innovation management in healthcare (TQIM-H). To establish the effectiveness of applying TQIM-H for the development of effective healthcare innovation, this study developed a TQIM-H conceptual framework using multiple methodologies including a literature review, multiple case studies analysis, Delphi study with healthcare experts, Technology Acceptance Model (TAM), and triangulation with an external dataset. We constructed a TQIM-H conceptual framework, consisting of seven dimensions, that can be used in developing innovation projects in hospitals and which agrees with safety and quality principles in hospitals.
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Martinez Leal I, Martinez J, Britton M, Chen TA, Correa-Fernández V, Kyburz B, Nitturi V, Obasi EM, Drenner K, Williams T, Casey K, Carter BJ, Reitzel LR. Collaborative Learning: A Qualitative Study Exploring Factors Contributing to a Successful Tobacco Cessation Train-the-Trainer Program as a Community of Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7664. [PMID: 35805323 PMCID: PMC9266255 DOI: 10.3390/ijerph19137664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
Individuals with behavioral health conditions account for 50% of annual smoking-related deaths, yet rarely receive tobacco dependence treatment within local mental health authorities (LMHAs). As lack of training and knowledge are key barriers to providing tobacco dependence treatment, Taking Texas Tobacco-Free (TTTF) developed an iterative, 4-6-months train-the-trainer program to embed expertise and delivery of sustained education on tobacco-free workplace policies and practices in participating centers. We explore the employee "champions'" train-the-trainer program experiences using a community of practice (CoP) model to identify key contributors to successful program implementation. Across 3 different LMHAs, we conducted semi-structured individual and group interviews online at 2 time points. We interviewed each champion twice (except for 1 champion who dropped out between measurements); pre-implementation (3 group interviews; N = 4 + 4 + 3 = 11 champions); post-implementation (7 individual interviews and 1 group interview; 7 + 3 = 10 champions). Therefore, 11 champions participated in pre- and post-implementation interviews from July 2020-May 2021. Guided by an iterative, thematic analysis and constant comparison process, we inductively coded and summarized data into themes. Five factors contributed to successful program implementation: value of peer support/feedback; building knowledge, champion confidence, and program ownership; informative curriculum, adaptable to targeted populations; staying abreast of current tobacco/nicotine research and products; and TTTF team responsiveness and practical coaching/assistance. Champions reported the TTTF train-the-trainer program was successful and identified attitudes and CoP processes that effectively built organizational capacity and expertise to sustainably address tobacco dependence. Study findings can guide other agencies in implementing sustainable tobacco-free training programs.
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Affiliation(s)
- Isabel Martinez Leal
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Jayda Martinez
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
| | - Maggie Britton
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, Austin, TX 78703, USA; (B.K.); (T.W.); (K.C.)
| | - Vijay Nitturi
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Ezemenari M. Obasi
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Kelli Drenner
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
| | - Teresa Williams
- Integral Care, Austin, TX 78703, USA; (B.K.); (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, Austin, TX 78703, USA; (B.K.); (T.W.); (K.C.)
| | - Brian J. Carter
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
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Resident physicians' advice seeking and error making: A social networks approach. Health Care Manage Rev 2022; 47:E41-E49. [PMID: 35499396 DOI: 10.1097/hmr.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Resident physicians are especially at risk of being involved in medical errors because they bear tremendous responsibility for patient care yet are still in the process of learning and mastering their profession. To increase knowledge and gain information, they create a professional-instrumental network, that is, the deliberate initiation of advice ties with senior physicians. PURPOSE We aim to explore whether and how residents' networking with senior physicians is associated with their error rates. Specifically, we aim to identify whether the centralities of residents (advice seekers) and senior physicians (advice givers) in the social network are associated with residents' error rates. METHODOLOGY We surveyed 142 resident physicians working in 22 wards in two general hospitals about whom and how frequently they consult using a sociometric technique. Information about errors made in a 3-month period was collected independently. RESULTS Residents made less errors when they sought advice from few senior physicians but consulted more frequently with focal senior physicians (those whom many other advice seekers frequently consult). However, when residents sought advice from many senior physicians, their frequency of consultation with focal senior physicians was not associated with their number of errors. These effects were more pronounced for residents at the beginning of their residency period. CONCLUSIONS Results of this study provide evidence of a specific association between resident physicians' consultation patterns and their error rates. PRACTICE IMPLICATIONS Results inform ward managers about ways to leverage opportunities and remove constraints for residents to ask for advice and for focal physicians to provide it.
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Fernández-Peña R, Ovalle-Perandones MA, Marqués-Sánchez P, Ortego-Maté C, Serrano-Fuentes N. The use of social network analysis in social support and care: a systematic scoping review protocol. Syst Rev 2022; 11:9. [PMID: 35012676 PMCID: PMC8751069 DOI: 10.1186/s13643-021-01876-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent decades, the literature on Social Network Analysis and health has experienced a significant increase. Disease transmission, health behavior, organizational networks, social capital, and social support are among the different health areas where Social Network Analysis has been applied. The current epidemiological trend is characterized by a progressive increase in the population's ageing and the incidence of long-term conditions. Thus, it seems relevant to highlight the importance of social support and care systems to guarantee the coverage of health and social needs within the context of acute illness, chronic disease, and disability for patients and their carers. Thus, the main aim is to identify, categorize, summarize, synthesize, and map existing knowledge, literature, and evidence about the use of Social Network Analysis to study social support and care in the context of illness and disability. METHODS This scoping review will be conducted following Arksey and O'Malley's framework with adaptations from Levac et al. and Joanna Briggs Institute's methodological guidance for conducting scoping reviews. We will search the following databases (from January 2000 onwards): PubMed, MEDLINE, Web of Science Core Collection, SCOPUS, CINAHL, PsycINFO, Cochrane Database of Systematic Reviews, PROSPERO, and DARE. Complementary searches will be conducted in selected relevant journals. Only articles related to social support or care in patients or caregivers in the context of acute illnesses, disabilities or long-term conditions will be considered eligible for inclusion. Two reviewers will screen all the citations, full-text articles, and abstract the data independently. A narrative synthesis will be provided with information presented in the main text and tables. DISCUSSION The knowledge about the scientific evidence available in the literature, the methodological characteristics of the studies identified based on Social Network Analysis, and its main contributions will highlight the importance of health-related research's social and relational dimensions. These results will shed light on the importance of the structure and composition of social networks to provide social support and care and their impact on other health outcomes. It is anticipated that results may guide future research on network-based interventions that might be considered drivers to provide further knowledge in social support and care from a relational approach at the individual and community levels. TRIAL REGISTRATION Open Science Framework https://osf.io/dqkb5 .
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Affiliation(s)
- Rosario Fernández-Peña
- Department of Nursing, University of Cantabria, Santander, Spain. .,IDIVAL Nursing Research Group, Santander, Spain. .,SALBIS Research Group, Leon, University of Leon, Leon, Spain.
| | - María-Antonia Ovalle-Perandones
- SALBIS Research Group, Leon, University of Leon, Leon, Spain.,Library and Information Science Department, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Carmen Ortego-Maté
- Department of Nursing, University of Cantabria, Santander, Spain.,IDIVAL Nursing Research Group, Santander, Spain
| | - Nestor Serrano-Fuentes
- SALBIS Research Group, Leon, University of Leon, Leon, Spain.,NIHR ARC Wessex, School of Health Sciences, University of Southampton, Southampton, UK
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Allen LM, Hay M, Palermo C. Evaluation in health professions education-Is measuring outcomes enough? MEDICAL EDUCATION 2022; 56:127-136. [PMID: 34463357 DOI: 10.1111/medu.14654] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 05/28/2023]
Abstract
INTRODUCTION In an effort to increase the rigour of evaluation in health professions education (HPE), a range of evaluation approaches are used. These largely focus on outcome evaluation as opposed to programme evaluation. We aim to review and critique the use of outcome evaluation models, using the Kirkpatrick Model as an example given its wide acceptance and use, and advocate for the use of programme evaluation models that help us understand how and why outcomes are occurring. METHODS We systematically searched OVID medline, Scopus, CINAHL and Pubmed, and hand searched six leading HPE journals to provide an overview of the use of the Kirkpatrick Model as well as a range of programme evaluation models in HPE. In addition to this, we synthesised the existing critiques of the Kirkpatrick Model as an example of outcome evaluation, to highlight the limitations of such models. RESULTS The use of the Kirkpatrick Model in HPE is widespread and increasing; however, studies focus on categorising outcomes, rather than explaining how and why they occur. The main criticisms of the model are as follows: it is outcomes focused and fails to consider factors that can impact training outcomes; it assumes positive casual linkages between the levels; there is an assumption that the higher-level outcomes are more important; and unintended impacts are not considered. The use of the Kirkpatrick Model by the MERSQI, BEME and WHO contribute to the myth that the Kirkpatrick Model is the gold standard for programme evaluation. DISCUSSION Moving forward, evaluations of HPE interventions must shift from focusing largely on measuring outcomes of interventions with little consideration for how and why these outcomes are occurring to programme evaluation that investigates what contributes to these outcomes. Other models that facilitate the evaluation of the complex processes that occur in HPE should be used instead of Kirkpatrick's.
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Affiliation(s)
- Louise M Allen
- Monash Centre for Professional Development and Monash Online Education, Monash University, Clayton, Victoria, Australia
| | - Margaret Hay
- Monash Centre for Professional Development and Monash Online Education, Monash University, Clayton, Victoria, Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
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Hu H, Yang Y, Zhang C, Huang C, Guan X, Shi L. Review of social networks of professionals in healthcare settings-where are we and what else is needed? Global Health 2021; 17:139. [PMID: 34863221 PMCID: PMC8642762 DOI: 10.1186/s12992-021-00772-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/28/2021] [Indexed: 01/08/2023] Open
Abstract
Background Social Network Analysis (SNA) demonstrates great potential in exploring health professional relationships and improving care delivery, but there is no comprehensive overview of its utilization in healthcare settings. This review aims to provide an overview of the current state of knowledge regarding the use of SNA in understanding health professional relationships in different countries. Methods We conducted an umbrella review by searching eight academic databases and grey literature up to April 30, 2021, enhanced by citation searches. We completed study selection, data extraction and quality assessment using predetermined criteria. The information abstracted from the reviews was synthesized quantitatively, qualitatively and narratively. Results Thirteen reviews were included in this review, yielding 330 empirical studies. The degree of overlaps of empirical studies across included reviews was low (4.3 %), indicating a high diversity of included reviews and the necessity of this umbrella review. Evidence from low- and middle-income countries (LMIC), particularly Asian countries, was limited. The earliest review was published in 2010 and the latest in 2019. Six reviews focused on the construction or description of professional networks and seven reviews reported factors or influences of professional networks. We synthesized existing literature on social networks of health care professionals in the light of (i) theoretical frameworks, (ii) study design and data collection, (iii) network nodes, measures and analysis, and (iv) factors of professional networks and related outcomes. From the perspective of methodology, evidence lies mainly in cross-sectional study design and electronic data, especially administrative data showing “patient-sharing” relationships, which has become the dominant data collection method. The results about the impact of health professional networks on health-related consequences were often contradicting and not truly comparable. Conclusions Methodological limitations, inconsistent findings, and lack of evidence from LMIC imply an urgent need for further investigations. The potential for broader utilization of SNA among providers remains largely untapped and the findings of this review may contain important value for building optimal healthcare delivery networks. PROSPERO registration number The protocol was published and registered with PROSPERO, the International Prospective Register of Systematic Reviews (CRD42020205996). Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00772-7.
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Affiliation(s)
- Huajie Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 100191, Beijing, China
| | - Yu Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 100191, Beijing, China
| | - Chi Zhang
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Cong Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 100191, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 100191, Beijing, China. .,International Research Center for Medicinal Administration, Peking University, Beijing, China.
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 100191, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
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Poß-Doering R, Hegelow M, Borchers M, Hartmann M, Kruse J, Kampling H, Heuft G, Spitzer C, Wild B, Szecsenyi J, Friederich HC. Evaluating the structural reform of outpatient psychotherapy in Germany (ES-RiP trial) - a qualitative study of provider perspectives. BMC Health Serv Res 2021; 21:1204. [PMID: 34740343 PMCID: PMC8570230 DOI: 10.1186/s12913-021-07220-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Access to outpatient mental healthcare can be challenging for patients. In Germany, a national structural reform was implemented in 2017 to accelerate and enhance access to outpatient psychotherapy and reduce waiting times. During the first phase of the study ‘Evaluation of a structural reform of the outpatient psychotherapy guideline (ES-RiP)’ and embedded into a process evaluation, the implementation was to be evaluated through assessing general practitioners’ (GPs) and psychotherapists’ (PTs) perspectives regarding utilization of provided new measures, and perceived potential for optimization. Particular focus was on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs). Methods This exploratory cross-sectional qualitative study used on-site and online focus group discussions and semi-structured telephone interviews with GPs and outpatient PTs. Generated data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze participant characteristics collected via a socio-demographic questionnaire. Results Perspectives on the structural reform were heterogenous. GPs and PTs considered the component of timely initial psychotherapeutic assessment consultations beneficial. GPs disapproved of their deficits in detailed information about the structural reform and exchange with outpatient PTs. Improvement suggestions included structured short information exchange and joint quality circles. The overall number of available outpatient PTs in rural areas was perceived as insufficient. For patients with cMPs, GPs saw patient barriers for therapy access and continuity in low intrinsic motivation, physical impediments and older age. PTs also saw patient challenges regarding low intrinsic motivation and keeping scheduled appointments. They considered post-reform administrative efforts to be high and reported that the regulations (conformity) lead to planning difficulties and financial losses. Reform elements were tailored to fit in with PTs key therapy areas. Stronger networking and joint lectures were suggested as remedy for the currently still limited exchange with GPs. Unlike the GPs, PTs emphasized that accepting patients into psychotherapeutic treatment was independent of a possibly present chronic physical disease. Conclusions The findings contribute to understanding the integration of the delivered structural reform into daily care processes and provide an indication about reached targets and potential improvements. Further phases of the ES-RiP study can build on the findings and broaden insights. Trial registration Registration-ID DRKS00020344 (DRKS German Register of Clinical Trials. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07220-7.
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Affiliation(s)
- Regina Poß-Doering
- Department. of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Martin Hegelow
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, Germany
| | - Milena Borchers
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center of the Justus-Liebig-University, Friedrichstraße 33, 35392, Giessen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center of the Justus-Liebig-University, Friedrichstraße 33, 35392, Giessen, Germany
| | - Gereon Heuft
- University Hospital Muenster, Section Psychosomatic Medicine and Psychotherapy, Albert-Schweitzer-Campus 1 (Geb. A9), D-48149, Münster, Germany
| | - Carsten Spitzer
- University Medicine Rostock, Clinic for Psychosomatic Medicine and Psychotherapy, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department. of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, Germany
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Graessner H, Albanese A, Schöls L. Editorial: Networks in Movement Disorders. To Move or Not to Move. Front Neurol 2021; 12:758246. [PMID: 34721279 PMCID: PMC8555627 DOI: 10.3389/fneur.2021.758246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Holm Graessner
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Ludger Schöls
- Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany.,Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
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Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena. Antibiotics (Basel) 2021; 10:antibiotics10101151. [PMID: 34680732 PMCID: PMC8532997 DOI: 10.3390/antibiotics10101151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 01/22/2023] Open
Abstract
The three-armed cluster-randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance) aimed to foster appropriate antibiotic use and reduce overprescribing in German ambulatory care to counter antibiotic resistance. Multi-faceted interventions targeted primary care physicians, teams and patients. This study examined the effectiveness of the implementation program. ARena was conducted in 14 primary care networks with 196 practices. All arms received data-based feedback on antibiotics prescribing and quality circles. Arms II and III received different add-on components each. Primary outcome examined is the prescribing rate for systemic antibiotics for cases with non-complicated acute infections (upper respiratory tract, bronchitis, sinusitis, tonsillitis, otitis media). Secondary outcomes refer to the prescribing of quinolones and guideline-recommended antibiotics. Based on pseudonymized quarterly claims data, mixed logistic regression models examined pre-post intervention antibiotic prescribing rate changes and compared to matched standard care. A significant rate reduction (arm I 11.7%; arm II 9.9%; arm III 12.7%) and significantly lower prescribing rates were observed for all arms (20.1%, 18.9% and 23.6%) compared to matched standard care (29.4%). Fluoroquinolone prescribing was reduced in all intervention arms and rates for recommended substances generally increased. No significant post-interventional difference between intervention arms was detected. Findings indicate implementation program impact compared to standard care.
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MacKay D, Freeman N, Boyle JA, Campbell S, McLean A, Peiris D, Corpus S, Connors C, Moore E, Wenitong M, Silver B, McIntyre HD, Shaw JE, Brown A, Kirkham R, Maple-Brown L. Improving systems of prenatal and postpartum care for hyperglycemia in pregnancy: A process evaluation. Int J Gynaecol Obstet 2021; 155:179-194. [PMID: 34331708 DOI: 10.1002/ijgo.13850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve prenatal and postpartum care and health outcomes for women with hyperglycemia in pregnancy in regional and remote Australia. METHODS A qualitative evaluation, underpinned by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), was conducted mid-intervention. Semi-structured interviews were conducted with the participants, who included clinicians, regional policymakers and managers, and study implementation staff. RESULTS Interviewees (n = 45) reported that the early phase of the intervention had resulted in the establishment of a clinician network, increased clinician awareness of hyperglycemia in pregnancy, and improvements in management, including earlier referral for specialist care and a focus on improving communication with women. Enablers of implementation included existing relationships with stakeholders and alignment of the intervention with health service priorities. Challenges included engaging remote clinicians and the labor-intensive nature of maintaining a clinical register of women with hyperglycemia in pregnancy. CONCLUSION The early phase of this health systems intervention has had a positive perceived impact on systems of care for women with hyperglycemia in pregnancy. Findings have informed modifications to the intervention, including the development of a communication and engagement strategy.
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Affiliation(s)
- Diana MacKay
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Natasha Freeman
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sandra Campbell
- College of Nursing and Midwifery, Charles Darwin University, Cairns, Queensland, Australia
| | - Anna McLean
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Diabetes and Endocrinology, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - David Peiris
- Centre for Health Systems Science, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Sumaria Corpus
- Danila Dilba Health Service, Darwin, Northern Territory, Australia
| | - Christine Connors
- Population & Primary Health Care, Top End Health Service, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia
| | - Mark Wenitong
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Silver
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - H David McIntyre
- Clinical Unit, Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan E Shaw
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Renae Kirkham
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Louise Maple-Brown
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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McKinlay E, Esplin J, Howard-Brown C, Smith J, McBain L. Implementing a managed clinical network in a small country: A New Zealand case study. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1713536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Eileen McKinlay
- Department of Primary Health Care & General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Jo Esplin
- Sapere Research Group, Wellington, New Zealand
| | | | - Jo Smith
- Sapere Research Group, Wellington, New Zealand
| | - Lynn McBain
- Department of Primary Health Care & General Practice, University of Otago Wellington, Wellington, New Zealand
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Lazzari C, Kotera Y, Green P, Rabottini M. Social Network Analysis of Alzheimer's Teams: A Clinical Review and Applications in Psychiatry to Explore Interprofessional Care. Curr Alzheimer Res 2021; 18:380-398. [PMID: 34218779 DOI: 10.2174/1567205018666210701161449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 05/21/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Understanding the social networks of professionals in psychiatric hospitals and communities working with persons with Alzheimer's (PWA) disease helps tackle the flow of knowledge in patient care and the centrality of team members in providing information and advice to colleagues. OBJECTIVES To use Social Network Analysis (SNA) to confirm or reject the hypothesis that psychiatric professionals have equal status in sharing information and advice on the care of PWA and have reciprocal ties in a social network. METHODS The sample consisting of 50 psychiatric professionals working in geriatric psychiatry in the UK completed an anonymous online survey asking them to select the professional categories of the colleagues in the interprofessional team who are most frequently approached when providing or receiving advice about patient care and gathering patient information. SNA is both a descriptive qualitative analysis and a quantitative method that investigates the degree of the prestige of professionals in their working network and the reciprocity of their ties with other team members. FINDINGS The social network graphs and numerical outcomes showed that interprofessional teams in geriatric psychiatry have health carers who play central roles in providing the whole team with the knowledge necessary for patient care; these are primarily senior professionals in nursing and medical roles. However, the study reported that only 13% of professionals had reciprocal ties within teams. CONCLUSION The current research findings show that the impact of psychiatric health carers in interprofessional teams caring for PWA is not evenly distributed. Those with apparently higher seniority and experience are more frequently consulted; however, other more peripheral figures can be equally valuable in integrated care.
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Affiliation(s)
- Carlo Lazzari
- International Centre for Healthcare and Medical Education, Bristol, United Kingdom
| | - Yasuhiro Kotera
- Department of Health and Social Care, University of Derby, United Kingdom
| | - Pauline Green
- Department of Health and Social Care, University of Derby, United Kingdom
| | - Marco Rabottini
- International Centre for Healthcare and Medical Education, Bristol, United Kingdom
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Seid M, Hartley DM, Margolis PA. A science of collaborative learning health systems. Learn Health Syst 2021; 5:e10278. [PMID: 34277944 PMCID: PMC8278442 DOI: 10.1002/lrh2.10278] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Improving the U.S. healthcare system and health outcomes is one of the most pressing public health challenges of our time. Previously described Collaborative Learning Health Systems (CLHSs) are a promising approach to outcomes improvement. In order to fully realize this promise, a deeper understanding of this phenomenon is necessary. METHODS We drew on our experience over the past decade with CLHSs as well as qualitative literature review to answer three questions: What kind of phenomena are CLHSs? and what is an appropriate scientific approach? How might we frame CLHSs conceptually? What are potential mechanisms of action? RESULTS CLHSs are complex adaptive systems in which all stakeholders are able to collaborate, at scale, to create and share resources to satisfy a variety of needs. This is accomplished by providing infrastructure and services that enable stakeholders to act on their inherent motivations. This framing has implications for both research and practice. CONCLUSION Articulating this framework and potential mechanisms of action should facilitate research to test and refine hypotheses as well as guide practice to develop and optimize this promising approach to improving healthcare systems.
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Affiliation(s)
- Michael Seid
- Division of Pulmonary MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Cincinnati Children's Hospital, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsCollege of Medicine, University of CincinnatiCincinnatiOhioUSA
| | - David M. Hartley
- Cincinnati Children's Hospital, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsCollege of Medicine, University of CincinnatiCincinnatiOhioUSA
| | - Peter A. Margolis
- Cincinnati Children's Hospital, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsCollege of Medicine, University of CincinnatiCincinnatiOhioUSA
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Schaller A, Fohr G, Hoffmann C, Stassen G, Droste-Franke B. Supporting Cross-Company Networks in Workplace Health Promotion through Social Network Analysis-Description of the Methodological Approach and First Results from a Model Project on Physical Activity Promotion in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136874. [PMID: 34206851 PMCID: PMC8297148 DOI: 10.3390/ijerph18136874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/23/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
Cross-company networking and counseling is considered to be a promising approach for workplace health promotion in small and medium-sized enterprises. However, a systematic and empirical approach on how such networks can be developed is lacking. The aims of the present paper are to describe the approach of a social network analysis supporting the development of a cross-company network promoting physical activity and to present first results. In the process of developing the methodological approach, a common understanding of the nodes and edges within the project was elaborated. Based on the BIG-model as the theoretical framework of the project, five measuring points and an application-oriented data collection table were determined. Using Gephi, network size, degree, and distance measures, as well as density and clustering measures, were calculated and visualized in the course of the time. First results showed a continuous expansion and densification of the network. The application experience showed that the application of social network analysis in practical cross-company network development is promising but currently still very resource intensive. In order to address the current major challenges and enable routine application, the development of an application-oriented and feasible tool could make an essential contribution.
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Affiliation(s)
- Andrea Schaller
- Working Group Physical Activity-Related Prevention Research, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany; (C.H.); (G.S.)
- Correspondence: ; Tel.: +49-221-4982-8673
| | - Gabriele Fohr
- IQIB–Institut für Qualifizierende Innovationsforschung & -beratung, Wilhelmstraße 56, 53474 Bad Neuenahr-Ahrweiler, Germany; (G.F.); (B.D.-F.)
| | - Carina Hoffmann
- Working Group Physical Activity-Related Prevention Research, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany; (C.H.); (G.S.)
- Institute for Occupational Health Promotion, Neumarkt 35-37, 50667 Cologne, Germany
| | - Gerrit Stassen
- Working Group Physical Activity-Related Prevention Research, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany; (C.H.); (G.S.)
| | - Bert Droste-Franke
- IQIB–Institut für Qualifizierende Innovationsforschung & -beratung, Wilhelmstraße 56, 53474 Bad Neuenahr-Ahrweiler, Germany; (G.F.); (B.D.-F.)
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Implementing a Care Pathway for Complex Chronic Patients from a Nursing Perspective: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126324. [PMID: 34207974 PMCID: PMC8296156 DOI: 10.3390/ijerph18126324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022]
Abstract
A care pathway constitutes a complex care strategy for decision-making and the organization of processes in the care of complex chronic patients, avoiding the fragmentation of care. Health professionals play a decisive role in the implementation, development, and evaluation of care pathways. This study sought to explore nurses’ opinions on the care pathway for complex chronic patients three years after its implementation. The study participants were thirteen nurses with different roles who were involved in the care pathway. Thematic content analysis of the semi-structured interviews resulted in four major themes: (a) the strengths of the route; (b) the impact of the route on caregivers; (c) the weaknesses of the route; and (d) the future of the route. Overall, the pathway was positively valued for the benefits it provides to patients, the caregiver, and the administration of professional health care. Participants voiced their concerns regarding: communication and coordination difficulties among professionals across the different levels of care, the need for improved teamwork and consensus among professionals at the same center, and human and material resources. The ongoing evaluation and monitoring of facilitators and barriers is necessary throughout the implementation process, to ensure continuity and quality of care in the health system.
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Pavithra A. Towards developing a comprehensive conceptual understanding of positive hospital culture and approaches to healthcare organisational culture change in Australia. J Health Organ Manag 2021; ahead-of-print. [PMID: 33837683 DOI: 10.1108/jhom-10-2020-0385] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE The key aim of this narrative literature review, therefore, is to identify the key conceptual categories that inform the construction of positive person-centred culture within hospitals, and how these frameworks are brought to bear upon organisational culture within healthcare systems in Australia. DESIGN/METHODOLOGY/APPROACH This narrative review presents a thematic synthesis of literature identified through a systematic search protocol undertaken across 19 academic databases and Google Scholar as an additional search tool. Thematic qualitative analysis was performed on the research results to determine the common themes within the diverse literature presented within this study. FINDINGS Culture change interventions in hospitals attempt to address the problem of widespread unprofessional behaviour within healthcare systems. However, diverse definitions and seemingly fragmented approaches to understanding and enacting organisational culture change present a significant hurdle in achieving cohesive and sustainable healthcare reform. This narrative literature review offers a comprehensive conceptual view of the key approaches that inform positive person-centred culture within hospital settings. In total, three primary dimensions, belonging, behaving and being, aligned against organisational goals, individual behaviours and worker as well as organisational identity were identified. Other individual and group interactional dynamics that give rise to negative organisational culture are further analysed to understand the fault lines along which existing culture change interventions are typically operationalised. RESEARCH LIMITATIONS/IMPLICATIONS This review is not exhaustive and is limited in its methodological scope. The central values and themes identified within the literature are integral to designing humanised healthcare systems. However, owing to the qualitative nature and contextual variability of these factors, these themes do not lend themselves to replicable quantification. SOCIAL IMPLICATIONS This analysis contributes to foundational research efforts towards transforming healthcare practice to be more aligned with humanised and equitable values within increasingly complex healthcare organisational settings. Designing culture change interventions that align more suitably with the values-driven categories identified in this literature review may increase the effectiveness and sustainability of these interventions and reform efforts at organisational and systemic levels. ORIGINALITY/VALUE This article presents a comprehensive framework to approach healthcare organisational reform through shared and equitable models of operation, management and governance rather than continuing to promote narrowly defined outcomes derived from commodified models of healthcare practice.
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Affiliation(s)
- Antoinette Pavithra
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Sydney, Australia
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van Rinsum CE, Gerards SMPL, Rutten GM, van de Goor IAM, Kremers SPJ, Mercken L. Lifestyle coaches as a central professional in the health care network? Dynamic changes over time using a network analysis. BMC Health Serv Res 2021; 21:247. [PMID: 33740982 PMCID: PMC7980338 DOI: 10.1186/s12913-021-06252-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Overweight and obesity are problems that are increasing globally in both children as well as adults, and may be prevented by adopting a healthier lifestyle. Lifestyle coaches counsel overweight and obese children (and their parents) as well as adults in initiating and maintaining healthier lifestyle behaviours. It is currently unclear whether this novel professional in the Dutch health care system functions as a linchpin in networks that evolve around lifestyle-related health problems. The aim of the present study is to investigate the formation and development of networks of lifestyle coaches and their positions within these networks. Methods In this longitudinal study, key professionals and professionals within relevant organisations in the Coaching on Lifestyle (CooL) care networks were asked to fill in three online questionnaires. Respondents were asked to indicate whether they collaborated with each of the specified professionals in the context of CooL. The overall network structures and the central role of the lifestyle coaches were examined by using network analysis. Results The results showed that the networks in three out of four regions were relatively centralised, but that none of the networks were dense, and that the professionals seemed to collaborate less with others over time. Half of the lifestyle coaches had a high number of collaborations and a central position within their networks, which also increased over time. In half of the regions, the lifestyle coaches had increased their role as consultants, while their role as gatekeeper and liaison decreased over time. In most regions, the sector of lifestyle coaches had a central position in their networks in just one measurement. Other central sectors were the local sports organisation, public health services, youth health care and the municipal government. Conclusions Overall, we cannot conclude that more central and denser networks were formed during the study period. In addition, the lifestyle coaches were not often positioned as a central sector within these networks. Entrepreneurial, network and brokering competences are required for lifestyle coaches to build up denser networks. Trial registration NTR6208; date registered: 13–01-2017; retrospectively registered; Netherlands Trial Register.
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Affiliation(s)
- Celeste E van Rinsum
- Department of Health Promotion, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
| | - Sanne M P L Gerards
- Department of Health Promotion, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Geert M Rutten
- Faculty of Science and Engineering, University College Venlo, Maastricht University, P.O. Box 8, Venlo, 5900 AA, The Netherlands
| | - Ien A M van de Goor
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE, The Netherlands
| | - Stef P J Kremers
- Department of Health Promotion, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
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Long JC, Gul H, McPherson E, Best S, Augustsson H, Churruca K, Ellis LA, Braithwaite J. A dynamic systems view of clinical genomics: a rich picture of the landscape in Australia using a complexity science lens. BMC Med Genomics 2021; 14:63. [PMID: 33639930 PMCID: PMC7912922 DOI: 10.1186/s12920-021-00910-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Clinical genomics represents a paradigm shifting change to health service delivery and practice across many conditions and life-stages. Introducing this complex technology into an already complex health system is a significant challenge that cannot be managed in a reductionist way. To build robust and sustainable, high quality delivery systems we need to step back and view the interconnected landscape of policymakers, funders, managers, multidisciplinary teams of clinicians, patients and their families, and health care, research, education, and philanthropic institutions as a dynamic whole. This study holistically mapped the landscape of clinical genomics within Australia by developing a complex graphic: a rich picture. Using complex systems theory, we then identified key features, challenges and leverage points of implementing clinical genomics. METHODS We used a multi-stage, exploratory, qualitative approach. We extracted data from grey literature, empirical literature, and data collected by the Australian Genomic Health Alliance. Nine key informants working in clinical genomics critiqued early drafts of the picture, and validated the final version. RESULTS The final graphic depicts 24 stakeholder groups relevant to implementation of genomics into Australia. Clinical genomics lies at the intersection of four nested systems, with interplay between government, professional bodies and patient advocacy groups. Barriers and uncertainties are also shown. Analysis using complexity theory showed far-reaching interdependencies around funding, and identified unintended consequences. CONCLUSION The rich picture of the clinical genomic landscape in Australia is the first to show key stakeholders, agencies and processes and their interdependencies. Participants who critiqued our results were instantly intrigued and engaged by the graphics, searching for their place in the whole and often commenting on insights they gained from seeing the influences and impacts of other stakeholder groups on their own work. Funding patterns showed unintended consequences of increased burdens for clinicians and inequity of access for patients. Showing the system as a dynamic whole is the only way to understand key drivers and barriers to largescale interventions. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Hossai Gul
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Elise McPherson
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Hanna Augustsson
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, Australia
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Bhatti S, Wake N, Jani Y. Evaluating the effectiveness of digital communication within the National Medication Safety Network for England. Eur J Hosp Pharm 2021; 29:275-279. [PMID: 33608395 DOI: 10.1136/ejhpharm-2020-002517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The medication safety officer (MSO) role was created following a patient safety alert, with an action for MSOs to be active participants in a national network in England, which included regular online webinar meetings and an online forum. The aim of the study was to assess the effectiveness of digital platforms in facilitating interaction and communication by the MSO network. The objectives were to establish the proportion of MSOs who interact through monthly webinars and the online forum. A secondary objective was to identify barriers and facilitators for engaging digitally within the MSO network. METHODS An online survey was used alongside semistructured interviews. The online survey was disseminated to all 400 MSOs registered with the UK Department of Health Central Alerting System from December 2018 to February 2019. Interviewees were identified purposively through snowball sampling and voluntarily through the survey. RESULTS 84 MSOs responded to the survey (21% response rate) and 10 participated in the semistructured interviews. The majority of the respondents were pharmacists (79/84, 94%) from NHS large healthcare providers (44/84, 52%). MSO respondents (61/84, 73%) joined the monthly webinar and 47/84 (56%) believed the webinar was useful for networking. Ten (12%) did not attend the webinars due to technical difficulties or lack of time. The online forum was used less frequently, with a third (27/84, 32%) that had never used it. CONCLUSIONS Digital communications through webinars and online forums were perceived by respondents as a way to facilitate networking but require a robust information technology infrastructure that can be accessed without difficulty. User-friendly platforms can help the MSO network achieve critical mass and greater interaction, allowing timely access to information.
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Affiliation(s)
- Samrina Bhatti
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK .,NHS Specialist Pharmacy Service, London North West Healthcare, Harrow, UK
| | - Nicola Wake
- NHS Specialist Pharmacy Service, London North West Healthcare, Harrow, UK
| | - Yogini Jani
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK.,School of Pharmacy, University College London, London, UK
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Kierkegaard P, Owen-Smith J. Determinants of physician networks: an ethnographic study examining the processes that inform patterns of collaboration and referral decision-making among physicians. BMJ Open 2021; 11:e042334. [PMID: 33402408 PMCID: PMC7786804 DOI: 10.1136/bmjopen-2020-042334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Most scholarly attention to studying collaborative ties in physician networks has been devoted to quantitatively analysing large, complex datasets. While valuable, such studies can reduce the dynamic and contextual complexities of physician collaborations to numerical values. Qualitative research strategies can contribute to our understanding by addressing the gaps left by more quantitative approaches. This study seeks to contribute to the literature that applies network science approaches to the context of healthcare delivery. We use qualitative, observational and interview, methods to pursue an in-depth, micro-level approach to the deeply social and discursive processes that influence patterns of collaboration and referral decision-making in physician networks. DESIGN Qualitative methodologies that paired ethnographic field observations, semistructured interviews and document analysis were used. An inductive thematic analysis approach was used to analyse, identify and describe patterns in those data. SETTING This study took place in a high-volume cardiovascular department at a major academic medical centre (AMC) located in the Midwest region of the USA. PARTICIPANTS Purposive and snowballing sampling were used to recruit study participants for both the observational and face-to-face in-depth interview portions of the study. In total, 25 clinicians and 43 patients participated in this study. RESULTS Two primary thematic categories were identified: (1) circumstances for external engagement; and (2) clinical conditions for engagement. Thematic subcategories included community engagement, scientific engagement, reputational value, experiential information, professional identity, self-awareness of competence, multidisciplinary programmes and situational factors. CONCLUSION This study adds new contextual knowledge about the mechanisms that characterise referral decision-making processes and how these impact the meaning of physician relationships, organisation of healthcare delivery and the knowledge and beliefs that physicians have about their colleagues. This study highlights the nuances that influence how new collaborative networks are formed and maintained by detailing how relationships among physicians develop and evolve over time.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London, UK
- CRUK Convergence Science Centre, Institute of Cancer Research & Imperial College London, London, UK
| | - Jason Owen-Smith
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Department of Sociology, University of Michigan, Ann Arbor, Michigan, USA
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Burn AM, Vainre M, Humphrey A, Howarth E. Evaluating the CYP-IAPT transformation of child and adolescent mental health services in Cambridgeshire, UK: a qualitative implementation study. Implement Sci Commun 2020; 1:89. [PMID: 33073242 PMCID: PMC7556968 DOI: 10.1186/s43058-020-00078-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Children and Young People's Improving Access to Psychological Therapies (CYP-IAPT) programme was introduced to transform Child and Adolescent Mental Health Services (CAMHS) across England. The programme comprised a set of principles that local CAMHS partnerships were expected to operationalise and embed with the aim of increasing access to services and improving the quality of care. This study explored how the implementation of the CYP-IAPT programme was executed and experienced by CAMHS professionals in the county of Cambridgeshire (UK), and the extent to which the CYP-IAPT principles were perceived to be successfully embedded into everyday practice. Methods We analysed 275 documents relating to the CYP-IAPT programme issued between 2011 and 2015. We also conducted a thematic analysis of 20 qualitative interviews, undertaken at two time points, with professionals from three CAMHS teams in Cambridgeshire. Analysis was informed by implementation science frameworks. Results Document analysis suggested that the CYP-IAPT programme was initially not clearly defined and lacked guidance on how to operationalise key programme principles and apply them in everyday practice. There was also a degree of programme evolution over time, which made it difficult for local stakeholders to understand the scope and aims of CYP-IAPT. Interviews with staff showed low coherent understanding of the programme, variable levels of investment among stakeholders and difficulties in collaborative working. Barriers and facilitators to programme implementation were identified at individual, service and strategic levels. These in turn impacted the local implementation efforts and sustainability of the programme in Cambridgeshire. Conclusions We identified factors relating to programme design and national and local implementation planning, as well as features of inner and outer context, which impacted on the delivery and sustainability of the programme. These findings can be drawn upon to inform the development and delivery of other local and national quality improvement (QI) initiatives relating to children and young people's mental health.
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Affiliation(s)
- Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Maris Vainre
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Ayla Humphrey
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Emma Howarth
- School of Psychology, University of East London, London, UK
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Allen LM, Hay M, Armstrong E, Palermo C. Applying a social theory of learning to explain the possible impacts of continuing professional development (CPD) programs. MEDICAL TEACHER 2020; 42:1140-1147. [PMID: 32706608 DOI: 10.1080/0142159x.2020.1795097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Continuing professional development (CPD) is essential for life-long learning of health professionals, yet evaluations of CPD focus on a narrow range of impacts. This study explored the range of impacts that are possible from attending CPD programs that foster social learning, and applied Wenger's social theory of learning to explain why these impacts occur. METHODS Twenty semi-structured in-depth interviews were conducted with a purposive sample of past participants from two immersive CPD institutes. Inductive thematic analysis was used to analyse the data. RESULTS Five themes were identified; (i) growing and utilising a network of like-minded individuals, (ii) forming stronger identities, (iii) applying learnings to practice, (iv) obtaining achievements and recognition, and (v) going beyond the scholar. Participants described experiencing both immediate and sustained impacts as a result of attending the courses. Concepts from Wenger's social learning theory including peripheral membership, reification and multimembership helped to explain why these impacts occur. CONCLUSIONS The results suggest that a range of sustained impacts are possible as a result of attending CPD programs, but ongoing social learning is crucial to achieving these impacts. The social process of learning should be considered in the design of future CPD.
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Affiliation(s)
- Louise M Allen
- Faculty of Medicine Nursing and Health Sciences Education Portfolio, Monash University, Melbourne, Australia
| | - Margaret Hay
- Monash Centre for Professional Development and Monash Online Education, Monash University, Melbourne, Australia
| | | | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Melbourne, Australia
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Hovlid E, Braut GS, Hannisdal E, Walshe K, Bukve O, Flottorp S, Stensland P, Frich JC. Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis. BMJ Open 2020; 10:e038850. [PMID: 32868366 PMCID: PMC7462249 DOI: 10.1136/bmjopen-2020-038850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES External inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections. METHODS We performed a literature search (1980-January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change. RESULTS We included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation's current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance. CONCLUSIONS External inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.
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Affiliation(s)
- Einar Hovlid
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| | - Geir Sverre Braut
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Western Norway University of Applied Sciences, Haugesund, Norway
| | - Einar Hannisdal
- Department of health, County Governor in Oslo and Akershus, Oslo, Norway
| | - Kieran Walshe
- The University of Manchester Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Oddbjørn Bukve
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
| | | | - Per Stensland
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| | - Jan C Frich
- Institute of Health and Society, Universitetet i Oslo, Oslo, Norway
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