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Primeau MD, Jobin-Gelinas M, Maleko Mayabanza C, Mayaza M, Blouin G. Improving access and quality of primary healthcare through women and adolescents' user committees: A mixed-methods case study in Kinshasa, Democratic Republic of the Congo. Int J Health Plann Manage 2024. [PMID: 39354578 DOI: 10.1002/hpm.3854] [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: 05/09/2024] [Revised: 08/23/2024] [Accepted: 09/13/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Patient engagement is seen as a fundamental strategy for achieving quality patient-centred care, especially in community-based primary healthcare. Despite growing interest in patient engagement in Sub-Saharan Africa, few patient engagement initiatives have been identified, and those often are limited to lower levels of engagement, in participation in health research or in health system improvement. With the aim of giving a voice to under-represented community groups in healthcare governance, the Access to Health services in Kinshasa (ASSK) project supported the implementation of primary health services user committees in the Democratic Republic of the Congo, designed to enable the representation of two user groups with specific unmet sexual and reproductive health (SRH) needs: women and adolescents. AIMS AND METHODS Using a mixed-method case study design combining quantitative secondary data (from the national health management information system-DHIS2) and qualitative data from two research World Café (WC1: Women user committees (WUC) n = 55; WC2: Adolescents user committee (AUC) n = 63), this paper looks at the implementation facilitators and barriers, and at the results of this initiative. RESULTS Women and adolescent members of the user committees highlighted that their participation resulted in increased knowledge of SRH and their related rights, as well as in their 'soft skills' such as communication and leadership. In addition, participants reported greater transparency and accountability on the part of the community primary health centres (e.g. by displaying fees for procedures to counter over-billing). Ultimately, WUC and AUC were associated with improved health practices in the community such as increased use of SRH services (increase of 613% for Makala and 160% for Maluku II), including adolescent family planning (increase of 320% for Makala and 12% for Maluku II) and assisted childbirth for women15-49 years old (increase of 283% for Makala and 23% for Maluku II)). CONCLUSIONS Patient user committees for specific marginalised or under-represented groups appear to be an effective way of improving the quality of primary health care services. Further research is needed to better understand how to maximise its potential.
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Affiliation(s)
- Marie-Douce Primeau
- Université de Montréal - Unité de Santé Internationale, Montréal, Québec, Canada
| | - Marie Jobin-Gelinas
- Université de Montréal - Unité de Santé Internationale, Montréal, Québec, Canada
| | | | - Maguy Mayaza
- Santé Monde, Kinshasa, Democratic Republic of the Congo
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Pomey M, Schaad B, Lasserre‐Moutet A, Böhme P, Jackson M. Towards a New Integrated Model for Taking Into Account the Experiential Knowledge of People With Chronic Diseases, Integrating Mediation, Therapeutic Education and Partnership: The Expanded Chronic Care Patient-Professional Partnership Model. Health Expect 2024; 27:e70054. [PMID: 39373129 PMCID: PMC11456963 DOI: 10.1111/hex.70054] [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: 02/06/2024] [Revised: 09/10/2024] [Accepted: 09/21/2024] [Indexed: 10/08/2024] Open
Abstract
INTRODUCTION The Chronic Care Model (CCM), the Expanded Chronic Care Model (ECCM) and the eHealth Enhanced Chronic Care Model (eCCM) focus on how healthcare teams and eHealth support can offer effective care and relevant solutions for patients facing chronic care conditions. However, they do not consider how patients can help these teams in their work, nor do they promote ways in which patients can help themselves. However, in the last decade, three different models have emerged that can complete our capacity to design and deliver integrated care for people with chronic diseases. In this article, we propose a revised version of the model that integrates the patient perspective and patients' experience-based knowledge. It integrates three different ways of engaging patients that complement the other patient engagement point of view: the experience of care and mediation in healthcare, therapeutic patient education and patient learning pathways, as well as patient-professional partnership. METHODOLOGY For each of the three models, we conducted a review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct and government reports on patient engagement and partnership with their healthcare providers, to integrate the different components of these models into the ECCM and eCCM. The goal is to create a model that better takes into account the experiential knowledge of patients and citizens throughout its different dimensions. RESULTS We identified 129 papers based on their framework, design, sample, measures and fit with patient engagement and chronic illness and added our own research when relevant. Integrating the three models provides an opportunity to amplify the role played by the patient perspective in the management of chronic disease. The Expanded Chronic Care Patient-Professional Partnership Model (E2C3PM) is intended to rebalance power relations between healthcare professionals and patients (and their caregivers). This new model is based on recognizing patients' experiential knowledge and their roles as caregivers and as full members of the care team. Integrating patient empowerment into the E2C3PM underscores the importance of coproduction care with patients at the clinical, organizational and system levels within a supportive environment. CONCLUSION Applying this new model should make it possible to better take into account the complexity of chronic diseases, improving the integration not only of care, services and eHealth support but also the various determinants of health and reaching a mutually beneficial settlement among all actors involved. PATIENT OR PUBLIC CONTRIBUTION A patient-researcher contributed to the development of the protocol, the data collection and the preparation and writing of this manuscript.
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Affiliation(s)
- Marie‐Pascale Pomey
- Research Centre of the University of Montreal Hospital CentreMontréalQuébecCanada
- Centre d'excellence sur le partenariat avec les patients et le publicMontréalQuébecCanada
- Department of Health Policy, Management and Evaluation, School of Public HealthUniversity of MontréalQuébecCanada
- Department of Family Medicine and Emergency MedicineUniversity of MontréalMontréalQuébecCanada
| | - Béatrice Schaad
- Institut des Humanités en Médecine du Centre Hospitalier Universitaire Vaudois (CHUV)LausanneSwitzerland
- Centre sur le vécu des patient.es et des professionnel.lesDirection générale du Centre Hospitalier Universitaire Vaudois (CHUV)/Faculté de Biologie et de Médecine de l'Université de Lausanne (UNIL)LausanneSwitzerland
| | - Aline Lasserre‐Moutet
- Centre d'éducation thérapeutique du patientHôpitaux Universitaires de GenèveGenèveSwitzerland
| | - Philip Böhme
- Department of Endocrinology, Diabetology and NutritionCHRU NancyNancyFrance
- University of Lorraine, Inserm, NGERENancyFrance
| | - Mathieu Jackson
- Centre d'excellence sur le partenariat avec les patients et le publicMontréalQuébecCanada
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Zovich B, Patel P, Tu T, Wang S, Jubah D, Zagorski J. Perspectives of People Living With Chronic Hepatitis D: Impact of Disease and Unmet Needs Along the Care Cascade. J Viral Hepat 2024. [PMID: 39287176 DOI: 10.1111/jvh.14005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 08/13/2024] [Accepted: 08/23/2024] [Indexed: 09/19/2024]
Abstract
Hepatitis D virus leads to a severe form of viral hepatitis and affects nearly 5% of people living with chronic hepatitis B. Chronic infection with hepatitis D virus leads to more rapid progression to cirrhosis, hepatocellular carcinoma and ultimately liver disease-related death compared with hepatitis B monoinfection. Health outcomes and treatment adherence can be affected by patient perception of, engagement in, and satisfaction with care. Our objective was to better understand the experiences of people with chronic hepatitis D, identify their preferred sources of information, and recognise unmet needs from their perspectives. Sixty-seven participants from the United States and the European Union took part in monthly, online, self-guided surveys for a minimum of 3 months with an optional extension. Participants reported feeling anxious and scared at the time of diagnosis but over time came to accept living with chronic hepatitis D. They voiced a need for access to information from trusted sources, fewer barriers to care, and shorter wait times for provider visits and test results after diagnosis. Participants experienced both physical and psychological strain living with chronic hepatitis D. Although most participants reported the ability to continue their regular activities and employment, some stated such activities were done at a reduced pace. Self-reported overall health appeared to be closely linked with emotional support. Understanding patient perspectives, with concurrent clinician perspectives, is crucial when working toward developing solutions to fulfil unmet patient needs associated with chronic hepatitis D management and advancing health equity.
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Affiliation(s)
| | - Poonum Patel
- Gilead Sciences, Inc., Foster City, California, USA
| | - Thomas Tu
- Storr Liver Centre, Westmead Clinical School and Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- Sydney Institute for Infectious Diseases, University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
- HepBCommunity.Org, Sydney, New South Wales, Australia
- Hepatitis B Voices Australia, Melbourne, Victoria, Australia
| | - Su Wang
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
- Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Darlene Jubah
- HDV Community Advisory Board, New York, New York, USA
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Wilson H, Avsar P, McEvoy N, Byrne S, Brunetti G, Patton D, Moore Z. Integrating technologies to enhance risk assessment for the early detection and prevention of pressure ulcers. J Wound Care 2024; 33:644-651. [PMID: 39287040 DOI: 10.12968/jowc.2024.0126] [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] [Indexed: 09/19/2024]
Abstract
Pressure ulcers (PU) are a globally recognised healthcare concern, with their largely preventable development prompting the implementation of targeted preventive strategies. Risk assessment is the first step to planning individualised preventive measures. However, despite the long use of risk assessment, and the >70 risk assessment tools currently available, PUs remain a significant concern. Various technological advancements, including artificial intelligence, subepidermal moisture measurement, cytokine measurement, thermography and ultrasound are emerging as promising tools for PU detection, and subsequent prevention of more serious PU damage. Given the rise in availability of these technologies, this advances the question of whether our current approaches to PU prevention can be enhanced with the use of technology. This article delves into these technologies, suggesting that they could lead healthcare in the right direction, toward optimal assessment and adoption of focused prevention strategies.
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Affiliation(s)
- Hannah Wilson
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Healthcare Sciences, University of Wales, Cardiff, UK
| | - Natalie McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Sorcha Byrne
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Giulio Brunetti
- Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Zena Moore
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Healthcare Sciences, University of Wales, Cardiff, UK
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- Department of Nursing, Lida Institute, Shanghai, China
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia
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Khosravi M, Mojtabaeian SM, Zare Z. Factors influencing the use of big data within healthcare services: a systematic review. HEALTH INF MANAG J 2024:18333583241270484. [PMID: 39166442 DOI: 10.1177/18333583241270484] [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: 08/23/2024]
Abstract
Background: The emergence of big data holds the promise of aiding healthcare providers by identifying patterns and converting vast quantities of data into actionable insights facilitating the provision of precision medicine and decision-making. Objective: This study aimed to investigate the factors influencing use of big data within healthcare services to facilitate their use. Method: A systematic review was conducted in February 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Database searches for articles published between 01 January 2020 and 18 February 2024 and included PubMed, Scopus, ProQuest and Cochrane Library. The Authority, Accuracy, Coverage, Objectivity, Date, Significance ( AACODS) checklist was used to evaluate the quality of the included articles. Subsequently, a thematic analysis was conducted on the findings of the review, using the Boyatzis approach. Results: A final selection of 46 studies were included in this systematic review. A significant proportion of these studies demonstrated acceptable quality, and the level of bias was deemed satisfactory. Thematic analysis identified seven major themes that influenced the use of big data in healthcare services. These themes were grouped into four primary categories: performance expectancy, effort expectancy, social influence, and facilitating conditions. Factors associated with "effort expectancy" were the most highly cited in the included studies (67%), while those related to "social influence" received the fewest citations (15%). Conclusion: This study underscored the critical role of "effort expectancy" factors, particularly those under the theme of "data complexity and management," in the process of using big data in healthcare services. Implications: Results of this study provide groundwork for future research to explore facilitators and barriers to using big data in health care, particularly in relation to data complexity and the efficient and effective management of big data, with significant implications for healthcare administrators and policymakers.
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Affiliation(s)
| | | | - Zahra Zare
- Shiraz University of Medical Sciences, Iran
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Gumilar KE, Indraprasta BR, Hsu YC, Yu ZY, Chen H, Irawan B, Tambunan Z, Wibowo BM, Nugroho H, Tjokroprawiro BA, Dachlan EG, Mulawardhana P, Rahestyningtyas E, Pramuditya H, Putra VGE, Waluyo ST, Tan NR, Folarin R, Ibrahim IH, Lin CH, Hung TY, Lu TF, Chen YF, Shih YH, Wang SJ, Huang J, Yates CC, Lu CH, Liao LN, Tan M. Disparities in medical recommendations from AI-based chatbots across different countries/regions. Sci Rep 2024; 14:17052. [PMID: 39048640 PMCID: PMC11269683 DOI: 10.1038/s41598-024-67689-0] [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: 03/06/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
This study explores disparities and opportunities in healthcare information provided by AI chatbots. We focused on recommendations for adjuvant therapy in endometrial cancer, analyzing responses across four regions (Indonesia, Nigeria, Taiwan, USA) and three platforms (Bard, Bing, ChatGPT-3.5). Utilizing previously published cases, we asked identical questions to chatbots from each location within a 24-h window. Responses were evaluated in a double-blinded manner on relevance, clarity, depth, focus, and coherence by ten experts in endometrial cancer. Our analysis revealed significant variations across different countries/regions (p < 0.001). Interestingly, Bing's responses in Nigeria consistently outperformed others (p < 0.05), excelling in all evaluation criteria (p < 0.001). Bard also performed better in Nigeria compared to other regions (p < 0.05), consistently surpassing them across all categories (p < 0.001, with relevance reaching p < 0.01). Notably, Bard's overall scores were significantly higher than those of ChatGPT-3.5 and Bing in all locations (p < 0.001). These findings highlight disparities and opportunities in the quality of AI-powered healthcare information based on user location and platform. This emphasizes the necessity for more research and development to guarantee equal access to trustworthy medical information through AI technologies.
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Affiliation(s)
- Khanisyah E Gumilar
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan.
- Department of Obstetrics and Gynecology, Hospital of Universitas Airlangga-Faculty of Medicine, Universitas Airlangga, Jl. Dharmahusada Permai, Mulyorejo, Kec. Mulyorejo, Surabaya, Jawa Timur, 60115, Indonesia.
| | - Birama R Indraprasta
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Yu-Cheng Hsu
- Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Zih-Ying Yu
- Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC
| | - Hong Chen
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Budi Irawan
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Zulkarnain Tambunan
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Bagus M Wibowo
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Hari Nugroho
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Brahmana A Tjokroprawiro
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Erry G Dachlan
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Pungky Mulawardhana
- Department of Obstetrics and Gynecology, Hospital of Universitas Airlangga-Faculty of Medicine, Universitas Airlangga, Jl. Dharmahusada Permai, Mulyorejo, Kec. Mulyorejo, Surabaya, Jawa Timur, 60115, Indonesia
| | - Eccita Rahestyningtyas
- Department of Obstetrics and Gynecology, Hospital of Universitas Airlangga-Faculty of Medicine, Universitas Airlangga, Jl. Dharmahusada Permai, Mulyorejo, Kec. Mulyorejo, Surabaya, Jawa Timur, 60115, Indonesia
| | - Herlangga Pramuditya
- Department of Obstetrics and Gynecology, Dr. Ramelan Naval Hospital, Surabaya, Indonesia
| | - Very Great E Putra
- Department of Obstetrics and Gynecology, Dr. Kariadi Central General Hospital, Semarang, Indonesia
| | - Setyo T Waluyo
- Department of Obstetrics and Gynecology, Ulin General Hospital, Banjarmasin, Indonesia
| | - Nathan R Tan
- Department of Modern and Classical Languages and Literature, University of South Alabama, Mobile, AL, USA
| | - Royhaan Folarin
- Department of Anatomy, Faculty of Basic Medical Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Ibrahim H Ibrahim
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Cheng-Han Lin
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Tai-Yu Hung
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Ting-Fang Lu
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Yen-Fu Chen
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Yu-Hsiang Shih
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Shao-Jing Wang
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Jingshan Huang
- School of Computing and College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Clayton C Yates
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Chien-Hsing Lu
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC.
| | - Li-Na Liao
- Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC.
| | - Ming Tan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan.
- Institute of Biochemistry and Molecular Biology, Graduate Institute of Biomedical Sciences, China Medical University (Taiwan), No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC.
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Kerr D, Ahn D, Waki K, Wang J, Breznen B, Klonoff DC. Digital Interventions for Self-Management of Type 2 Diabetes Mellitus: Systematic Literature Review and Meta-Analysis. J Med Internet Res 2024; 26:e55757. [PMID: 39037772 DOI: 10.2196/55757] [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: 12/22/2023] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND The proliferation of digital technology has the potential to transform diabetes management. One of the critical aspects of modern diabetes management remains the achievement of glycemic targets to avoid acute and long-term complications. OBJECTIVE This study aims to describe the landscape of evidence pertaining to the relative effectiveness or efficacy and safety of various digital interventions for the self-management of type 2 diabetes mellitus (T2DM), with a primary focus on reducing glycated hemoglobin A1c (HbA1c) levels. METHODS A systematic literature review (SLR) was conducted by searching Embase, MEDLINE, and CENTRAL on April 5, 2022. Study selection, data extraction, and quality assessment were performed by 2 independent reviewers. Eligibility criteria for the SLR included randomized controlled trials (RCTs) and comparative observational studies evaluating interventions containing both human (eg, coaching) and digital components (eg, glucose meter) in adult patients with T2DM. The primary meta-analysis was restricted to studies that reported laboratory-measured HbA1c. In secondary analyses, meta-regression was performed with the intensity of coaching in the digital intervention as a categorical covariate. RESULTS In total, 28 studies were included in this analysis. Most studies (23/28, 82%) used the reduction of HbA1c levels as the primary end point, either directly or as a part of a multicomponent outcome. In total, 21 studies reported statistically significant results with this primary end point. When stratified into 3 intervention categories by the intensity of the intervention supporting the digital health technology (analyzing all 28 studies), the success rate appeared to be proportional to the coaching intensity (ie, higher-intensity studies reported higher success rates). When the analysis was restricted to RCTs using the comparative improvement of HbA1c levels, the effectiveness of the interventions was less clear. Only half (12/23, 52%) of the included RCTs reported statistically significant results. The meta-analyses were broadly aligned with the results of the SLR. The primary analysis estimated a greater reduction in HbA1c associated with digital interventions compared with usual care (-0.31%, 95% CI -0.45% to -0.16%; P<.001). Meta-regression estimated reductions of -0.45% (95% CI -0.81% to -0.09%; P=.02), -0.29% (95% CI -0.48% to -0.11%; P=.003), and -0.28% (95% CI -0.65% to 0.09%; P=.20) associated with high-, medium-, and low-intensity interventions, respectively. CONCLUSIONS These findings suggest that reducing HbA1c levels in individuals with T2DM with the help of digital interventions is feasible, effective, and acceptable. One common feature of effective digital health interventions was the availability of timely and responsive personalized coaching by a dedicated health care professional.
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Affiliation(s)
- David Kerr
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, United States
| | - David Ahn
- Mary & Dick Allen Diabetes Center at Hoag, Newport Beach, CA, United States
| | - Kayo Waki
- The University of Tokyo, Tokyo, Japan
| | - Jing Wang
- Florida State University College of Nursing, Tallahassee, FL, United States
| | - Boris Breznen
- Evidinno Outcomes Research Inc, Vancouver, BC, Canada
| | - David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, United States
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Fulbrook P, Lovegrove J, Ven S, Schnaak S, Nowicki T. Use of a risk-based intervention bundle to prescribe and implement interventions to prevent pressure injury: An observational study. J Adv Nurs 2024. [PMID: 38969344 DOI: 10.1111/jan.16309] [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: 02/20/2024] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024]
Abstract
AIM To explore the relationship between the prescription and implementation of pressure injury preventative interventions following risk assessment combined with a risk-stratified intervention bundle. DESIGN Single-centre, cross-sectional, observational, prospective. METHODS The charts and bedsides of 341 adult inpatients were examined. Data collection included pressure injury risk level, prescribed preventative interventions and evidence of intervention implementation. RESULTS Most patients (68.6%) were at risk of pressure injury, and most interventions were prescribed according to their risk level. However, evidence from direct observation and/or documentation indicated intervention implementation rates were relatively poor. Of nine interventions mandated for all patients, compliance with three patient-/carer-focused interventions was particularly poor, with evidence indicating they had been implemented for 3%-10% of patients. Also, nutritional screening-related interventions were implemented poorly. Clinically indicated implementation of heel-elevation devices and bariatric equipment was low for at-risk patients, and the implementation of interventions for patients with existing pressure injuries was suboptimal. Significant proportions of several interventions that were observed as having been implemented were not documented as such. CONCLUSION While most interventions were prescribed according to patient risk level, the overall implementation of interventions was poor. However, the results may in part be due to failure to document interventions as opposed to omitting them. IMPLICATIONS FOR PATIENT CARE Documentation of interventions is crucial as it provides evidence of the care provided. An increased focus on documentation of pressure injury preventative interventions is required, with a clear distinction between prescription and implementation. IMPACT The results highlighted several deficiencies in care, particularly relating to evidence of implementation, patient involvement and nutritional screening. The results from this study will be used to inform and improve future pressure injury prevention practice within the study hospital and should be used to inform and benchmark pressure injury preventative practices in other hospitals. REPORTING METHOD The study adheres to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Saroeun Ven
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Sarah Schnaak
- Quality and Effectiveness Support Team, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Tracy Nowicki
- Quality and Effectiveness Support Team, The Prince Charles Hospital, Brisbane, Queensland, Australia
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DeCelie I, Sturm B. Relationships among health promotion behaviors, patient engagement, and the nurse practitioner-patient partnership. J Am Assoc Nurse Pract 2024:01741002-990000000-00230. [PMID: 38905125 DOI: 10.1097/jxx.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 05/16/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Individuals adopting health promotion behaviors benefit from improved health and reduced risk of chronic diseases. Patient engagement and a strong provider-patient partnership may play a role in health promotion. PURPOSE This study examined the relationships between patient engagement, the nurse practitioner-patient partnership and health promotion behaviors among adults in a primary care setting. METHODOLOGY A descriptive correlational study using convenience sampling to recruit 85 participants from a nurse practitioner primary care practice. Participants completed questionnaires measuring health promotion behaviors (Health Promoting Lifestyle Profile II), the quality of the nurse practitioner-patient partnership (Patient Reactions Assessment), and a person's capacity to engage in their health care (Person Engagement Index). RESULTS Moderate to strong correlations were found among the main study variables. Multiple regression analysis found a person's capacity to engage in health care significantly predicted health promotion behaviors (R2 = 0.362, p < .001) and explained 36.2% of the variance in health promotion behaviors. CONCLUSIONS Patient engagement is a significant predictor of health promotion behaviors. The interactive care model can serve as a framework for nurse practitioners to build partnerships and facilitate patient engagement. Nurse practitioners can serve as a coach, navigator, collaborator, and trusted health care partner with their patients. IMPLICATIONS Nurse practitioners in primary care may need to restructure the health care encounter to allow for adequate time to communicate, listen, educate, and enlist patients in the shared decision-making process. Nurse practitioners can provide the support patients need to engage in their health care as they accept greater responsibility for their health.
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10
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Hou S, Wang X, Zhao Z, Ma Y, Liu J, Zhang Z, Ma J. A Scale for Measuring Electronic Patient Engagement Behaviors: Development and Validation. Patient Prefer Adherence 2024; 18:917-929. [PMID: 38685912 PMCID: PMC11057637 DOI: 10.2147/ppa.s444633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Purpose Advancements in electronic health (eHealth) technology have profoundly impacted patient engagement. This study aimed to develop and validate the Electronic Patient Engagement Behavior (EPEB) scale to measure the conceptual and underlying framework of patient engagement behaviors in an eHealth context. Patients and Methods Initial measurement items were generated based on a literature review and qualitative research. Two rounds of surveys, a pilot survey and validation survey, were conducted to evaluate the psychometric properties of the scale. Results The EPEB scale consists of 15 items in four dimensions: disease information search, physician-patient interaction, social interaction between patients, and disease self-monitoring. In the pilot survey, the exploratory factor analysis revealed a four-factor model, explaining 69.411% of variance. In the validation survey, the Cronbach's α coefficient of each sub-scale was 0.865, 0.904, 0.904, and 0.900 respectively. The Spearman-Brown split coefficient of the scale was 0.963. The results of the cross-sex measurement equivalence test indicate that all fit indices met the measurement criteria. The confirmatory factor analysis indicated second-order 4-factor model fit the data well. The EPEB has a good reliability and validity. Conclusion The EPEB scale provides a reliable tool for measuring patient engagement behaviors in the eHealth context. The utilization of this scale may yield valuable insights into strategies for enhancing patient engagement and optimizing health outcomes.
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Affiliation(s)
- Shengchao Hou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xiubo Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Zizhao Zhao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yongqiang Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Jing Liu
- Administrative Office, Yuebei People’s Hospital, Shaoguan, People’s Republic of China
| | - Ziyun Zhang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Jingdong Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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11
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Jiang Y, Hwang M, Cho Y, Friese CR, Hawley ST, Manojlovich M, Krauss JC, Gong Y. The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study. J Med Internet Res 2024; 26:e47685. [PMID: 38457204 PMCID: PMC10960221 DOI: 10.2196/47685] [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: 03/29/2023] [Revised: 09/18/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Actively engaging patients with cancer and their families in monitoring and reporting medication safety events during care transitions is indispensable for achieving optimal patient safety outcomes. However, existing patient self-reporting systems often cannot address patients' various experiences and concerns regarding medication safety over time. In addition, these systems are usually not designed for patients' just-in-time reporting. There is a significant knowledge gap in understanding the nature, scope, and causes of medication safety events after patients' transition back home because of a lack of patient engagement in self-monitoring and reporting of safety events. The challenges for patients with cancer in adopting digital technologies and engaging in self-reporting medication safety events during transitions of care have not been fully understood. OBJECTIVE We aim to assess oncology patients' perceptions of medication and communication safety during care transitions and their willingness to use digital technologies for self-reporting medication safety events and to identify factors associated with their technology acceptance. METHODS A cross-sectional survey study was conducted with adult patients with breast, prostate, lung, or colorectal cancer (N=204) who had experienced care transitions from hospitals or clinics to home in the past 1 year. Surveys were conducted via phone, the internet, or email between December 2021 and August 2022. Participants' perceptions of medication and communication safety and perceived usefulness, ease of use, attitude toward use, and intention to use a technology system to report their medication safety events from home were assessed as outcomes. Potential personal, clinical, and psychosocial factors were analyzed for their associations with participants' technology acceptance through bivariate correlation analyses and multiple logistic regressions. RESULTS Participants reported strong perceptions of medication and communication safety, positively correlated with medication self-management ability and patient activation. Although most participants perceived a medication safety self-reporting system as useful (158/204, 77.5%) and easy to use (157/204, 77%), had a positive attitude toward use (162/204, 79.4%), and were willing to use such a system (129/204, 63.2%), their technology acceptance was associated with their activation levels (odds ratio [OR] 1.83, 95% CI 1.12-2.98), their perceptions of communication safety (OR 1.64, 95% CI 1.08-2.47), and whether they could receive feedback after self-reporting (OR 3.27, 95% CI 1.37-7.78). CONCLUSIONS In general, oncology patients were willing to use digital technologies to report their medication events after care transitions back home because of their high concerns regarding medication safety. As informed and activated patients are more likely to have the knowledge and capability to initiate and engage in self-reporting, developing a patient-centered reporting system to empower patients and their families and facilitate safety health communications will help oncology patients in addressing their medication safety concerns, meeting their care needs, and holding promise to improve the quality of cancer care.
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Affiliation(s)
- Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
| | - Misun Hwang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Youmin Cho
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Christopher R Friese
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Sarah T Hawley
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, United States
| | | | - John C Krauss
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Yang Gong
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
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12
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Petersen C, Galvin HK, Lehmann CU, Sharko M. Equitable Interoperability Through Precise Control of Sensitive Health Information: An Emerging Pathway to Health Equity. Ann Intern Med 2024; 177:387-388. [PMID: 38437704 DOI: 10.7326/m23-2876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Affiliation(s)
- Carolyn Petersen
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota (C.P.)
| | - Hannah K Galvin
- Department of Information Technology, Cambridge Health Alliance, Cambridge, Massachusetts (H.K.G.)
| | - Christoph U Lehmann
- Clinical Informatics Center, The University of Texas Southwestern Medical Center, Dallas, Texas (C.U.L.)
| | - Marianne Sharko
- Department of Population Health Sciences and Department of Pediatrics, Weill Cornell Medicine, New York, New York (M.S.)
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Al Harbi S, Aljohani B, Elmasry L, Baldovino FL, Raviz KB, Altowairqi L, Alshlowi S. Streamlining patient flow and enhancing operational efficiency through case management implementation. BMJ Open Qual 2024; 13:e002484. [PMID: 38423585 PMCID: PMC10910643 DOI: 10.1136/bmjoq-2023-002484] [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: 06/30/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Improving patient flow in hospitals represents a worldwide healthcare challenge. The objective of this project was to depict the effectiveness of case management in improving patient flow in a tertiary hospital setting. METHODS Quality improvement methods, including quantitative pre-Lean and post-Lean design, the Plan-Do-Check-Act concept, the Single Minute Exchange of Dies and the 'demand and supply approach' of the Institute of Healthcare Improvement, were adapted to examine and modify factors influencing hospital patient flow. RESULTS This study (conducted from the last quarter of 2019 through September 2022) resulted in a remarkable improvement in patient flow, as evident from the reduction in average hospital length of stay (from 11.5 to 4.4 days) and average emergency department boarding time (from 11.9 to 1.2 hours) and the improvement of bed turnover rate (from 0.57 to 0.93), (p<0.001, p=0.017, p=0.038, respectively), with net cost savings of 123 130 192 million Saudi Riyals (US$32 821 239). CONCLUSION Implementing a well-structured case management programme can enhance care coordination, streamlilne transitions, boost patient outcomes, and increase revenues within hospital settings.
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Affiliation(s)
- Sultanah Al Harbi
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Baker Aljohani
- Medical Administration, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Lamiaa Elmasry
- Quality Improvement and Patient Safety Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Frenk Lee Baldovino
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Kamille Bianca Raviz
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Lama Altowairqi
- Admission Office Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Seetah Alshlowi
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
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Porri D, Morabito LA, Cavallaro P, La Rosa E, Li Pomi A, Pepe G, Wasniewska M. Time to act on childhood obesity: the use of technology. Front Pediatr 2024; 12:1359484. [PMID: 38434727 PMCID: PMC10904600 DOI: 10.3389/fped.2024.1359484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Childhood obesity is rapidly increasing worldwide and there is an urgent need to implement treatment and prevention programs. Over the last decade, in addition to increasing rates of childhood obesity, we have also observed rapid technological and digital development. The Covid-19 pandemic has largely contributed to both expansions but has also allowed an opening towards a broader vision of medicine, through new therapeutic opportunities such as mobile healthcare. The digital and technological delivery of obesity prevention and treatment programs can represent an innovative tool to support children and families to overcome some limitations and barriers such as the accessibility of programs that prevent them from adopting healthy lifestyle changes. This review aimed to summarize the impact of different digital interventions for children and adolescent affected by obesity.
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Affiliation(s)
| | | | - Paola Cavallaro
- Unit of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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15
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Cashaback JGA, Allen JL, Chou AHY, Lin DJ, Price MA, Secerovic NK, Song S, Zhang H, Miller HL. NSF DARE-transforming modeling in neurorehabilitation: a patient-in-the-loop framework. J Neuroeng Rehabil 2024; 21:23. [PMID: 38347597 PMCID: PMC10863253 DOI: 10.1186/s12984-024-01318-9] [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: 07/10/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
In 2023, the National Science Foundation (NSF) and the National Institute of Health (NIH) brought together engineers, scientists, and clinicians by sponsoring a conference on computational modelling in neurorehabiilitation. To facilitate multidisciplinary collaborations and improve patient care, in this perspective piece we identify where and how computational modelling can support neurorehabilitation. To address the where, we developed a patient-in-the-loop framework that uses multiple and/or continual measurements to update diagnostic and treatment model parameters, treatment type, and treatment prescription, with the goal of maximizing clinically-relevant functional outcomes. This patient-in-the-loop framework has several key features: (i) it includes diagnostic and treatment models, (ii) it is clinically-grounded with the International Classification of Functioning, Disability and Health (ICF) and patient involvement, (iii) it uses multiple or continual data measurements over time, and (iv) it is applicable to a range of neurological and neurodevelopmental conditions. To address the how, we identify state-of-the-art and highlight promising avenues of future research across the realms of sensorimotor adaptation, neuroplasticity, musculoskeletal, and sensory & pain computational modelling. We also discuss both the importance of and how to perform model validation, as well as challenges to overcome when implementing computational models within a clinical setting. The patient-in-the-loop approach offers a unifying framework to guide multidisciplinary collaboration between computational and clinical stakeholders in the field of neurorehabilitation.
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Affiliation(s)
- Joshua G A Cashaback
- Biomedical Engineering, Mechanical Engineering, Kinesiology and Applied Physiology, Biome chanics and Movement Science Program, Interdisciplinary Neuroscience Graduate Program, University of Delaware, 540 S College Ave, Newark, DE, 19711, USA.
| | - Jessica L Allen
- Department of Mechanical Engineering, University of Florida, Gainesville, USA
| | | | - David J Lin
- Division of Neurocritical Care and Stroke Service, Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Veterans Affairs, Center for Neurorestoration and Neurotechnology, Rehabilitation Research and Development Service, Providence, USA
| | - Mark A Price
- Department of Mechanical and Industrial Engineering, Department of Kinesiology, University of Massachusetts Amherst, Amherst, USA
| | - Natalija K Secerovic
- School of Electrical Engineering, The Mihajlo Pupin Institute, University of Belgrade, Belgrade, Serbia
- Laboratory for Neuroengineering, Institute for Robotics and Intelligent Systems ETH Zürich, Zurich, Switzerland
| | - Seungmoon Song
- Mechanical and Industrial Engineering, Northeastern University, Boston, USA
| | - Haohan Zhang
- Department of Mechanical Engineering, University of Utah, Salt Lake City, USA
| | - Haylie L Miller
- School of Kinesiology, University of Michigan, 830 N University Ave, Ann Arbor, MI, 48109, USA.
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Nielssen I, Santana M, Pokharel S, Strain K, Kiryanova V, Zelinsky S, Khawaja Z, Khanna P, Rychtera A, Ambasta A. Operationalizing the principles of patient engagement through a Patient Advisory Council: Lessons and recommendations. Health Expect 2024; 27:e13909. [PMID: 37942678 PMCID: PMC10726262 DOI: 10.1111/hex.13909] [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: 01/19/2023] [Revised: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Inclusiveness, Support, Mutual Respect and Co-Build are the four pillars of patient engagement according to the Strategy for Patient-Oriented Research (SPOR). The aim of this manuscript is to describe the operationalization of these principles through the creation of a Patient Advisory Council (PAC) for the research study titled 'Re-Purposing the Ordering of Routine laboratory Tests (RePORT)'. METHODS Researchers collaborated with the Alberta SPOR SUPPORT Unit (AbSPORU) Patient Engagement Team to create a diverse PAC. Recruitment was intentional and included multiple perspectives and experiences. PAC meetings were held monthly, and patient research partners received support to function as co-chairs of the PAC. Patient research partners were offered training, support and tailored modalities of compensation to actively engage with the PAC. Regular member check-ins occurred through reflexivity and a formal evaluation of PAC member engagement. RESULTS The PAC included between 9 and 11 patient research partners, principal investigator, research study coordinator, improvement scientist, resident physician and support members from the AbSPORU team. Twelve monthly PAC meetings were held during the first phase of the project. The PAC made course-changing contributions to study design including study objectives, recruitment poster, interview guide and development of codes for thematic analysis. Patient research partners largely felt that their opinions were valued. Diversity in the PAC membership enhanced access to diverse patient participants. Furthermore, support for co-chairs and patient research partner members enabled active engagement in research. In addition, a culture of mutual respect facilitated patient partner engagement, and co-design approaches yielded rich research outputs. CONCLUSIONS Collaboration between research teams and Patient Engagement Teams can promote effective patient engagement through a PAC. Deliberate and flexible strategies are needed to manage the PAC to create an ecology of Inclusiveness, Support, Mutual Respect, and Co-Build for meaningful patient engagement. PATIENT OR PUBLIC CONTRIBUTION Patient research partners were involved in the decision to write this manuscript and collaborated equitably in the conception and development of this manuscript, including providing critical feedback. Patient research partners were active members of the PAC and informed the research project design, participant recruitment strategies, data collection and analysis, and will be involved in the implementation and dissemination of results. They are currently involved in the co-development of a patient engagement strategy using a Human-Centered Design process.
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Affiliation(s)
- Ingrid Nielssen
- Strategy for Patient Oriented Research (SPOR) Support UnitEdmontonAlbertaCanada
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Maria Santana
- Strategy for Patient Oriented Research (SPOR) Support UnitEdmontonAlbertaCanada
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Surakshya Pokharel
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Ward of the 21st Century, Calgary Zone of Alberta Health ServicesUniversity of CalgaryCalgaryCanada
| | - Kimberly Strain
- Strategy for Patient Oriented Research (SPOR) Support UnitEdmontonAlbertaCanada
| | - Veronika Kiryanova
- Strategy for Patient Oriented Research (SPOR) Support UnitEdmontonAlbertaCanada
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Sandra Zelinsky
- Strategy for Patient Oriented Research (SPOR) Support UnitEdmontonAlbertaCanada
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Zoha Khawaja
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Ward of the 21st Century, Calgary Zone of Alberta Health ServicesUniversity of CalgaryCalgaryCanada
| | - Prachi Khanna
- Department of Biology, Faculty of ScienceUniversity of British ColumbiaVancouverCanada
| | - Anni Rychtera
- Strategy for Patient Oriented Research (SPOR) Support UnitVancouverBritish ColumbiaCanada
| | - Anshula Ambasta
- Department of Anesthesia, Pharmacology and Therapeutics, Therapeutics InitiativeUniversity of British ColumbiaVancouverCanada
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
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17
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Weber C, Nørgaard B. Nurses' perspectives on patient involvement in an emergency department - An interview study. Int Emerg Nurs 2024; 72:101401. [PMID: 38198947 DOI: 10.1016/j.ienj.2023.101401] [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: 07/19/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Patient involvement in healthcare decisions is key to patient-centred care, and it is an area subject to continuous political focus. However, patient-centred care and patient involvement are challenging to implement in an emergency department (ED) setting, as EDs tend to focus on structures, processes, and outcomes. This study explored nurses' perspectives on patient involvement in an ED setting. METHOD This study applied an explorative design and conducted focus group interviews to generate data; abductive reasoning was chosen as the analytical method. Two focus groups were held in February 2021, each including six ED nurses. RESULTS Four themes were generated: notions of patient involvement, significant factors, ED culture, and management. Nurses considered patient involvement an optional add-on and, to some extent, a matter of tokenism carried forward by managers who are afraid of complaints and bad media coverage. Patient involvement in the form of providing information to patients was considered important yet less critical than life-saving and technical tasks. CONCLUSION ED nurses' perspectives on patient involvement are particularly influenced by the technical and life-saving culture in an ED. Information provision is considered patient involvement and is decided and administered by nurses.
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Affiliation(s)
- Charlotte Weber
- Næstved, Slagelse and Ringsted Hospitals, Region Zealand, Denmark
| | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Denmark.
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Holdsworth LM, Giannitrapani K, Gamboa RC, O'Hanlon C, Singh N, Walling A, Lindvall C, Lorenz K. Role matters in understanding 'quality' in palliative care: a qualitative analysis of patient, caregiver and practitioner perspectives. BMJ Open 2024; 14:e076768. [PMID: 38233055 PMCID: PMC10806673 DOI: 10.1136/bmjopen-2023-076768] [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: 06/15/2023] [Accepted: 12/01/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVES To compare the discussions from two panels on the concept of palliative care quality for patients with advanced cancer, exploring the priorities reflected in each group's perspectives. DESIGN We convened two RAND-UCLA appropriateness panel discussions on palliative care quality in advanced cancer. Discussions were audio-recorded and transcribed verbatim. Panel transcripts were analysed thematically using a matrix approach to examine perceptions and experiences of quality. SETTING Discussions were framed within the context of advanced cancer care and palliative care. PARTICIPANTS The patient-caregiver panel had 9 patients with current or a history of cancer and caregivers, and the practitioner panel had 10 expert practitioners representing fields of oncology, primary care, social work, palliative care, nursing, pain management and ethics. RESULTS Our analysis identified three thematic categories for understanding quality common across both groups and nine subthemes within those categories. At the highest level, quality was conceived as: (1) the patient and caregiver experience of care, (2) technical competence and (3) the structure of health system. Among the subthemes, four were present in only one of the two group's discussions: 'purpose and action' was specific to the patient-caregiver panel, whereas 'adhering to best medical practice', 'mitigating unintended consequences and side effects', and 'health system resources and costs' were specific to the practitioner panel. CONCLUSIONS While both panels aligned on the three key domains of quality, the particular dimensions through which they perceived quality varied in relation to their experience and role as a professional provider of care versus recipient of healthcare services. These differences suggest the importance of adopting a collaborative approach to quality measurement and improvement so that the values of all interested parties are represented in improvement efforts.
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Affiliation(s)
- Laura M Holdsworth
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Karleen Giannitrapani
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Raziel C Gamboa
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Claire O'Hanlon
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- RAND Corporation, Santa Monica, California, USA
| | - Nainwant Singh
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Anne Walling
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Karl Lorenz
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
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Conti I, Davidson M, Cutress RI, McIntosh SA, Head MG. Global trends in psycho-oncology research investments 2016-2020: A content analysis. Psychooncology 2024; 33:e6273. [PMID: 38141045 DOI: 10.1002/pon.6273] [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: 07/28/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE An estimated one-third of cancer patients experience a clinically significant psychological disorder, however it is unclear to what extent this is reflected in research funding. To address this a systematic analysis the allocation of psycho-oncology research funding globally between 2016 and 2020 was conducted. METHODS A global dataset of 66,388 cancer research awards, from 2016 to 2020 inclusive and totalling $24.5 billion USD was assembled from public and philanthropic funders. Each award was previously categorised by cancer site type and research theme, including psychosocial research and these awards were further sub-categorised for this analysis. RESULTS There was $523m of funding awarded for psychological research across 1122 studies: 2.14% of all cancer research funding during this period ($24.5 billion). Median funding per award was $97,473 (IQR $36,864 - $453,051). Within psychological research, mental health received most funding ($174m, 33.5% of psychological funding). Cognitive behavioural therapy (CBT) focused research was the specific psychological support with the highest proportion of funding at $14 million. By country of funder, the USA provided most investment ($375.5 m, 71.8%). CONCLUSIONS Psycho-oncology research received relatively little funding, for example, when compared with pre-clinical cancer research. There needs to be a shift from pre-clinical science to research that benefits cancer patients in the shorter-term. Low- and middle-income countries, and ethnic minorities in higher-income settings, were underrepresented despite having a large cancer burden, indicating inequities that need to be addressed.
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Affiliation(s)
| | - Mitchell Davidson
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ramsey I Cutress
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Michael G Head
- Clinical Informatics Research Unit, Faculty of Medicine, Southampton, UK
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20
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Hirata K, Hatakeyama Y, Onishi R, Seto K, Matsumoto K, Fujita S, Nagai Y, Iida S, Hasegawa T. Relationship Between Patients' "Sense of Participation" in Healthcare and Their Satisfaction A Survey of 5 Hospitals. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241278986. [PMID: 39300951 PMCID: PMC11425731 DOI: 10.1177/00469580241278986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 09/22/2024]
Abstract
Patient participation is considered important for the safety and quality of care. The patient's perception of actually being able to participate in healthcare, namely, the sense of participation, may influence patient satisfaction (PS). This study aimed to quantitatively determine the relationship between sense of participation to healthcare and PS. A questionnaire survey was conducted among 100 inpatients from each of the 5 target hospitals. The questionnaire included 6 PS items and 4 patient achievement goals, which were indicators of whether the patients had a sense of participation. The response rate was 60.6% (303/500). Patients who perceived that they could choose a treatment that reflected their values and wishes had significantly higher scores on all PS items. Patients who achieved the goal of "I want to be a member of the medical team and participate actively in treatment and safety activities" showed significantly higher PS related to coping to reduce pain and symptoms. Additionally, patients who achieved the goal of "I believe I am able to voluntarily learn about the disease/treatment and use it to make decisions" had significantly higher PS related to psychological support. Sense of participation may improve PS in a wide range of areas. Hospitals and healthcare workers are expected to empower patients to develop a sense of participation.
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Affiliation(s)
- Koki Hirata
- Toho University School of Medicine, Tokyo, Japan
| | | | - Ryo Onishi
- Toho University School of Medicine, Tokyo, Japan
| | - Kanako Seto
- Toho University School of Medicine, Tokyo, Japan
| | | | | | - Yoji Nagai
- Hitachinaka General Hospital, Ibaraki, Japan
| | - Shuhei Iida
- Tokyo Healthcare Foundation, Tokyo, Japan
- Nerima General Hospital, Tokyo, Japan
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21
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Meço BC, de Agua Reis AB, Berger-Estilita J, Jakobsen K, Alkış N, Radtke FM. Precision Anaesthesia: Advancing Patient-Centered Precision Care Through Repetitive Assessment of PROMs with the Safe Brain Initiative Approach. Turk J Anaesthesiol Reanim 2023; 51:374-379. [PMID: 37747258 PMCID: PMC10606742 DOI: 10.4274/tjar.2023.231420] [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: 09/26/2023] Open
Abstract
This article aims to introduce the Safe Brain Initiative (SBI) approach, focusing on collecting and leveraging Patient-Reported Outcome Measures (PROMs) to enhance patient-centred precision anaesthesia and prevent postoperative delirium (POD) and neurocognitive disorders (NCD). The SBI was implemented to systematically address the feedback gap in perioperative care by collecting and analysing real-world data. The initiative focuses on monitoring and preventing POD and NCD, providing effective anaesthesia care, assessing patient and team satisfaction, and evaluating environmental sustainability impact. Based on international guidelines, 18 core recommendations were established to address potential complications and challenges associated with anaesthesia. Preliminary results showed a notable reduction in POD and increased awareness among anaesthesia team members regarding PROMs. The SBI approach demonstrated significant benefits during emergency situations, such as the February 2023 earthquake in Turkey, by providing crucial support and comfort to victims requiring multiple surgical interventions. The SBI presents an innovative, cost-effective, and patient-centred approach to perioperative care. By integrating PROMs and systematic feedback mechanisms, the SBI aims to expedite the advancement of efficient, patient-centered precision perioperative care, improve patient outcomes, and elevate the quality of care. The initiative has shown promising results, and its adoption is growing globally. Collaboration among healthcare providers, researchers, and patients is crucial in shaping the future of anaesthesia practice and further improving patient outcomes. Turkish hospitals are encouraged to join the SBI to benefit from international collaborations and contribute to positive change in perioperative care standards. The SBI project significantly advances precision anaesthesia, emphasising personalised care and patient well-being.
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Affiliation(s)
- Başak Ceyda Meço
- Ankara University Faculty of Medicine, İbn-i Sina Hospital, Department of Anaesthesiology and Intensive Care Unit, Ankara, Turkey
- Ankara University Brain Research Center (AÜBAUM), Ankara, Turkey
| | | | - Joana Berger-Estilita
- University of Bern, Institute for Medical Education, Department of Anaesthesia; Hirslanden Salem-Spital, Institute of Anaesthesiology and Intensive Care, Bern, Switzerland
| | - Karina Jakobsen
- Nykøbing Falster Hospital, Clinic of Anaesthesia, Nykøbing Falster, Denmark
| | - Neslihan Alkış
- Ankara University Faculty of Medicine, İbn-i Sina Hospital, Department of Anaesthesiology and Intensive Care Unit, Ankara, Turkey
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22
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Rockwell MS, Oyese EG, Singh E, Vinson M, Yim I, Turner JK, Epling JW. A Scoping Review of Interventions to De-implement Potentially Harmful Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in Healthcare Settings. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.29.23293362. [PMID: 37546911 PMCID: PMC10402245 DOI: 10.1101/2023.07.29.23293362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Objectives Potentially harmful nonsteroidal anti-inflammatory drugs (NSAIDs) utilization persists at undesirable rates throughout the world. The purpose of this paper is to review the literature on interventions to de-implement potentially harmful NSAIDs in healthcare settings and to suggest directions for future research. Design Scoping review. Data Sources PubMed, CINAHL, Embase, Cochrane Central, and Google Scholar (2000-2022). Study Selection Studies reporting on the effectiveness of interventions to systematically reduce potentially harmful NSAID utilization in healthcare settings. Data Extraction Using Covidence systematic review software, we extracted study and intervention characteristics, including the effectiveness of interventions in reducing NSAID utilization. Results From 7,818 articles initially identified, 68 were included in the review. Most studies took place in European countries (45.6%) or the U.S. (35.3%), with randomized controlled trial as the most common design (55.9%). The majority of studies (76.2%) reported a reduction in the utilization of potentially harmful NSAIDs. Interventions were largely clinician-facing (76.2%) and delivered in primary care (60.2%). Academic detailing, clinical decision support or electronic medical record interventions, performance reports, and pharmacist review were frequent approaches employed. NSAID use was most commonly classified as potentially harmful based on patients' age (55.8%) or history of gastrointestinal disorders (47.1%) or kidney disease (38.2%). Only 7.4% of interventions focused on over-the-counter NSAIDs in addition to prescription. Few studies (5.9%) evaluated pain or quality of life following NSAIDs discontinuation. Conclusion Many varied interventions are effective in de-implementing potentially harmful NSAIDs in healthcare settings. Efforts to adapt, scale, and disseminate these interventions are needed. In addition, future interventions should address over-the-counter NSAIDs, which are broadly available and widely used. Evaluating unintended consequences of interventions, including patient-focused outcomes, is another important priority.
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Affiliation(s)
- Michelle S Rockwell
- Department of Family & Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Emma G Oyese
- Department of Family & Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Eshika Singh
- Department of Family & Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | | | - Isaiah Yim
- Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Jamie K Turner
- Translational Biology, Medicine, and Health Graduate Program, Virginia Tech, Roanoke, VA
| | - John W Epling
- Department of Family & Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
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23
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Lee M, Kang D, Kang E, Kim S, Kim Y, Ahn JS, Park S, Lee YY, Oh D, Noh JM, Cho J. Efficacy of the PRO-CTCAE mobile application for improving patient participation in symptom management during cancer treatment: a randomized controlled trial. Support Care Cancer 2023; 31:321. [PMID: 37148373 PMCID: PMC10163577 DOI: 10.1007/s00520-023-07779-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE Although mobile-based symptom monitoring is expected to improve patient participation in symptom management during anticancer therapy, previous trials have not evaluated its effectiveness. Therefore, this study aims to evaluate the impact of a symptom monitoring mobile application on improving patient participation in symptom management during anticancer therapy. METHODS We conducted a single-center, open-label, randomized controlled trial that enrolled patients with breast, lung, head and neck, esophageal, or gynecologic cancer who were scheduled to receive anticancer therapy (oral or intravenous) between October 2020 and March 2021. We excluded patients with physical or psychological problems. The intervention group received a symptom monitoring application for 8 weeks, and the control group received the usual clinical practice. At 8 weeks, the improvement in patient participation in symptom management was assessed, and additionally quality of life and unplanned clinical visits were assessed. RESULTS A total of 222 patients were included in the analysis, of whom 142 were randomly assigned to the intervention group and 71 to the control group. The intervention group reported better outcome in patient participation in symptom management than the control group at 8 weeks (mean scores of 8.5 vs. 8.0; P = 0.01). There were no significant differences between the groups in Quality of life (P = 0.88) and unplanned clinical visits (P = 0.39-0.76). CONCLUSIONS This study is meaningful in figuring out that the mobile-based symptom monitoring made them more engaged in their management. Future research should continue to evaluate the effects of patient participation as mediators of clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04568278.
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Affiliation(s)
- Mangyeong Lee
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Eunjee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sooyeon Kim
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Youngha Kim
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sehhoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Myung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Juhee Cho
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea.
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.
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