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Sutherland K, Yeung W, Mak Y, Levesque JF. Envisioning the future of clinical analytics: a modified Delphi process in New South Wales, Australia. BMC Med Inform Decis Mak 2020; 20:210. [PMID: 32887609 PMCID: PMC7650225 DOI: 10.1186/s12911-020-01226-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/20/2020] [Indexed: 12/02/2022] Open
Abstract
Background Clinical analytics is a rapidly developing area of informatics and knowledge mobilisation which has huge potential to improve healthcare in the future. It is widely acknowledged to be a powerful mediator of clinical decision making, patient-centred care and organisational learning. As a result, healthcare systems require a strategic foundation for clinical analytics that is sufficiently directional to support meaningful change while flexible enough to allow for iteration and responsiveness to context as change occurs. Methods In New South Wales, the most populous state in Australia, the Clinical Analytics Working Group was charged with developing a five-year vision for the public health system. A modified Delphi process was undertaken to elicit expert views and to reach a consensus. The process included a combination of face-to-face workshops, traditional Delphi voting via email, and innovative, real-time iteration between text re-formulation and voting until consensus was reached. The six stage process engaged 35 experts — practising clinicians, patients and consumers, managers, policymakers, data scientists and academics. Results The process resulted in the production of 135 ideas that were subsequently synthesised into 23 agreed statements and encapsulated in a single page (456 word) narrative. Conclusion The visioning process highlighted three key perspectives (clinicians, patients and managers) and the need for synchronous (during the clinical encounter) and asynchronous (outside the clinical encounter) clinical decision support and reflective practice tools; the use of new and multiple data sources and communication formats; and the role of research and education.
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Affiliation(s)
- Kim Sutherland
- NSW Agency for Clinical Innovation, Chatswood, NSW, Australia.
| | | | - Yoke Mak
- eHealth NSW, Chatswood, NSW, Australia
| | - Jean-Frederic Levesque
- NSW Agency for Clinical Innovation, Chatswood, NSW, Australia.,Centre for Primary Health Care and Equity, UNSW, Randwick, New South Wales, Australia
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Holen-Rabbersvik E, Thygesen E, Eikebrokk TR, Fensli RW, Slettebø Å. Barriers to exchanging healthcare information in inter-municipal healthcare services: a qualitative case study. BMC Med Inform Decis Mak 2018; 18:92. [PMID: 30404630 PMCID: PMC6223094 DOI: 10.1186/s12911-018-0701-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 10/26/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In recent years, inter-municipal cooperation in healthcare services has been an important measure implemented to meet future demographic changes in western countries. This entails an increased focus on communication and information sharing across organisational borders. Technology enables efficient and effective solutions to enhance such cooperation. However, the systems in the healthcare sector tend not to communicate with one another. There is a lack of literature focusing on communication and information sharing in inter-municipal healthcare services. The aim of this article is to investigate both the characteristics of communication and information sharing, and the factors that serve as barriers to communication and information sharing for employees in inter-municipal healthcare services. METHODS In this study, a qualitative case study approach is used to investigate both characteristics of communication and information sharing, and factors enabling barriers to communication and information sharing for employees in newly established inter-municipal healthcare services. Data collection methods were individual interviews, focus group interviews, observation studies and a workshop. A total of 18 persons participated in the study. The interviews, observations and workshop were conducted over a period of ten months. RESULTS Communication and information sharing practices were found to be complex and characterised by multiple actors, information types and a combination of multiple actions. Findings indicate that 1. IT capability and usability 2. Differences 3. Privacy, confidentiality and security and 4. Awareness are all factors enabling barriers to communication and information sharing in inter-municipal healthcare services. Specifically, these barriers were related to lack of EHR usability, inadequate workflow processes, digital systems incompatibility, the understanding of needs in different systems and knowledge and practices regarding privacy and confidentiality. CONCLUSION By focusing on the context of inter-municipal cooperation when assessing communication and information sharing in healthcare services, this article contributes to close a gap in existing knowledge. The perspective of the employees provides useful insight, and findings can be relevant for future theory development and for managers and policymakers in inter-municipal services.
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Affiliation(s)
- Elisabeth Holen-Rabbersvik
- Department of Health and Nursing Science, Centre for eHealth, University of Agder, PO Box 509, 4898 Grimstad, Norway
| | - Elin Thygesen
- Department of Health and Nursing Science, Centre for eHealth, University of Agder, PO Box 509, 4898 Grimstad, Norway
| | - Tom Roar Eikebrokk
- Department of Information Systems, University of Agder, PO Box 422, 4604 Kristiansand, Norway
| | - Rune Werner Fensli
- Department of Information and Communication Technology, Centre for eHealth, University of Agder, PO Box 509, 4898 Grimstad, Norway
| | - Åshild Slettebø
- Department of Health and Nursing Science, Centre for care research, South University of Agder, PO Box 509, 4898 Grimstad, Norway
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Holen-Rabbersvik E, Eikebrokk TR, Fensli RW, Thygesen E, Slettebø Å. Critical issues for employees in inter-municipal health care services: a multiple case study. BMC Health Serv Res 2018; 18:805. [PMID: 30348149 PMCID: PMC6196433 DOI: 10.1186/s12913-018-3586-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/01/2018] [Indexed: 11/23/2022] Open
Abstract
Background Traditional, hierarchical government structures have recently been challenged by increased complexity, fragmented services and heavy public demand. When healthcare services become fragmented and decentralised, they require redesign. Inter-municipal cooperation is a strategy to deal with current challenges and future demographic changes. Few studies exist that can help us conceptualize challenges regarding employment in this context and inform managers in the involved municipalities. This study aims to identify critical issues for employees in inter-municipal health care services and to elaborate on how and why these issues are experienced. Methods A multiple qualitative case study was conducted with data from interviews, observation studies, a participant workshop and inter-municipal healthcare service project documents and reports. The study involved two districts in Norway and six cases including 17 informants. First, a within-case analysis was conducted for all cases; second, a cross-case analysis was conducted in each district to examine replication, contrasts and extension to emergent findings; and, eventually, replicated findings in Districts 1 and 2 were analysed across districts. Results Three critical issues were identified: support, differences, and geographical distances. Employees working in teams experienced fewer challenges than did those working as isolated individuals. Conclusions Critical issues for employees represent an important aspect of inter-municipal cooperation, and additional research should be undertaken to inform future policy and practice.
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Affiliation(s)
- Elisabeth Holen-Rabbersvik
- Faculty of Health and Sport Sciences, University of Agder, PO Box 509, Jon Lilletunsvei 9, 4898, Grimstad, Norway.
| | - Tom Roar Eikebrokk
- Faculty of Social Sciences, University of Agder, PO Box 422, Universitetsveien 25, 4630, Kristiansand, Norway
| | - Rune Werner Fensli
- Faculty of Engineering and Science, University of Agder, PO Box 509, Jon Lilletunsvei 9, Grimstad, 4898, Norway
| | - Elin Thygesen
- Faculty of Health and Sport Sciences, University of Agder, PO box 422, Universitetsveien 25, 4630, Kristiansand, Norway
| | - Åshild Slettebø
- Faculty of Health and Sport Sciences, University of Agder, PO Box 509, Jon Lilletunsvei 9, 4898, Grimstad, Norway
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Glette MK, Kringeland T, Røise O, Wiig S. Exploring physicians' decision-making in hospital readmission processes - a comparative case study. BMC Health Serv Res 2018; 18:725. [PMID: 30231903 PMCID: PMC6146774 DOI: 10.1186/s12913-018-3538-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 09/12/2018] [Indexed: 11/23/2022] Open
Abstract
Background Hospital readmissions is an increasingly serious international problem, associated with higher risks of adverse events, especially in elderly patients. There can be many causes and influential factors leading to hospital readmissions, but they are often closely related, making hospital readmissions an overall complex area. In addition, a comprehensive coordination reform was introduced into the Norwegian healthcare system in 2012. The reform changed the premises for readmissions with economic incentives enhancing early transfer from secondary to primary care, making research on readmissions in the municipalities more urgent than ever. General practitioners (GPs) and nursing home physicians, have traditionally held a gatekeepers function in hospital readmissions from the municipal healthcare service, as they are the main decision-makers in questions of hospital readmissions. Still, the GPs’ gatekeeper function is an under-investigated area in hospital readmission research. The aim of the study was to increase knowledge about factors that lead to hospital readmissions among elderly in municipal healthcare, with special attention to GPs’ and nursing home physicians’ decision making. Method The study was conducted as a comparative case study. Two municipalities affiliated with the same hospital, but with different readmission rates were recruited. Twenty GPs and nursing home physicians from each municipality were recruited and interviewed. Forty hours of observation were conducted during the huddles in one long-term and one short-term nursing home in each municipality. Results Seven themes describing how different factors influence physicians’ decision-making in the hospital readmission process in two municipalities were identified. Poor communication, continuity and information flow account for hospital readmissions in both municipalities. Several factors, including nurse staffing and competence, patients and their families, time constraints and experience affected physicians’ decision-making. Conclusion Communication, continuity and information flow contributed to hospital readmissions in both municipalities. The cross-case analysis revealed slight differences between municipalities. More research focusing on GPs’ and nursing home physicians’ decision-making, nursing home nurses and home care nurses’ experience of hospital readmissions and discharges is needed. Electronic supplementary material The online version of this article (10.1186/s12913-018-3538-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malin Knutsen Glette
- Faculty of Health, Western Norway University of Applied Sciences, Haugesund, Norway. .,Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway.
| | - Tone Kringeland
- Faculty of Health, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Olav Røise
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siri Wiig
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
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Halvorsrud K, Flynn D, Ford GA, McMeekin P, Bhalla A, Balami J, Craig D, White P. A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England. BMC Health Serv Res 2018; 18:135. [PMID: 29471828 PMCID: PMC5824465 DOI: 10.1186/s12913-018-2922-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/06/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intra-arterial thrombectomy is the gold standard treatment for large artery occlusive stroke. However, the evidence of its benefits is almost entirely based on trials delivered by experienced neurointerventionists working in established teams in neuroscience centres. Those responsible for the design and prospective reconfiguration of services need access to a comprehensive and complementary array of information on which to base their decisions. This will help to ensure the demonstrated effects from trials may be realised in practice and account for regional/local variations in resources and skill-sets. One approach to elucidate the implementation preferences and considerations of key experts is a Delphi survey. In order to support commissioning decisions, we aimed using an electronic Delphi survey to establish consensus on the options for future organisation of thrombectomy services among physicians with clinical experience in managing large artery occlusive stroke. METHODS A Delphi survey was developed with 12 options for future organisation of thrombectomy services in England. A purposive sampling strategy established an expert panel of stroke physicians from the British Association of Stroke Physicians (BASP) Clinical Standards and/or Executive Membership that deliver 24/7 intravenous thrombolysis. Options with aggregate scores falling within the lowest quartile were removed from the subsequent Delphi round. Options reaching consensus following the two Delphi rounds were then ranked in a final exercise by both the wider BASP membership and the British Society of Neuroradiologists (BSNR). RESULTS Eleven stroke physicians from BASP completed the initial two Delphi rounds. Three options achieved consensus, with subsequently wider BASP (97%, n = 43) and BSNR members (86%, n = 21) assigning the highest approval rankings in the final exercise for transferring large artery occlusive stroke patients to nearest neuroscience centre for thrombectomy based on local CT/CT Angiography. CONCLUSIONS The initial Delphi rounds ensured optimal reduction of options by an expert panel of stroke physicians, while subsequent ranking exercises allowed remaining options to be ranked by a wider group of experts within stroke to reach consensus. The preferred implementation option for thrombectomy is investigating suspected acute stroke patients by CT/CT Angiography and secondary transfer of large artery occlusive stroke patients to the nearest neuroscience (thrombectomy) centre.
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Affiliation(s)
- Kristoffer Halvorsrud
- Institute of Health and Society Newcastle University, Newcastle Upon Tyne, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Darren Flynn
- Institute of Health and Society Newcastle University, Newcastle Upon Tyne, UK
| | - Gary A. Ford
- Institute of Neuroscience, Newcastle University, 3-4, Claremont Terrace, Newcastle upon Tyne, NE2 4AX UK
- Oxford University Hospitals NHS Trust and Oxford University, Oxford, UK
| | - Peter McMeekin
- School of Health, Community and Education Studies, Northumbria University, Newcastle Upon Tyne, UK
| | - Ajay Bhalla
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Joyce Balami
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Dawn Craig
- Institute of Health and Society Newcastle University, Newcastle Upon Tyne, UK
| | - Phil White
- Institute of Neuroscience, Newcastle University, 3-4, Claremont Terrace, Newcastle upon Tyne, NE2 4AX UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Garmann-Johnsen NF, Eikebrokk TR. Dynamic capabilities in e-health innovation: Implications for policies. HEALTH POLICY AND TECHNOLOGY 2017. [DOI: 10.1016/j.hlpt.2017.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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La Rocca A, Hoholm T. Coordination between primary and secondary care: the role of electronic messages and economic incentives. BMC Health Serv Res 2017; 17:149. [PMID: 28212653 PMCID: PMC5316199 DOI: 10.1186/s12913-017-2096-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 02/11/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In Norway, a government reform has recently been introduced to enhance coordination between primary and secondary care. This paper examines the effects of two newly introduced measures to improve the coordination: an ICT-based communication tool/standard and an economic incentive scheme. METHOD This qualitative study is based primarily on 27 open-ended interviews. We interviewed nine employees at a hospital (the focal actor), 17 employees from seven different municipalities, and a representative of a Regional Health Authority. RESULTS ICT-based communication is perceived to facilitate information exchange between primary and secondary care, thus positively affecting coordination. However, the economic incentive scheme appears to have the opposite effect by creating tensions between the two organizations and accentuating power asymmetry in favor of secondary care. CONCLUSIONS The inter-organizational nature of coordination in health care makes it crucial for policymakers and management of care organizations to conceive incentives and instruments that work jointly across organizations rather than at only one of the health care organizations involved. Such an approach is likely to favor a more symmetrical pattern of collaboration between primary and secondary care.
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Affiliation(s)
- Antonella La Rocca
- Akershus University Hospital, Sykehusveien 25, Lørenskog, 1478 Norway
- Department of Innovation and Economic Organization, BI Norwegian Business School, Nydalsveien 37, Oslo, 0484 Norway
| | - Thomas Hoholm
- Akershus University Hospital, Sykehusveien 25, Lørenskog, 1478 Norway
- Department of Innovation and Economic Organization, BI Norwegian Business School, Nydalsveien 37, Oslo, 0484 Norway
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Linkov F, Valappil B, McAfee J, Goughnour SL, Hildrew DM, McCall AA, Linkov I, Hirsch B, Snyderman C. Development of an evidence-based decision pathway for vestibular schwannoma treatment options. Am J Otolaryngol 2017; 38:57-64. [PMID: 27780583 DOI: 10.1016/j.amjoto.2016.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/22/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS). METHODS This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator. Previously diagnosed VS patients were recruited by clinical investigators at the University of Pittsburgh Medical Center (UPMC). Classical content analysis was used for focus group data analysis. Providers were recruited from practices within the UPMC system and were surveyed using Delphi methods. This information can provide a basis for multi-criteria decision analysis (MCDA) framework to develop a treatment decision support system for patients with VS. RESULTS Eight themes were derived from these data (focus group + surveys): doctor/health care system, side effects, effectiveness of treatment, anxiety, mortality, family/other people, quality of life, and post-operative symptoms. These data, as well as feedback from physicians were utilized in building a multi-criteria decision model. DISCUSSION The study illustrated steps involved in the development of a decision support model that integrates evidence-based data and patient values to select treatment alternatives. CONCLUSIONS Studies focusing on the actual development of the decision support technology for this group of patients are needed, as decisions are highly multifactorial. Such tools have the potential to improve decision making for complex medical problems with alternate treatment pathways.
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