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van der Zee C, Chang-Wolf J, Koopmanschap MA, van Leeuwen R, Wisse RPL. Assessing the Carbon Footprint of Telemedicine: A Systematic Review. Health Serv Insights 2024; 17:11786329241271562. [PMID: 39139395 PMCID: PMC11320403 DOI: 10.1177/11786329241271562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/28/2024] [Indexed: 08/15/2024] Open
Abstract
Background Healthcare is responsible for 4% to 10% of carbon emissions worldwide, of which 22% is related to transport. Telemedicine emerged as a potential solution to reduce the footprint, for example, by reducing travel. However, a need to understand which variables to include in carbon footprint estimations in telemedicine limits our understanding of the beneficial impact telemedicine might have on our environment. This paper aims to systematically assess the reported carbon footprint and include variables assessed by the literature, comparing telemedicine with usual care. Methods The systematic review followed the PRISMA guidelines in PubMed, Medline, Embase and Scopus. A quality assessment was performed using a transparency checklist for carbon footprint calculators. Carbon emissions were evaluated based on four categories, including patient travel, and streamlined life cycle assessment (LCA) for assessing included variables relevant to telemedicine. Results We included 33 articles from 1117 records for analysis. The average transparency score was 38% (range 18%-68%). The median roundtrip travel distance for each patient was 131 km (interquartile range [IQR]: 60.8-351), or 25.6 kgCO2 (IQR: 10.6-105.6) emissions. There is high variance among included variables. Saved emissions are structurally underestimated by not including external factors such as a streamlined LCA. Conclusions Telemedicine aids in reducing emissions, with travel distance being the most significant contributor. Additionally, we recommend accounting for the LCA since it highlights important nuances. This review furthers the debate on assessing carbon footprint savings due to telemedicine.
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Affiliation(s)
- Casper van der Zee
- Ophthalmology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jennifer Chang-Wolf
- Ophthalmology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc A Koopmanschap
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Redmer van Leeuwen
- Ophthalmology Department, University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Workgroup of Sustainable Ophthalmology, Utrecht, The Netherlands
| | - Robert PL Wisse
- Ophthalmology Department, University Medical Center Utrecht, Utrecht, The Netherlands
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Anaraki NR, Mukhopadhyay M, Jewer J, Patey C, Norman P, Hurley O, Etchegary H, Asghari S. A qualitative study of the barriers and facilitators impacting the implementation of a quality improvement program for emergency departments: SurgeCon. BMC Health Serv Res 2024; 24:855. [PMID: 39068432 PMCID: PMC11283688 DOI: 10.1186/s12913-024-11345-w] [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: 07/04/2023] [Accepted: 07/23/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The implementation of intervention programs in Emergency Departments (EDs) is often fraught with complications due to the inherent complexity of the environment. Hence, the exploration and identification of barriers and facilitators prior to an implementation is imperative to formulate context-specific strategies to ensure the tenability of the intervention. OBJECTIVES In assessing the context of four EDs prior to the implementation of SurgeCon, a quality improvement program for ED efficiency and patient satisfaction, this study identifies and explores the barriers and facilitators to successful implementation from the perspective of the healthcare providers, patients, researchers, and decision-makers involved in the implementation. SETTINGS Two rural and two urban Canadian EDs with 24/7 on-site physician support. METHODS Data were collected prior to the implementation of SurgeCon, by means of qualitative and quantitative methods consisting of semi-structured interviews with 31 clinicians (e.g., physicians, nurses, and managers), telephone surveys with 341 patients, and structured observations from four EDs. The interpretive description approach was utilized to analyze the data gathered from interviews, open-ended questions of the survey, and structured observations. RESULTS A set of five facilitator-barrier pairs were extracted. These key facilitator-barrier pairs were: (1) management and leadership, (2) available resources, (3) communications and networks across the organization, (4) previous intervention experiences, and (5) need for change. CONCLUSION Improving our understanding of the barriers and facilitators that may impact the implementation of a healthcare quality improvement intervention is of paramount importance. This study underscores the significance of identifing the barriers and facilitators of implementating an ED quality improvement program and developing strategies to overcome the barriers and enhance the facilitators for a successful implementations. We propose a set of strategies for hospitals when implementing such interventions, these include: staff training, champion selection, communicating the value of the intervention, promoting active engagement of ED staff, assigning data recording responsibilities, and requiring capacity analysis. TRIAL REGISTRATION ClinicalTrials.gov. NCT04789902. 10/03/2021.
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Affiliation(s)
- Nahid Rahimipour Anaraki
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Meghraj Mukhopadhyay
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Jennifer Jewer
- Faculty of Business Administration, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Christopher Patey
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Paul Norman
- Eastern Health, Carbonear Institute for Rural Reach and Innovation By the Sea, Carbonear General Hospital, Carbonear, NL, A1Y 1A4, Canada
| | - Oliver Hurley
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Holly Etchegary
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Shabnam Asghari
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
- Discipline of Family Medicine, Faculty of Medicine, Faculty of Medicine Building, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, Newfoundland, A1B 3V6, Canada.
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Otto L, Schlieter H, Harst L, Whitehouse D, Maeder A. The telemedicine community readiness model-successful telemedicine implementation and scale-up. Front Digit Health 2023; 5:1057347. [PMID: 36910573 PMCID: PMC9995762 DOI: 10.3389/fdgth.2023.1057347] [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: 09/29/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
To successfully scale-up telemedicine initiatives (TIs), communities play a crucial role. To empower communities fulfilling this role and increase end users' acceptance of TIs, support tools (from now on entitled artifacts) are needed that include specific measures to implement and scale up telemedicine. Addressing this need, the article introduces the Telemedicine Community Readiness Model (TCRM). The TCRM is designed to help decision-makers in communities to create a favorable environment that facilitates the implementation and scale-up of TIs. The TCRM is a practical tool to assess communities' readiness to implement TIs and identify aspects to improve this readiness. The development process follows a design-science procedure, which integrates literature reviews and semi-structured expert interviews to justify and evaluate design decisions and the final design. For researchers, the paper provides insights into factors that influence telemedicine implementation and scale-up (descriptive role of knowledge) on the community level. For practitioners, it provides a meaningful tool to support the implementation and scale-up of TIs (prescriptive role of knowledge). This should help to realize the potential of telemedicine solutions to increase access to healthcare services and their quality.
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Affiliation(s)
- Lena Otto
- Research Group Digital Health, Technische Universität Dresden, Dresden, Germany
| | - Hannes Schlieter
- Research Group Digital Health, Technische Universität Dresden, Dresden, Germany
| | - Lorenz Harst
- Center for Evidence-Based Healthcare, Branch Office at the Medical Campus Chemnitz of the TU Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Diane Whitehouse
- European Health Telematics Association (EHTEL), Brussels, Belgium
| | - Anthony Maeder
- Flinders Digital Health Research Centre, Flinders University, Adelaide, SA, Australia
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A Survey of Tele-Critical Care State and Needs in 2019 and 2020 Conducted among the Members of the Society of Critical Care Medicine. Healthcare (Basel) 2022; 10:healthcare10081445. [PMID: 36011102 PMCID: PMC9408319 DOI: 10.3390/healthcare10081445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
The study’s objective was to assess facilitators and barriers of Tele-Critical Care (TCC) perceived by SCCM members. By utilizing a survey distributed to SCCM members, a cross-sectional study was developed to analyze survey results from December 2019 and July 2020. SCCM members responded to the survey (n = 15,502) with a 1.9% response rate for the first distribution and a 2.54% response rate for the second survey (n = 9985). Participants (n = 286 and n = 254) were almost equally distributed between non-users, providers, users, and potential users of TCC services. The care delivery models for TCC were similar across most participants. Some consumers of TCC services preferred algorithmic coverage and scheduled rounds, while reactive and on-demand models were less utilized. The surveys revealed that outcome-driven measures were the principal form of TCC performance evaluation. A 1:100 (provider: patients) ratio was reported to be optimal. Factors related to costs, perceived lack of need for services, and workflow challenges were described by those who terminated TCC services. Barriers to implementation revolved around lack of reimbursement and adequate training. Interpersonal communication was identified as an essential TCC provider skill. The second survey introduced after the onset pandemic demonstrated more frequent use of advanced practice providers and focus on performance measures. Priorities for effective TCC deployment include communication, knowledge, optimal operationalization, and outcomes measurement at the organizational level. The potential effect of COVID-19 during the early stages of the pandemic on survey responses was limited and focused on the need to demonstrate TCC value.
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Long JC, Sarkies MN, Francis Auton E, Nguyen HM, Pomare C, Hardwick R, Braithwaite J. Conceptualising contexts, mechanisms and outcomes for implementing large-scale, multisite hospital improvement initiatives: a realist synthesis. BMJ Open 2022; 12:e058158. [PMID: 35589340 PMCID: PMC9126051 DOI: 10.1136/bmjopen-2021-058158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/26/2022] [Indexed: 12/15/2022] Open
Abstract
DESIGN Realist synthesis. STUDY BACKGROUND Large-scale hospital improvement initiatives can standardise healthcare across multiple sites but results are contingent on the implementation strategies that complement them. The benefits of these implemented interventions are rarely able to be replicated in different contexts. Realist studies explore this phenomenon in depth by identifying underlying context-mechanism-outcome interactions. OBJECTIVES To review implementation strategies used in large-scale hospital initiatives and hypothesise initial programme theories for how they worked across different contexts. METHODS An iterative, four-step process was applied. Step 1 explored the concepts inherent in large-scale interventions using database searches and snowballing. Step 2 identified strategies used in their implementation. Step 3 identified potential initial programme theories that may explain strategies' mechanisms. Step 4 focused on one strategy-theory pairing to develop and test context-mechanism-outcome hypotheses. Data was drawn from searches (March-May 2020) of MEDLINE, Embase, PubMed and CINAHL, snowballed from key papers, implementation support websites and the expertise of the research team and experts. INCLUSION CRITERIA reported implementation of a large-scale, multisite hospital intervention. RAMESES reporting standards were followed. RESULTS Concepts were identified from 51 of 381 articles. Large-scale hospital interventions were characterised by a top-down approach, external and internal support and use of evidence-based interventions. We found 302 reports of 28 different implementation strategies from 31 reviews (from a total of 585). Formal theories proposed for the implementation strategies included Diffusion of Innovation, and Organisational Readiness Theory. Twenty-three context-mechanism-outcome statements for implementation strategies associated with planning and assessment activities were proposed. Evidence from the published literature supported the hypothesised programme theories and were consistent with Organisational Readiness Theory's tenets. CONCLUSION This paper adds to the literature exploring why large-scale hospital interventions are not always successfully implemented and suggests 24 causative mechanisms and contextual factors that may drive outcomes in the planning and assessment stage.
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Affiliation(s)
- Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mitchell N Sarkies
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | | | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Hayden EM, Davis C, Clark S, Joshi AU, Krupinski EA, Naik N, Ward MJ, Zachrison KS, Olsen E, Chang BP, Burner E, Yadav K, Greenwald PW, Chandra S. Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine. Acad Emerg Med 2021; 28:1452-1474. [PMID: 34245649 PMCID: PMC11150898 DOI: 10.1111/acem.14330] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Telehealth has the potential to significantly change the specialty of emergency medicine (EM) and has rapidly expanded in EM during the COVID pandemic; however, it is unclear how EM should intersect with telehealth. The field lacks a unified research agenda with priorities for scientific questions on telehealth in EM. METHODS Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in EM and telehealth created a research agenda for the topic. The multiyear process used a modified Delphi technique to develop research questions related to telehealth in EM. Research questions were excluded from the final research agenda if they did not meet a threshold of at least 80% of votes indicating "important" or "very important." RESULTS Round 1 of voting included 94 research questions, expanded to 103 questions in round 2 and refined to 36 questions for the final vote. Consensus occurred with a final set of 24 important research questions spanning five breakout group topics. Each breakout group domain was represented in the final set of questions. Examples of the questions include: "Among underserved populations, what are mechanisms by which disparities in emergency care delivery may be exacerbated or ameliorated by telehealth" (health care access) and "In what situations should the quality and safety of telehealth be compared to in-person care and in what situations should it be compared to no care" (quality and safety). CONCLUSION The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. Our consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps. Support should be provided to answer the research questions to guide the evidenced-based development of telehealth in EM.
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Affiliation(s)
- Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Aditi U Joshi
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Neel Naik
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erica Olsen
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Kabir Yadav
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peter W Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shruti Chandra
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Jansson S, Farahshoor S, Linden K, Bogren M. The implementation process of the Confident Birth method in Swedish antenatal education: opportunities, obstacles and recommendations. Health Promot Int 2021; 36:649-659. [PMID: 32944762 PMCID: PMC8384378 DOI: 10.1093/heapro/daaa096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Antenatal clinics in western Sweden have recently invested in a birth method called Confident Birth. In this study, we investigate midwives' and first line managers' perceptions regarding the method, and identify opportunities and obstacles in its implementation. Semi-structured individual interviews were conducted with ten midwives and five first line managers working in 19 antenatal clinics in western Sweden. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. Intervention Characteristics-such as perceptions about the Confident Birth method-were found to have equipped the midwives with coping strategies that were useful for expecting parents during birth. Outer Setting-the method was implemented to harmonize the antenatal education, and provided a mean for a birth companionship of choice. Inner setting-included time-consuming preparations and insufficient information at all levels, which affected the implementation. Characteristics of individuals-, such as knowledge and believes in the method, where trust in the method was seen as an opportunity, while long experience of teaching other birth preparatory methods, affected how the Confident Birth method was perceived. Process-such as no strategy for ensuring that the core of the method remained intact or plans for guiding its implementation were major obstacles to successful implementation. The findings speak to the importance of adequate planning, time, information and communication throughout the process to have a successful implementation. Based on lessons learned from this study, we have developed recommendations for successful implementation of interventions, such as the Confident Birth, in antenatal care settings.
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Affiliation(s)
- Sofia Jansson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sepideh Farahshoor
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Varsi C, Ledel Solem IK, Eide H, Børøsund E, Kristjansdottir OB, Heldal K, Waxenberg LB, Weiss KE, Schreurs KMG, Morrison EJ, Stubhaug A, Solberg Nes L. Health care providers' experiences of pain management and attitudes towards digitally supported self-management interventions for chronic pain: a qualitative study. BMC Health Serv Res 2021; 21:275. [PMID: 33766028 PMCID: PMC7992849 DOI: 10.1186/s12913-021-06278-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic pain constitutes a significant burden for the individuals affected, and is a frequent reason why patients seek health care services. While in-person psychosocial interventions can be of support to people living with chronic pain, such interventions are not always accessible. eHealth interventions may provide greater accessibility, but the evidence and use of digital self-management solutions for chronic pain are still limited and the lack of health care provider input in the development process of such solutions a concern. Therefore, the aim of the current study was to investigate health care providers' experiences of treating patients with chronic pain, their attitudes towards, and use of, digital solutions in pain management, and their suggestions for content and design elements for a potential digital pain self-management intervention. METHODS Twelve health care providers representing a variety of health care disciplines participated in semi-structured interviews. The interviews were analyzed using thematic analysis. RESULTS The material was analyzed into three main themes: [1] Patients with chronic pain and their current use of the health care services, [2] Health care providers' own motivation and impression of patient prerequisites for use of digital self-management interventions, and [3] Suggestions for content and design elements in a digital self-management intervention for people living with chronic pain. The challenges faced by patients living with chronic pain were described as numerous. Despite interest and positive attitudes, few of the health care providers had used or recommended eHealth solutions to their patients. A range of potential content and functionality elements were identified, including aspects of motivation and engagement and providers also emphasized the importance of easy access and positive, personal content to support existing treatment. CONCLUSIONS This study offers insights into health care providers' considerations for the potential of digital self-management interventions supporting patients living with chronic pain. Findings indicate the need for change and a more comprehensive treatment approach to pain management. eHealth solutions may contribute to such change, and providers pointed to a need for health care provider involvement, timely support and follow-up as important factors for integrating digital pain self-management interventions into clinical care. TRIAL REGISTRATION ClinicalTrials.gov : NCT03705104.
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Affiliation(s)
- Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway. .,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Ingrid Konstanse Ledel Solem
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hilde Eide
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway
| | - Olöf B Kristjansdottir
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | | | - Lori B Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Karen E Weiss
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Karlein M G Schreurs
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | | | - Audun Stubhaug
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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9
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Barker LT, Bond WF, Vincent AL, Cooley KL, McGarvey JS, Vozenilek JA, Powell ES. A novel in situ simulation framework for introduction of a new technology: the 3-Act-3-Debrief model. Adv Simul (Lond) 2020; 5:25. [PMID: 32999737 PMCID: PMC7519488 DOI: 10.1186/s41077-020-00145-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/01/2020] [Indexed: 12/21/2022] Open
Abstract
Background New technologies for clinical staff are typically introduced via an “in-service” that focuses on knowledge and technical skill. Successful adoption of new healthcare technologies is influenced by multiple other factors as described by the Consolidated Framework in Implementation Research (CFIR). A simulation-based introduction to new technologies provides opportunity to intentionally address specific factors that influence adoption. Methods The new technology proposed for adoption was a telehealth cart that provided direct video communication with electronic intensive care unit (eICU) staff for a rural Emergency Department (ED). A novel 3-Act-3-Debrief in situ simulation structure was created to target predictive constructs from the CFIR and connect debriefing to specific workflows. The structure and content of the simulation in relation to the framework is described. Participants completed surveys pre-simulation/post-simulation to measure change in their readiness to adopt the new technology. Results The scenario was designed and pilot tested before implementation at two rural EDs. There were 60 interprofessional participants across the 2 sites, with 58 pre-simulation and 59 post-simulation surveys completed. The post-simulation mean ratings for each readiness measure (feasibility, quality, resource availability, role clarity, staff receptiveness, and tech usability) increased significantly as a result of the simulation experience. Conclusions A novel 3-stage simulation-debriefing structure positively targets factors influencing the adoption of new healthcare technologies.
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Affiliation(s)
- Lisa T Barker
- Jump Simulation (an OSF Healthcare and University of Illinois College of Medicine at Peoria Collaboration), OSF HealthCare and University of Illinois College of Medicine, 1306 N. Berkeley Avenue, Peoria, IL USA.,Department of Emergency Medicine, OSF HealthCare, University of Illinois College of Medicine, Peoria, USA
| | - William F Bond
- Jump Simulation (an OSF Healthcare and University of Illinois College of Medicine at Peoria Collaboration), OSF HealthCare and University of Illinois College of Medicine, 1306 N. Berkeley Avenue, Peoria, IL USA.,Department of Emergency Medicine, OSF HealthCare, University of Illinois College of Medicine, Peoria, USA
| | - Andrew L Vincent
- Department of Emergency Medicine, OSF HealthCare, University of Illinois College of Medicine, Peoria, USA
| | - Kimberly L Cooley
- Jump Simulation (an OSF Healthcare and University of Illinois College of Medicine at Peoria Collaboration), OSF HealthCare and University of Illinois College of Medicine, 1306 N. Berkeley Avenue, Peoria, IL USA
| | - Jeremy S McGarvey
- Jump Simulation (an OSF Healthcare and University of Illinois College of Medicine at Peoria Collaboration), OSF HealthCare and University of Illinois College of Medicine, 1306 N. Berkeley Avenue, Peoria, IL USA
| | - John A Vozenilek
- Jump Simulation (an OSF Healthcare and University of Illinois College of Medicine at Peoria Collaboration), OSF HealthCare and University of Illinois College of Medicine, 1306 N. Berkeley Avenue, Peoria, IL USA.,Department of Emergency Medicine, OSF HealthCare, University of Illinois College of Medicine, Peoria, USA
| | - Emilie S Powell
- Department of Emergency Medicine, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, USA
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Abstract
Context: Considering the pivotal role of telemedicine in providing healthcare services for remote areas, some of the military medical centers, especially in developed countries, use different types of telemedicine programs. Objectives: The present study aimed at identifying the implemented telemedicine projects in military medicine worldwide and introducing their features. Evidence Acquisition: The current systematic review was performed in 2018. PubMed, Scopus, Embase, and Web of Science databases were searched for articles published from 2014 to 2018 by a combination of related keywords, and the related original articles were then selected based on the inclusion and exclusion criteria. Data were collected by a data extraction form, and then the data were summarized and reported based on the study objectives. Results: Of the 173 articles retrieved from the first round of search, 12 were included in the study; five (41.66%) studies had used the synchronous (real-time telemedicine) method. The United States, with nine studies, had the highest number of projects in military telemedicine. Most studies (n = 7) were performed on tele-psychology and the application of telemedicine in psychology. All selected studies reported the positive effects of telemedicine on providing healthcare for military forces. Conclusions: The proper utilization of telemedicine equipment is effective in saving time for both patients and healthcare providers, reducing costs, supporting in natural disasters, and satisfying patients with military medicine. To achieve telemedicine program objectives, they should be set precisely. Considering the importance of timely healthcare services, it is suggested to utilize synchronous methods and tools such as video conferencing.
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11
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Moeckli J, Gutierrez J, Kaboli PJ. Perceived Need and Potential Applications of a Telehospitalist Service in Rural Areas. Telemed J E Health 2020; 27:90-95. [PMID: 32316876 DOI: 10.1089/tmj.2020.0018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Rural hospitals struggle to staff inpatient services and may not have the clinical expertise to achieve optimal outcomes. Telehospitalist services could address these problems by bringing hospital medicine expertise to rural communities. Introduction: Veterans Health Administration (VHA) rural hospitals need staffing alternatives to address gaps in inpatient coverage. This needs assessment identified perceived need for telehospitalist services as well as potential applications, benefits, and barriers from an administration perspective. Materials and Methods: We used a rapid qualitative assessment approach based on semistructured interviews with 15 physician administrators at 12 rural and low-complexity hospitals in VHA in 2018. Results: We identified a range of needs that could be addressed by telehospitalist services, including direct care delivery, support for local providers, and on-demand coverage to fill staffing gaps. Potential benefits included cost reductions, improved care quality, education, and addressing feelings of insular practice. Potential barriers included provider buy-in, cost, and technological limitations. Discussion: Our findings suggest that telehospitalist services could address inpatient coverage gaps, but with a range of views on how the service could be deployed. Telehospitalist services providing intermittent coverage could meet unmet clinical needs at appropriate economies of scale. Administrators were enthusiastic about applying innovative inpatient telemedicine initiatives, but perceived staff reluctance. The dynamic and multidisciplinary nature of inpatient care requires program acceptance at multiple levels, which may account for why it traditionally lags behind outpatient telemedicine. Conclusions: Rural hospital physician administrators perceived telehospitalist models as a viable option to address staffing needs and improve quality of care.
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Affiliation(s)
- Jane Moeckli
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.,The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Jeydith Gutierrez
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.,The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Peter J Kaboli
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.,The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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12
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Austin T, Chreim S, Grudniewicz A. Examining health care providers' and middle-level managers' readiness for change: a qualitative study. BMC Health Serv Res 2020; 20:47. [PMID: 31952525 PMCID: PMC6969476 DOI: 10.1186/s12913-020-4897-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline providers or individuals in non-managerial positions and offers limited attention to individuals in middle management positions who are expected to lead frontline providers in change implementation. Yet middle-level managers are also recipients of changes that are planned and decreed by those in higher positions. This study sought to examine both frontline provider and middle manager readiness for change in the context of primary care program integration. Methods Using a qualitative case study approach, we examined how frontline providers and middle managers experienced six readiness factors: discrepancy, appropriateness, valence, efficacy, fairness and trust in management. Data were collected through documents, meeting observation and semi-structured interviews with frontline providers and middle managers involved in the change. Results The findings highlighted similarities and differences in readiness experiences of frontline providers and middle managers. Across both types of participants, we found that the notion of valence should be expanded to consider individuals’ evaluation of benefits to patients and the health system; efficacy applies to both content and process of change; fairness and trust in management findings require further exploration to determine their appropriateness to be incorporated in models of readiness for change; and trust in management (or lack of trust) has a cascading influence across the levels in the organization. Conclusions Our study makes a contribution by nuancing and extending conceptualizations of individual readiness factors, and by highlighting the central role of middle manager readiness for change. Implications of the study include the need to consider readiness factors prior to the implementation of change and the importance of fostering readiness throughout all levels of the organization.
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Affiliation(s)
- Tujuanna Austin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, K1N 6N5, Canada.
| | - Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, K1N 6N5, Canada
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13
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Squires JE, Graham I, Bashir K, Nadalin‐Penno L, Lavis J, Francis J, Curran J, Grimshaw JM, Brehaut J, Ivers N, Michie S, Hillmer M, Noseworthy T, Vine J, Demery Varin M, Aloisio LD, Coughlin M, Hutchinson AM. Understanding context: A concept analysis. J Adv Nurs 2019; 75:3448-3470. [DOI: 10.1111/jan.14165] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/24/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Janet E. Squires
- School of Nursing, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Ian Graham
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
- School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
| | - Kainat Bashir
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
| | - Letitia Nadalin‐Penno
- School of Nursing, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
| | - John Lavis
- Department of Clinical Epidemiology & Biostatistics McMaster University Hamilton Ontario Canada
- McMaster Health Forum Hamilton Ontario Canada
| | - Jill Francis
- School of Health Sciences, City University of London London United Kingdom
| | - Janet Curran
- IWK Health Centre Halifax Nova Scotia Canada
- School of Nursing Dalhousie University Halifax Nova Scotia Canada
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
- Medicine University of Ottawa Ottawa Ontario Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
- School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
| | - Noah Ivers
- Women's College Research Institute Toronto Ontario Canada
- Women's College Hospital Toronto Ontario Canada
- Department of Family and Community Medicine University of Toronto Toronto Ontario Canada
| | - Susan Michie
- Psychology Department University College London London United Kingdom
| | - Michael Hillmer
- Information Management, Data, and Analytics Ontario Ministry of Health and Long‐term Care Toronto Ontario Canada
| | - Thomas Noseworthy
- British Columbia Academic Health Science Network Vancouver British Columbia Canada
| | - Jocelyn Vine
- School of Nursing Dalhousie University Halifax Nova Scotia Canada
- Patient Care IWK Health Centre Halifax Nova Scotia Canada
| | - Melissa Demery Varin
- School of Nursing, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
| | - Laura D. Aloisio
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Mary Coughlin
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Alison M. Hutchinson
- School of Nursing and Midwifery, Faculty of Health Deakin University Melbourne Victoria Australia
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14
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Hower KI, Pfaff H, Kowalski C, Wensing M, Ansmann L. Measuring change attitudes in health care organizations. J Health Organ Manag 2019; 33:266-285. [PMID: 31122117 DOI: 10.1108/jhom-06-2018-0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Measuring attitudes of healthcare providers and managers toward change in health care organizations (HCOs) has been of widespread interest. The purpose of this paper is to evaluate the psychometric characteristics and usability of an abbreviated German version of the Change Attitude Scale. DESIGN/METHODOLOGY/APPROACH The Change Attitude Scale was used in a survey of healthcare providers and managers in German hospitals after the implementation of a breast cancer center concept. Reliability analysis, confirmatory factor analysis, structural equation modeling and bivariate analysis were conducted. FINDINGS Data from 191 key persons in 82 hospitals were analyzed. The item-scale structure produced an acceptable model fit. Convergent validity was shown by significant correlations with measures of individuals' general opinions of the breast center concept. A non-significant correlation with a scale measuring the hospital's hierarchical structure of leadership verified discriminant validity. The interaction of key persons' change attitude and hospitals' change performance through change culture as a mediator supported the predictive validity. RESEARCH LIMITATIONS/IMPLICATIONS The study found general support for the validity and usability of a short version of the German Change Attitude Scale. PRACTICAL IMPLICATIONS Since attitudes toward change influence successful implementation, the survey may be used to tailor the design of implementation programs and to create a sustainable culture of high readiness for change. ORIGINALITY/VALUE This is the first study finding that a short instrument can be used to measure attitudes toward change among healthcare providers and managers in HCOs.
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Affiliation(s)
- Kira Isabel Hower
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne , Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne , Cologne, Germany
| | - Christoph Kowalski
- Certification Program Cancer Centers, German Cancer Society (DKG), Berlin, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University , Heidelberg, Germany
| | - Lena Ansmann
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky Oldenburg University , Oldenburg, Germany
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15
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Abstract
OBJECTIVE Although there is growing evidence regarding the utility of telemedicine in providing care for acutely ill children in underserved settings, adoption of pediatric emergency telemedicine remains limited, and little data exist to inform implementation efforts. Among clinician stakeholders, we examined attitudes regarding pediatric emergency telemedicine, including barriers to adoption in rural settings and potential strategies to overcome these barriers. METHODS Using a sequential mixed-methods approach, we first performed semistructured interviews with clinician stakeholders using thematic content analysis to generate a conceptual model for pediatric emergency telemedicine adoption. Based on this model, we then developed and fielded a survey to further examine attitudes regarding barriers to adoption and strategies to improve adoption. RESULTS Factors influencing adoption of pediatric emergency telemedicine were identified and categorized into 3 domains: contextual factors (such as regional geography, hospital culture, and individual experience), perceived usefulness of pediatric emergency telemedicine, and perceived ease of use of pediatric emergency telemedicine. Within the domains of perceived usefulness and perceived ease of use, belief in the relative advantage of telemedicine was the most pronounced difference between telemedicine proponents and nonproponents. Strategies identified to improve adoption of telemedicine included patient-specific education, clinical protocols for use, decreasing response times, and simplifying the technology. CONCLUSIONS More effective adoption of pediatric emergency telemedicine among clinicians will require addressing perceived usefulness and perceived ease of use in the context of local factors. Future studies should examine the impact of specific identified strategies on adoption of pediatric emergency telemedicine and patient outcomes in rural settings.
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Shulver W, Killington M, Crotty M. 'Massive potential' or 'safety risk'? Health worker views on telehealth in the care of older people and implications for successful normalization. BMC Med Inform Decis Mak 2016; 16:131. [PMID: 27733195 PMCID: PMC5062826 DOI: 10.1186/s12911-016-0373-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/07/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Telehealth technologies, which enable delivery of healthcare services at distance, offer promise for responding to the challenges created by an ageing population. However, successful implementation of telehealth into mainstream healthcare systems has been slow and fraught with failure. Understanding of frontline providers' experiences and attitudes regarding telehealth is a crucial aspect of successful implementation. This study aims to examine healthcare worker views on telehealth, and their implications for implementation to mainstream healthcare services for older people. The study includes a focus on two further dimensions of urban versus rural services and level of clinician experience with telehealth. METHODS Seven semi-structured focus groups were conducted with a total of 44 healthcare workers providing services to older people in the areas of rehabilitation and allied health, residential aged care and palliative care. Focus groups included both telehealth experienced and inexperienced groups. Of the experienced groups, two provided services to both urban and rural patients, and two to rural patients. Inexperienced groups included one rural and two urban. Thematic analysis was undertaken to identify predominant themes. Between-group differences and agreement in viewpoints for each of these themes are discussed and mapped to the theoretical constructs of Normalization Process Theory. RESULTS The views of participants varied with the extent of telehealth experience and perception of accessibility of healthcare services. Four themes describing clinician attitudes and perceptions that could impact on successful implementation of telehealth services are outlined: 1) Workability of telehealth: exponential growth in access or decay in the quality of healthcare? 2) What is an acceptable level of risk to patient safety with telehealth? 3) Shifting responsibilities and recalibrating the team; and 4) Change of architecture required to enable integration of telehealth service delivery. CONCLUSIONS The use of telehealth technologies to provide healthcare services to older people may be more readily normalized in areas where existing services are limited. Though exposure to telehealth may be a factor, changes to the perceived feasibility of telehealth in relation to conventional services, as well as supportive infrastructure and training and skill recalibration may be more critical to successful normalization of telehealth services for older people.
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Affiliation(s)
- Wendy Shulver
- Rehabilitation, Aged and Extended Care, Flinders University, Daws Road, Daw Park, Adelaide, South Australia, Australia.
| | - Maggie Killington
- Rehabilitation, Aged and Extended Care, Flinders University, Daws Road, Daw Park, Adelaide, South Australia, Australia.,Rehabilitation and Aged Care, Repatriation General Hospital, Adelaide, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Daws Road, Daw Park, Adelaide, South Australia, Australia.,Rehabilitation and Aged Care, Repatriation General Hospital, Adelaide, South Australia, Australia
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17
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Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based Patient-Provider Communication Service in Five Settings: A Qualitative Study. J Med Internet Res 2015; 17:e262. [PMID: 26582138 PMCID: PMC4704938 DOI: 10.2196/jmir.5091] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 12/17/2022] Open
Abstract
Background Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge. Objective The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success. Methods This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients. Results Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementation units. Most of the distinguishing constructs were related to the inner setting domain of CFIR, indicating that institutional factors were particularly important for successful implementation. Health care providers’ beliefs in the intervention as useful for themselves and their patients as well as the implementation process itself were also important. A comparison of constructs across ours and 2 other studies that also used the CFIR to discriminate between high and low implementation success showed that 24 CFIR constructs distinguished between high and low implementation units in at least 1 study; 11 constructs distinguished in 2 studies. However, only 2 constructs (patient need and resources and available resources) distinguished consistently between high and low implementation units in all 3 studies. Conclusions The CFIR is a helpful framework for illuminating barriers and facilitators influencing IPPC implementation. However, CFIR’s strength of being broad and comprehensive also limits its usefulness as an implementation framework because it does not discriminate between the relative importance of its many constructs for implementation success. This is the first study to identify which CFIR constructs are the most promising to distinguish between high and low implementation success across settings and interventions. Findings from this study can contribute to the refinement of CFIR toward a more succinct and parsimonious framework for planning and evaluation of the implementation of clinical interventions. ClinicalTrial Clinicaltrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6cWeqN1uY)
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Affiliation(s)
- Cecilie Varsi
- Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway
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18
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Ray KN, Demirci JR, Bogen DL, Mehrotra A, Miller E. Optimizing Telehealth Strategies for Subspecialty Care: Recommendations from Rural Pediatricians. Telemed J E Health 2015; 21:622-9. [PMID: 25919585 DOI: 10.1089/tmj.2014.0186] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telehealth offers strategies to improve access to subspecialty care for children in rural communities. Rural pediatrician experiences and preferences regarding the use of these telehealth strategies for children's subspecialty care needs are not known. We elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies. MATERIALS AND METHODS Seventeen semistructured telephone interviews were conducted with rural pediatricians from 17 states within the United States. Interviewees were recruited by e-mails to a pediatric rural health listserv and to rural pediatricians identified through snowball sampling. Themes were identified through thematic analysis of interview transcripts. Institutional Review Board approval was obtained. RESULTS Rural pediatricians identified several telehealth strategies to improve access to subspecialty care, including physician access hotlines, remote electronic medical record access, electronic messaging systems, live video telemedicine, and telehealth triage systems. Rural pediatricians provided recommendations for optimizing the utility of each of these strategies based on their experiences with different systems. Rural pediatricians preferred specific telehealth strategies for specific clinical contexts, resulting in a proposed framework describing the complementary role of different telehealth strategies for pediatric subspecialty care. Finally, rural pediatricians identified additional benefits associated with the use of telehealth strategies and described a desire for telehealth systems that enhanced (rather than replaced) personal relationships between rural pediatricians and subspecialists. CONCLUSIONS Rural pediatricians described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians provided recommendations for optimizing individual telehealth strategies. Input from rural pediatricians will be crucial for optimizing specific telehealth strategies and designing effective telehealth systems.
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Affiliation(s)
- Kristin N Ray
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jill R Demirci
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Debra L Bogen
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ateev Mehrotra
- 2 Department of Healthcare Policy and Medicine, Harvard Medical School , Boston, Massachusetts.,3 RAND Corporation , Boston, Massachusetts
| | - Elizabeth Miller
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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19
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Patientensicherheitsarbeit in Schweden. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:16-22. [DOI: 10.1007/s00103-014-2074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Holmner A, Ebi KL, Lazuardi L, Nilsson M. Carbon footprint of telemedicine solutions--unexplored opportunity for reducing carbon emissions in the health sector. PLoS One 2014; 9:e105040. [PMID: 25188322 PMCID: PMC4154849 DOI: 10.1371/journal.pone.0105040] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 07/19/2014] [Indexed: 11/25/2022] Open
Abstract
Background The healthcare sector is a significant contributor to global carbon emissions, in part due to extensive travelling by patients and health workers. Objectives To evaluate the potential of telemedicine services based on videoconferencing technology to reduce travelling and thus carbon emissions in the healthcare sector. Methods A life cycle inventory was performed to evaluate the carbon reduction potential of telemedicine activities beyond a reduction in travel related emissions. The study included two rehabilitation units at Umeå University Hospital in Sweden. Carbon emissions generated during telemedicine appointments were compared with care-as-usual scenarios. Upper and lower bound emissions scenarios were created based on different teleconferencing solutions and thresholds for when telemedicine becomes favorable were estimated. Sensitivity analyses were performed to pinpoint the most important contributors to emissions for different set-ups and use cases. Results Replacing physical visits with telemedicine appointments resulted in a significant 40–70 times decrease in carbon emissions. Factors such as meeting duration, bandwidth and use rates influence emissions to various extents. According to the lower bound scenario, telemedicine becomes a greener choice at a distance of a few kilometers when the alternative is transport by car. Conclusions Telemedicine is a potent carbon reduction strategy in the health sector. But to contribute significantly to climate change mitigation, a paradigm shift might be required where telemedicine is regarded as an essential component of ordinary health care activities and not only considered to be a service to the few who lack access to care due to geography, isolation or other constraints.
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Affiliation(s)
- Asa Holmner
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Kristie L Ebi
- ClimAdapt, LLC, Seattle, Washington, United States of America; Department of public health and clinical medicine, epidemiology and global health, Umeå University, Umeå, Sweden
| | - Lutfan Lazuardi
- Department of Public Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Maria Nilsson
- Department of public health and clinical medicine, epidemiology and global health, Umeå University, Umeå, Sweden
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Zapka J, Amella E, Magwood G, Madisetti M, Garrow D, Batchelor-Aselage M. Challenges in efficacy research: the case of feeding alternatives in patients with dementia. J Adv Nurs 2014; 70:2072-2085. [PMID: 24612316 PMCID: PMC4130777 DOI: 10.1111/jan.12365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2014] [Indexed: 11/28/2022]
Abstract
AIMS To explore factors at the family caregiver and nursing home administrative levels that may affect participation in a clinical trial to determine the efficacy of hand feeding vs. percutaneous gastrostomy tube feeding in persons with late-stage dementia. BACKGROUND Decision-making regarding use of tube feeding vs. hand feeding for persons with late-stage dementia is fraught with practical, emotional and ethical issues and is not informed by high levels of evidence. DESIGN Qualitative case study. METHODS Transcripts of focus groups with family caregivers were reviewed for themes guided by behavioural theory. Analyses of notes from contacts with nursing home administrators and staff were reviewed for themes guided by an organizational readiness model. Data were collected between the years 2009-2012. RESULTS Factors related to caregiver willingness to participate included understanding of the prognosis of dementia, perceptions of feeding needs and clarity about research protocols. Nursing home willingness to participate was influenced by corporate approval, concerns about legal and regulatory issues, and prior relationships with investigators. CONCLUSION Participation in rigorous trials requires lengthy navigation of complex corporate requirements and training competent study staff. Objective deliberation by caregivers will depend on appropriate recruitment timing, design of recruitment materials and understanding of study requirements. The clinical standards and policy environment and the secular trends there-in have relevance to the responses of people at all levels.
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Affiliation(s)
- Jane Zapka
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elaine Amella
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gayenell Magwood
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohan Madisetti
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Donald Garrow
- Gulf Comprehensive Gastroenterology, Englewood, Florida, USA
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Adler-Milstein J, Kvedar J, Bates DW. Telehealth Among US Hospitals: Several Factors, Including State Reimbursement And Licensure Policies, Influence Adoption. Health Aff (Millwood) 2014; 33:207-15. [PMID: 24493762 DOI: 10.1377/hlthaff.2013.1054] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Julia Adler-Milstein
- Julia Adler-Milstein ( ) is an assistant professor at the School of Information and the School of Public Health, University of Michigan, in Ann Arbor
| | - Joseph Kvedar
- Joseph Kvedar is director of the Center for Connected Health, Partners Healthcare System, in Boston, Massachusetts
| | - David W. Bates
- David W. Bates is chief of the Division of General Medicine, senior vice president for quality and safety, and chief quality officer, all at Brigham and Women’s Hospital, in Boston
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24
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Jones R. Development of a Questionnaire and Cross-Sectional Survey of Patient eHealth Readiness and eHealth Inequalities. MEDICINE 2.0 2013; 2:e9. [PMID: 25075244 PMCID: PMC4084763 DOI: 10.2196/med20.2559] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/24/2013] [Accepted: 08/16/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND Many speak of the digital divide, but variation in the opportunity of patients to use the Internet for health (patient eHealth readiness) is not a binary difference, rather a distribution influenced by personal capability, provision of services, support, and cost. Digital divisions in health have been addressed by various initiatives, but there was no comprehensive validated measure to know if they are effective that could be used in randomized controlled trials (RCTs) covering both non-Internet-users and the range of Internet-users. OBJECTIVE The aim of this study was to develop and validate a self-completed questionnaire and scoring system to assess patient eHealth readiness by examining the spread of scores and eHealth inequalities. The intended use of this questionnaire and scores is in RCTs of interventions aiming to improve patient eHealth readiness and reduce eHealth inequalities. METHODS Based on four factors identified from the literature, a self-completed questionnaire, using a pragmatic combination of factual and attitude questions, was drafted and piloted in three stages. This was followed by a final population-based, cross-sectional household survey of 344 people used to refine the scoring system. RESULTS the patient ehealth readiness questionnaire (perq) includes questions used to calculate four subscores: patients' perception of (1) provision, (2) their personal ability and confidence, (3) their interpersonal support, and (4) relative costs in using the Internet for health. These were combined into an overall PERQ score (0-9) which could be used in intervention studies. Reduction in standard deviation of the scores represents reduction in eHealth inequalities. CONCLUSIONS PERQ appears acceptable for participants in British studies. The scores produced appear valid and will enable assessment of the effectiveness of interventions to improve patient eHealth readiness and reduce eHealth inequalities. Such methods need continued evolution and redevelopment for other environments. Full documentation and data have been published to allow others to develop the tool further.
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Affiliation(s)
- Ray Jones
- University of Plymouth Faculty of Health, Education, and Society Plymouth United Kingdom
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