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Bertelsen PS, Bossen C, Knudsen C, Pedersen AM. Data work and practices in healthcare: A scoping review. Int J Med Inform 2024; 184:105348. [PMID: 38309238 DOI: 10.1016/j.ijmedinf.2024.105348] [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: 09/18/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/05/2024]
Abstract
CONTEXT In healthcare, digitization has been widespread and profound, entailing a deluge of data. This has spurred ambitions for healthcare to become data-driven to improve efficiency and quality, and within medicine itself to improve diagnosing and treating diseases. The generation and processing of data requires human intervention and work, though this is often not acknowledged. PURPOSE The paper investigates who, where, by which means, and for which purposes data work is conducted which is crucial for healthcare managers and policy makers if ambitions to become data-driven are to succeed. To guide further research, it also provides an overview of existing research on data work and practices. METHODS We conducted a scoping review based on a search for papers including the terms healthcare or health care combined with at least one of the following terms: data work, data worker*, data practice*, data practitioner* in Scopus and Web of Science. 74 papers on data work or practices in healthcare were included. ANALYSIS The 74 papers were coded and analyzed regarding the following themes: the kind of data workers and practitioners, organizational settings, involved technologies, purposes, data work tasks, theories and concepts, and definitions of data work and practice. RESULTS Data work is pervasive in healthcare and conducted by various professions and people and in various contexts. The field researching data work and practices is emerging, with publications spread across multiple venues. and there is a need for more precise definitions of data work. Further, data work and practices are useful concepts that have enabled the exploration of those efforts and tasks in detail. CONCLUSION The research on data work and practices in healthcare is emerging and promising. We call for more research to consolidate the field and to better understand and support the work needed for healthcare to become data-driven.
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Affiliation(s)
| | - Claus Bossen
- Department of Digital Design and Information Studies, Aarhus University, Denmark.
| | - Casper Knudsen
- Department of Sustainability and Planning, Aalborg University, Denmark
| | - Asbjørn M Pedersen
- Department of Digital Design and Information Studies, Aarhus University, Denmark
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Edmiston P, Lukhang Klippel S, Baran JD, Khakpour D, Hirsch IB, Trikudanathan S. The Role of a "Technology Navigator" in an Academic Diabetes Clinic: A Feasibility Evaluation. Diabetes Technol Ther 2024; 26:65-69. [PMID: 37955667 DOI: 10.1089/dia.2023.0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Patient-generated device data play an important role in diabetes management. However, acquiring these data remains a challenge. This project aimed to understand whether implementing dedicated "Technology Navigator" (TN) personnel at a large academic diabetes clinic could facilitate access to device data without increasing work for clinic staff. A sample of visits pre- and post-TN implementation (n = 173) showed a 22% (41% vs. 19%) increase in patients who successfully shared their data from home before their visit and a 52% (67% vs. 15%) increase in visits where data were available to the provider for review before the appointment, whereas billing claims for continuous glucose monitor interpretation increased by 86% during the same period. Time analysis suggests that home uploads could save up to 747 h in medical assistant labor annually. Incorporating a TN may improve data availability, decrease time spent on nonbillable activities, and support data interpretation and billing.
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Affiliation(s)
- Paige Edmiston
- Department of Anthropology, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Sarah Lukhang Klippel
- Department of Medicine, University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
| | - Jesica D Baran
- Department of Medicine, University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, USA
| | - Dori Khakpour
- Department of Medicine, University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
| | - Irl B Hirsch
- Department of Medicine, University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, USA
| | - Subbulaxmi Trikudanathan
- Department of Medicine, University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, USA
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Haase CB, Ajjawi R, Bearman M, Brodersen JB, Risor T, Hoeyer K. Data as symptom: Doctors' responses to patient-provided data in general practice. SOCIAL STUDIES OF SCIENCE 2023; 53:522-544. [PMID: 37096688 PMCID: PMC10363926 DOI: 10.1177/03063127231164345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
People are increasingly able to generate their own health data through new technologies such as wearables and online symptom checkers. However, generating data is one thing, interpreting them another. General practitioners (GPs) are likely to be the first to help with interpretations. Policymakers in the European Union are investing heavily in infrastructures to provide GPs access to patient measurements. But there may be a disconnect between policy ambitions and the everyday practices of GPs. To investigate this, we conducted semi-structured interviews with 23 Danish GPs. According to the GPs, patients relatively rarely bring data to them. GPs mostly remember three types of patient-generated data that patients bring to them for interpretation: heart and sleep measurements from wearables and results from online symptom checkers. However, they also spoke extensively about data work with patient queries concerning measurements from the GPs' own online Patient Reported Outcome system and online access to laboratory results. We juxtapose GP reflections on these five data types and between policy ambitions and everyday practices. These data require substantial recontextualization work before the GPs ascribe them evidential value and act on them. Even when they perceived as actionable, patient-provided data are not approached as measurements, as suggested by policy frameworks. Rather, GPs treat them as analogous to symptoms-that is to say, GPs treat patient-provided data as subjective evidence rather than authoritative measures. Drawing on Science and Technology Studies (STS) literature,we suggest that GPs must be part of the conversation with policy makers and digital entrepreneurs around when and how to integrate patient-generated data into healthcare infrastructures.
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Affiliation(s)
| | - Rola Ajjawi
- Deakin University, Melbourne, VIC, Australia
| | | | - John Brandt Brodersen
- University of Copenhagen, Copenhagen, Denmark
- Primary Health Care Research Unit, Region Zealand, Denmark
- University of Tromsø, Tromsø, Norway
| | - Torsten Risor
- University of Copenhagen, Copenhagen, Denmark
- University of Tromsø, Tromsø, Norway
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Bergholdt SH, Hansen DG, Johnsen AT, Boman BS, Jensen PT. A NEw MOdel of individualized and patient-centered follow-up for women with gynecological cancer (the NEMO study)-protocol and rationale of a randomized clinical trial. Trials 2023; 24:74. [PMID: 36726187 PMCID: PMC9890753 DOI: 10.1186/s13063-022-07022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/15/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Follow-up programs for gynecological cancer patients are currently under revision. There is limited evidence that traditional follow-up and clinical examinations improve survival in an early-stage gynecological setting. Further, traditional follow-up programs fail to accommodate the patient's need for psychosocial and sexual supportive care and to actively involve patients and their relatives in the follow-up process. Individualized programs may replace traditional routine follow-up with fixed intervals and length. Focusing on alarm-symptoms and self-reporting may ensure detection of recurrence while allowing a continuous attention to the patient's well-being and return to daily life. In this study, a nurse-led, individualized, and need-based intervention with a specific focus on patient empowerment is tested against a standard physician-led model primarily focusing on the detection of recurrence. METHODS The study is designed as a clinical, randomized trial conducted in one of four national onco-gynecological centers in Denmark. Patients with early-stage cervical or endometrial cancer are eligible for inclusion. The intervention group undergoes individualized, nurse-led follow-up supporting patient empowerment including repeated use of electronic patient-reported outcome measures (ePROMs) before each contact as a dialogue support tool. The follow-up contacts are mainly conducted by telephone. All project nurses attended a special training program before project start and are all well-educated and dedicated onco-gynecological nurses. The control group receives standard, physician-led, follow-up without use of ePROMs or specific focus on empowerment. The effect of the intervention is evaluated by questionnaires completed by patients at baseline (3 months after surgery) and 12, 18, and 36 months after surgery. Outcomes include empowerment using the Skill and technique subscale of the HEI-Q questionnaire as the primary outcome while fear of cancer recurrence and health-related quality of life as well as the remaining subscales of the HEI-Q represent secondary outcomes. Data is collected by use of the REDCap technology, which also provides a customized visual support function for the dialogue tool. DISCUSSION This study will provide new information about follow-up in early-stage gynecological cancer settings and thereby contribute to improvement of future follow-up programs. Importantly, the study will provide knowledge about the impact of specific focus on patient empowerment in follow-up programs and, further, how to facilitate empowerment among patients. TRIAL REGISTRATION The study is registered at clinicaltrials.gov: ID no. NCT03838861. Registered on 6 February 2019. Protocol version 2, issue date 21 November 2022.
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Affiliation(s)
- Stinne Holm Bergholdt
- grid.10825.3e0000 0001 0728 0170Department of Clinical Medicine, Faculty of Health Science, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Dorte Gilsaa Hansen
- grid.7143.10000 0004 0512 5013Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anna Thit Johnsen
- grid.10825.3e0000 0001 0728 0170Department of Psychology, University of Southern Denmark, Odense, Denmark ,grid.476266.7Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | | | - Pernille Tine Jensen
- grid.10825.3e0000 0001 0728 0170Department of Clinical Medicine, Faculty of Health Science, University of Southern Denmark, Odense, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Torenholt R, Langstrup H. Between a logic of disruption and a logic of continuation: Negotiating the legitimacy of algorithms used in automated clinical decision-making. Health (London) 2023; 27:41-59. [PMID: 33685260 DOI: 10.1177/1363459321996741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation: here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools - involving algorithmic sorting - in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians' expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems.
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Thestrup Hansen S, Piil K, Bak Hansen L, Ledertoug KM, Hølge-Hazelton B, Schmidt VJ. Electronic patient-reported outcome measures to enable systematic follow-up in treatment and care of women diagnosed with breast cancer: a feasibility study protocol. BMJ Open 2022; 12:e065110. [PMID: 36385030 PMCID: PMC9670949 DOI: 10.1136/bmjopen-2022-065110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The use of patient-reported outcome measures (PROMs) in clinical practice has the potential to promote person-centred care and improve patients' health-related quality of life. We aimed to develop an intervention centred around electronic PROMs (ePROMs) for systematic follow-up in patients diagnosed with breast cancer and to evaluate its feasibility. METHODS AND ANALYSIS We developed a nurse-oriented and surgeon-oriented intervention in PROMs, including (1) an education programme for nurses and surgeons; (2) administration of BREAST-Q as proactive ePROMs during follow-up in patients diagnosed with breast cancer and (3) feedback to nurses and surgeons on PROM scores and a guidance manual for healthcare practitioners. Subsequently, we designed a non-controlled feasibility evaluation on the outcomes acceptability, demand, implementation, practicality and integration. The feasibility evaluation includes qualitative ethnographic studies exploring the user perspectives of patients, nurses and surgeons and quantitative studies to explore the characteristics of the patient population regarding demographic background, response rates and response patterns. The feasibility study was initiated in September 2021, will continue until 2024 and will include approximately 900 patients. EPROMs are collected at the following assessment time points: baseline (after diagnosis, before surgery), 1-year follow-up and 3-year endpoint. ETHICS AND DISSEMINATION The study will be conducted according to the General Data Protection Regulation and the fifth version of the Helsinki Declaration. The National Committee on Health Research Ethics approved the study according to the law of the Committee § 1, part 4. All data will be anonymised before its publication. The results of the feasibility study will be published in peer-reviewed, international journals.
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Affiliation(s)
- Stine Thestrup Hansen
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Karin Piil
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lone Bak Hansen
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, København, Denmark
| | - Karen Marie Ledertoug
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
- Copenhagen Emergency Medical Services, Capital Region of Denmark, Ballerup, Denmark
| | - Bibi Hølge-Hazelton
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Research Support Unit, Zealand University Hospital, Roskilde, Denmark
| | - Volker Jürgen Schmidt
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, København, Denmark
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Reitzel SB, Lynning M, Skovgaard L. Neurologists' views on patient reported outcomes in multiple sclerosis care. Heliyon 2022; 8:e09637. [PMID: 35711978 PMCID: PMC9193910 DOI: 10.1016/j.heliyon.2022.e09637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/12/2021] [Accepted: 05/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background The value that patient reported outcomes (PROs) can bring to the clinical encounter is increasingly being recognized. Within the field of Multiple Sclerosis (MS), a number of activities have been initiated internationally with the aim of integrating PROs in MS care. Integration of PROs in MS care will, among other things, require MS neurologists' acceptance of PROs. This qualitative study aimed to explore MS specialized neurologists’ view on the potentials and barriers for the use of PROs in the clinical setting. Methods Eight neurologists specialized in MS participated in a series of individual in-depth semi-structured interviews. Interviews were audio-recorded and transcribed. A thematic analysis was conducted using a reflexive thematic approach to identify meaning units and themes emerging from the interviews. The analysis focused on barriers and potentials for PROs that relate to the specific characteristics of MS. Results Three main themes emerged from the data. “The role of PROs in describing the patient's situation” describes how informants perceived MS as a complex disease, and in this context, PROs can bring forth new or otherwise hidden information, but they may also blur the picture. The theme “The validity of PROs reported by MS patients may be questionable” describes how impairments caused by MS, such as cognitive and physical disabilities, were identified as risk factors that could cause unreliable self-reported outcome measures within this patient group. Finally, the theme “Involving the patient” regards how the clinical conversation was viewed as the most important source of patient reported information, but at the same time PROs carry the potential to enhance shared decision making. Conclusion This study indicates that, according to MS neurologists, integration of PROs in MS clinical practice, though possibly valuable, is not without challenges. Possible benefits of PROs include the ability to bring forth otherwise hidden information on the patient's health status and the enhancement of shared decision making. Barriers include difficulties in capturing the full situation of the patient via PROs due to the complexity of MS as well as the issue of various MS-related impairments compromising the validity of PROs reported by MS patients. The complexity of MS affects neurologists' attitudes towards PROs. PROs hold the potential to bring forth otherwise hidden information. Neurologists are sceptical regarding the quality of information from PROs. PROs may not provide sufficiently detailed information about patients' situations.
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Affiliation(s)
- Signe Baattrup Reitzel
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1. st., DK-2500, Valby, Denmark
| | - Marie Lynning
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1. st., DK-2500, Valby, Denmark
| | - Lasse Skovgaard
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1. st., DK-2500, Valby, Denmark
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Torenholt R, Tjørnhøj-Thomsen T. 'Is this something I should be worried about?': A study of nurses' recontextualisation work when making clinical decisions based on patient reported outcome data. Soc Sci Med 2021; 294:114645. [PMID: 35051741 DOI: 10.1016/j.socscimed.2021.114645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 01/13/2023]
Abstract
As clinical care practices are becoming more digitalised, information about patients is increasingly being encoded as quantified data, and the processes of sorting data are often supported by algorithmic computations. One such practice becoming more prevalent across Western countries is the clinical use of Patient Reported Outcome (PRO) data. Drawing on ethnographic fieldwork carried out in a Danish setting among nurses managing PRO-based breast cancer follow-up, we examine how clinical decisions are made on the basis of PRO-data and what this requires from the nurses. By applying the concept of recontextualisation work as an analytical perspective, we shed light on the efforts of nurses when mobilising complementary information about patients in order to recontextualise the otherwise decontextualised data, thereby giving data practical value in clinical decision-making. Recontextualisation work, we show, is shaped by organisational structure, available resources, and nurses' professional capacity. Drawing analytical attention to the work of recontextualisation allows for a nuanced understanding of the efforts required to make data workable and hence what it takes to carry out clinical decisions in today's datafied healthcare system.
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Affiliation(s)
- Rikke Torenholt
- Department of Public Health, Section for Health Services Research, Øster Farimagsgade 5, DK-1014, København K, Denmark.
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, Studiestræde 6, DK-1455, København K, Denmark.
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Infrastructuring experience: what matters in patient-reported outcome data measurement? BIOSOCIETIES 2021. [DOI: 10.1057/s41292-020-00221-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pitkänen LJ, Leskelä RL, Tolkki H, Torkki P. A Value-Based Steering Model for Healthcare. FRONTIERS IN HEALTH SERVICES 2021; 1:709271. [PMID: 36926492 PMCID: PMC10012620 DOI: 10.3389/frhs.2021.709271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022]
Abstract
This article aims to answer how a commissioning body can steer health services based on value in an environment where the commissioner is responsible for the health services of a population with varying health service needs. In this design science study, we constructed a value-based steering model consisting of three parts: (1) the principles of steering; (2) the steering process; and (3) Value Steering Canvas, a concrete tool for steering. The study is based on Finland, a tax-funded healthcare system, where healthcare is a public service. The results can be applied in any system where there is a commissioner and a service provider, whether they are two separate organizations or not. We conclude that steering can be done based on value. The commissioning body can start using value-based steering without changes in legislation or in the present service system. Further research is needed to test the model in practice.
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Affiliation(s)
- Laura J Pitkänen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Helena Tolkki
- Nordic Healthcare Group, Helsinki, Finland.,Faculty of Management and Business, Tampere University, Tampere, Finland
| | - Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Thestrup Hansen S, Kjerholt M, Friis Christensen S, Brodersen J, Hølge-Hazelton B. User experiences on implementation of patient reported outcome measures (PROMs)in a Haematological outpatient clinic. J Patient Rep Outcomes 2020; 4:87. [PMID: 33113030 PMCID: PMC7593370 DOI: 10.1186/s41687-020-00256-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022] Open
Abstract
Background PROMs can help healthcare professionals gain an improved understanding of patients’ physical burdens, functional levels, and (health-related) quality of life throughout disease and medical treatment. The aim of this study was to investigate the barriers and potential opportunities PROMs may present in a haematological outpatient clinic from three different perspectives: patients, nurses and haematologists. Methods The present study synthesizes three previously published studies that separately explored the experiences of patients, nurses and haematologists when implementing PROMs. The studies were all guided by the qualitative methodology Interpretive Description, including a focused ethnographic approach, to develop implications for future practice. Results The overall themes that emerged from the analysis were “Structural similarities influence the adoption of PROMs” and “Different perspectives on the potential of PROMs.” Conclusion Across the different user groups in the haematological outpatient clinic, the use of PROMs was thwarted due to an unquestioned commitment to biomedical knowledge and the system’s rationality and norms: PROM data was not used in patient consultations. Nurses and haematologists expressed different preferences related to potential future PROMs and different objectives for PROMs in clinical practice. From the different perspectives of the patients, nurses and haematologists, PROMs were not compatible with clinical practice. Further research is recommended to develop PROMs validated for use in haematological outpatient clinics. Moreover, implementation strategies adjusted to the structural barriers of the system are crucial. Supplementary information Supplementary information accompanies this paper at 10.1186/s41687-020-00256-z.
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Affiliation(s)
- Stine Thestrup Hansen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark. .,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. .,Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Roskilde, Denmark.
| | - Mette Kjerholt
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sarah Friis Christensen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- Section of General Practice and Research Unit for General practice, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Zealand Region, Denmark
| | - Bibi Hølge-Hazelton
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,The Research Support Unit, Zealand University Hospital, Roskilde, Denmark
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Introduction to the Special Issue on ‘Information Infrastructures in Healthcare: Governance, Quality Improvement and Service Efficiency’. Comput Support Coop Work 2020. [DOI: 10.1007/s10606-020-09381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thestrup Hansen S, Kjerholt M, Friis Christensen S, Hølge-Hazelton B, Brodersen J. Haematologists' experiences implementing patient reported outcome measures (PROMs) in an outpatient clinic: a qualitative study for applied practice. J Patient Rep Outcomes 2019; 3:74. [PMID: 31884569 PMCID: PMC6935381 DOI: 10.1186/s41687-019-0166-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/11/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The patient-doctor relationship is crucial to provide person-centred care, allowing the alleviation of symptom burden caused by disease or treatment. Implementing Patient Reported Outcome Measures (PROMs) is suggested to inform the decision-making process and lead to initiation of care. Yet there are knowledge gaps regarding how meaningful it is to incorporate PROMs in clinical settings. The aim of this study was to investigate haematologists' experiences when PROMs were implemented in an outpatient setting. METHODS Fourteen participant observations, 13 individual interviews and three in-depth interviews were conducted with haematologists, guided by the qualitative methodology Interpretive Description. Analysis was inspired by Habermas' critical theoretical framework. RESULTS The haematologists included were characterised by dichotomous experiences with PROMs, either resistant to or supporting their implementation. None were observed to elaborate on PROMs during consultations: instead, primary attention was spent discussing the hematological agenda dictated by the system. CONCLUSION The use of PROMs for individualized care was linked with extensive uncertainties and PROMs were not requested by the haematologists. To improve individualized care, other approaches may be more suitable. If PROMs are to be incorporated into future clinical practice, they should be tested tothe specific patient group and involve relevant users.
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Affiliation(s)
- Stine Thestrup Hansen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark.
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Mette Kjerholt
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sarah Friis Christensen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bibi Hølge-Hazelton
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- The Research Support Unit, Zealand University Hospital, Roskilde, Denmark
| | - John Brodersen
- Department of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre of Research & Education in General Practice, Primary Health Care Research Unit, Copenhagen, Region Zealand, Denmark
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Bossen C, Pine KH, Cabitza F, Ellingsen G, Piras EM. Data work in healthcare: An Introduction. Health Informatics J 2019; 25:465-474. [DOI: 10.1177/1460458219864730] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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