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Mukumbya B, Kitya D, Trillo-Ordonez Y, Sun K, Obiga O, Deng DD, Stewart KA, Ukachukwu AEK, Haglund MM, Fuller AT. The feasibility, appropriateness, and usability of mobile neuro clinics in addressing the neurosurgical and neurological demand in Uganda. PLoS One 2024; 19:e0305382. [PMID: 38913633 PMCID: PMC11195962 DOI: 10.1371/journal.pone.0305382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Uganda has a high demand for neurosurgical and neurological care. 78% of the over 50 million population reside in rural and remote communities where access to neurosurgical and neurological services is lacking. This study aimed to determine the feasibility, appropriateness, and usability of mobile neuro clinics (MNCs) in providing neurological care to rural and remote Ugandan populations. METHODS Neurosurgery, neurology, and mobile health clinic providers participated in an education and interview session to assess the feasibility, appropriateness, and usability of the MNC intervention. A qualitative analysis of the interview responses using the constructs in the updated Consolidated Framework for Implementation Research was performed. Providers' opinions were weighted using average sentiment scores on a novel sentiment-weighted scale adapted from the CFIR. A stakeholder analysis was also performed to assess the power and interest of the actors described by the participants. RESULTS Twenty-one healthcare providers completed the study. Participants discussed the potential benefits and concerns of MNCs as well as potential barriers and critical incidents that could jeopardize the intervention. Of the five CFIR domains evaluated, variables in the implementation process domain showed the highest average sentiment scores, followed by the implementation climate constructs, inner setting, innovation, and outer setting domains. Furthermore, many interested stakeholders were identified with diverse roles and responsibilities for implementing MNCs. These findings demonstrate that MNC innovation is feasible, appropriate, and usable. CONCLUSION The findings of this study support the feasibility, appropriateness, and usability of MNCs in Uganda. However, integration of this innovation requires careful planning and stakeholder engagement at all levels to ensure the best possible outcomes.
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Affiliation(s)
- Benjamin Mukumbya
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - David Kitya
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yesel Trillo-Ordonez
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Keying Sun
- Duke Global Health Institute, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Oscar Obiga
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Di D. Deng
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
| | | | - Alvan-Emeka K. Ukachukwu
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Health System, Durham, NC, United States of America
| | - Michael M. Haglund
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Health System, Durham, NC, United States of America
| | - Anthony T. Fuller
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
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Balt E, Heesen K, Popma A, Gilissen R, Mérelle S, Creemers D. Guiding principles for the implementation of a standardized psychological autopsy to understand and prevent suicide: a stakeholder analysis. Front Psychiatry 2023; 14:1256229. [PMID: 38025435 PMCID: PMC10644706 DOI: 10.3389/fpsyt.2023.1256229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Around 700,000 people die by suicide each year. While the global number of suicides declined over the last decade, the rates remained unchanged in the Netherlands. With this study, we aimed to provide guiding principles for the implementation of a national standardized psychological autopsy to better understand and prevent suicide, by exploring stakeholder perceptions and needs, and barriers to implementation. Methods We interviewed 47 representative stakeholders from various fields (e.g., mental healthcare professionals, policy advisors, researchers). A semi structured interview design was used, based on the RE-AIM and Consolidated Framework for Implementation Research (CFIR) theoretical frameworks. Results Themes relating to stakeholder perceptions and needs for a standardized psychological autopsy included valorization, accountability, integrability and the needs of the bereaved. Stakeholders believed that participation in a psychological autopsy can help bereaved in their process of grief but noted that evidence to frame the psychological autopsy as postvention is insufficient. The primary focal point should accordingly be to better understand and prevent suicide. Several key limitations of the proposed psychological autopsy approach were detailed, both methodological and implementational. Conclusion The stakeholder analysis delineates guiding principles for implementation. Stakeholders believe that a standardized psychological autopsy has merit, provided that key considerations, including valorization and accountability, are integrated in its design. Routine evaluation should be ensured. The findings may guide policy makers and researchers in their endeavors to support a learning, community-based approach for suicide prevention based on a standardized psychological autopsy.
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Affiliation(s)
- Elias Balt
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Karlijn Heesen
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Arne Popma
- Child and Adolescent Psychiatry & Psychosocial care, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Saskia Mérelle
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Daan Creemers
- Child and Adolescent Psychiatry, GGZ Oost-Brabant, Boekel, Netherlands
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Handley SC, Formanowski B, Passarella M, Kozhimannil KB, Leonard SA, Main EK, Phibbs CS, Lorch SA. Perinatal Care Measures Are Incomplete If They Do Not Assess The Birth Parent-Infant Dyad As A Whole. Health Aff (Millwood) 2023; 42:1266-1274. [PMID: 37669487 PMCID: PMC10901240 DOI: 10.1377/hlthaff.2023.00398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Measures of perinatal care quality and outcomes often focus on either the birth parent or the infant. We used linked vital statistics and hospital discharge data to describe a dyadic measure (including both the birth parent and the infant) for perinatal care during the birth hospitalization. In this five-state cohort of 2010-18 births, 21.6 percent of birth parent-infant dyads experienced at least one complication, and 9.6 percent experienced a severe complication. Severe infant complications were eight times more prevalent than severe birth parent complications. Among birth parents with a severe complication, the co-occurrence of a severe infant complication ranged from 2 percent to 51 percent, whereas among infants with a severe complication, the co-occurrence of a severe birth parent complication was rare, ranging from 0.04 percent to 5 percent. These data suggest that measures, clinical interventions, public reporting, and policies focused on either the birth parent or the infant are incomplete in their assessment of a healthy dyad. Thus, clinicians, administrators, and policy makers should evaluate dyadic measures, incentivize positive outcomes for both patients (parent and infant), and create policies that support the health of the dyad.
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Affiliation(s)
- Sara C Handley
- Sara C. Handley , Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Ciaran S Phibbs
- Ciaran S. Phibbs, Palo Alto Veterans Affairs Medical Center, Menlo Park, California; and Stanford University
| | - Scott A Lorch
- Scott A. Lorch, Children's Hospital of Philadelphia and University of Pennsylvania
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Nagineviciute M, Bartuseviciene E, Blazeviciene A. Woman-Centered Care: Standardized Outcomes Measure. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1537. [PMID: 37763656 PMCID: PMC10533153 DOI: 10.3390/medicina59091537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Patient- or woman-centered care, prioritizing women's perspectives, needs, and preferences, is a widely recommended approach to enhance the quality of maternity care services. It aligns with the broader principles of patient-centered care, emphasizing the importance of a collaborative and respectful relationship between healthcare providers and women. This study evaluates low-risk pregnancies managed by midwives and obstetrician-gynecologists in Lithuania using patient-reported outcome measures and patient-reported experience measures. Materials and Methods: A prospective cohort study was conducted between September 2022 and April 2023. Data were collected through patient-reported questionnaires. Results: A total of 153 pregnant women who had singleton, low-risk pregnancies participated in the study, of whom 24.8% had their pregnancies supervised by a midwife, and 75.2% of the participants had their pregnancies supervised by an obstetrician-gynecologist. The study found no statistically significant differences in assessed patient-reported outcome measures and patient-reported experience measures between both models of care. Conclusions: Adopting patient-centered approaches enables healthcare systems to understand and address women's specific needs and preferences, fostering high-quality and woman-centered care. This research adds to the growing evidence supporting midwife-led care and emphasizes the importance of personalized, woman-centered approaches in maternity care, ultimately enhancing maternal health outcomes and promoting positive experiences for low-risk pregnant women. The quality of care provided by midwives remains uncompromised and equivalently proficient compared to the care provided by collaborative teams.
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Affiliation(s)
- Milda Nagineviciute
- Department of Nursing, Faculty of Nursing, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Egle Bartuseviciene
- Department of Obstetrics and Gynecology, Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Aurelija Blazeviciene
- Department of Nursing, Faculty of Nursing, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
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Väyrynen K, Chen A, Leskelä RL, Raussi-Lehto E, Klemetti R, Heinonen S, Torkki P, Tekay A. Introducing standard patient-reported measures (PRMs) into routine maternity care: A pre-implementation qualitative study on women's perspectives in Finland. BMC Health Serv Res 2023; 23:845. [PMID: 37563587 PMCID: PMC10413725 DOI: 10.1186/s12913-023-09818-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/16/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Systematically using standard patient-reported measures (PRMs) in clinical routines is trending. The International Consortium for Health Outcomes Measurement (ICHOM) has developed condition-specific standard sets of patient-centred measures, one of which is the Pregnancy and Childbirth Standard (PCB) set, where standard PRMs are included. There is limited knowledge on the use of ICHOM PCB set-included PRMs (ICHOM-PCB-PRMs) in routine care. This study investigates women's perspectives on the future implementation of standard ICHOM-PCB-PRMs in routine maternity care in Finland. METHODS Semi-structured interviews were conducted. Pregnant and postpartum women were asked to evaluate each ICHOM-PCB-PRM in several dimensions, e.g., importance and quality of questions, and to provide their views on future implementation in terms of benefits, difficulties, and practices. With the predefined topics and themes, deductive analysis was applied. Ethical committee approval (HUS 220/880/2015) and research permissions were obtained. RESULTS 22 women participated. Participants felt that most of the ICHOM-PCB-PRMs were important, relevant, understandable, and appropriately designed, and agreed that some changes in ICHOM-PCB-PRMs were needed, e.g., adding other important measures, changing the wording, and adding open-ended questions. Women would be hesitant to answer questions honestly if follow-up actions were unclear. Most "outcome" measures could be asked repeatedly as maternal health status changes over time, and "experience" measures could be asked separately for different service providers. Disagreements regarding data collection at birth were observed. PRMs were regarded as a way for women to express their thoughts and feelings. Our participants were concerned about the possible consequences of negatively answering the PREMs questions and the availability of follow-up care. Participants expected that they could answer short and easy questions digitally before appointments, and that instructions and follow-up actions based on their answers should be available. CONCLUSION ICHOM-PCB-PRMs could be applicable in Finnish maternity care, but some modifications may be required. Careful consideration is needed regarding how and when PRMs questions are asked for eliciting more accurate and honest answers and minimizing women feeling judged, embarrassed, or offended. Follow-ups should be available according to women's responses and needs. This study provides insights on the adoption and implementation of standard PRMs in routine maternity care.
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Affiliation(s)
- Kirsi Väyrynen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Biomedicum 1, Helsinki, 00290, Finland
- Department of Obstetrics and Gynaecology, Central Finland Central Hospital, Hoitajantie 3, Jyväskylä, 40620, Finland
| | - An Chen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki, 00290, Finland.
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and Management, Aalto University, Maarintie 8, P.O. Box 15500, Aalto, FI-00076, Finland.
- Nordic Healthcare Group Oy, Vattuniemenranta 2, Helsinki, 00210, Finland.
- School of Public Health, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, Zhejiang Province, 310053, China.
| | - Riikka-Leena Leskelä
- Department of Public Health, Faculty of Medicine, University of Helsinki, Biomedicum 1, Helsinki, 00290, Finland
- Nordic Healthcare Group Oy, Vattuniemenranta 2, Helsinki, 00210, Finland
| | - Eija Raussi-Lehto
- Customer-oriented Wellbeing and Health Hub, Metropolia University of Applied Sciences, Myllypurontie 1, Helsinki, 00920, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University, Otakaari 3, Espoo, 02150, Finland
| | - Reija Klemetti
- Finnish National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki, 00290, Finland
| | - Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, Biomedicum 1, Helsinki, 00290, Finland
| | - Aydin Tekay
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki, 00290, Finland
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Chen A, Väyrynen K, Leskelä R, Torkki P, Heinonen S, Tekay A, Acharya G. The acceptability of implementing patient-reported measures in routine maternity care: A systematic review. Acta Obstet Gynecol Scand 2023; 102:406-419. [PMID: 36647292 PMCID: PMC10008272 DOI: 10.1111/aogs.14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/10/2022] [Accepted: 12/18/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Patient-reported measures (PRMs) are becoming popular as they might influence clinical decisions, help to deliver patient-centered care, and improve health care quality. However, the limited knowledge and consensus about the acceptability of implementing PRMs in maternity care hinder their widespread use in clinical practice, and evidence-based recommendations are lacking. This systematic review aims to synthesize available evidence on the acceptability of implementing PRMs in routine maternity care. MATERIAL AND METHODS Literature on the implementation of PRMs in maternity care was electronically searched in six databases (PsycARTICLES, PubMed, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and CINAHL), screened and selected for the topic of "acceptability". Theoretical Framework of Acceptability was used as the basic framework guiding data analysis and synthesis. Evidence was thematically analyzed and synthesized. Mixed Method Appraisal Tool and GRADE-CERQual approach were used to assess the quality of studies and evaluate the confidence in the review findings. RESULTS Overall, 4971 articles were screened. From 24 studies, we identified five themes regarding the acceptability of implementing PRMs in routine maternity care: (1) user's action and behavior, (2) stakeholders' attitudes, (3) perceived benefits, (4) perceived challenges and risks, and (5) stakeholders' preferences and suggestions on implementation. While pregnant and postpartum women, health professionals and other stakeholders involved in maternity care were generally positive about the implementation of PRMs in routine care and recognized the potential benefits (eg health improvement, women empowerment, care and services improvement and healthcare system advancement), they pointed out possible challenges and risks in answering PRMs questions, responding to answers, and setting up integrated information systems as well as suggested solutions in the aspects of PRMs data collection, follow-up care, and system-level management. The confidence in the review findings was moderate due to methodological limitations of included studies. CONCLUSIONS Available empirical evidence suggested that the use of PRMs in routine maternity care is acceptable among stakeholders involved in maternity care and the potential benefits of its integration in routine clinical practice to healthcare improvement has been recognized. However, possible challenges in data collection, follow-up care arrangement and system-level integration should be appropriately addressed.
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Affiliation(s)
- An Chen
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and ManagementAalto UniversityEspooFinland
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Nordic Healthcare Group OyHelsinkiFinland
| | - Kirsi Väyrynen
- Department of Obstetrics and GynecologyCentral Finland Central HospitaJyväskyläFinland
| | | | - Paulus Torkki
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and ManagementAalto UniversityEspooFinland
- Nordic Healthcare Group OyHelsinkiFinland
- Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Seppo Heinonen
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aydin Tekay
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Ganesh Acharya
- Division of Obstetrics & Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
- Women`s Health and Perinatology Research grroup, Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
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Laureij LT, Depla AL, Kariman SS, Lamain-de Ruiter M, Ernst-Smelt HE, Hazelzet JA, Franx A, Bekker MN. Women's experiences with using patient-reported outcome and experience measures in routine perinatal care in the Netherlands: a mixed-methods study. BMJ Open 2023; 13:e064452. [PMID: 36898740 PMCID: PMC10008176 DOI: 10.1136/bmjopen-2022-064452] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVES To gain insight into the experiences of women with completing and discussing patient-reported outcome measures (PROM) and patient-reported experience measures (PREM), and tailoring their care based on their outcomes. DESIGN A mixed-methods prospective cohort study. SETTING Seven obstetric care networks in the Netherlands that implemented a set of patient-centred outcome measures for pregnancy and childbirth (PCB set), published by the International Consortium for Health Outcomes Measurement. PARTICIPANTS All women, receiving the PROM and PREM questionnaires as part of their routine perinatal care, received an invitation for a survey (n=460) and an interview (n=16). The results of the survey were analysed using descriptive statistics; thematic inductive content analysis was applied on the data from open text answers and the interviews. RESULTS More than half of the survey participants (n=255) felt the need to discuss the outcomes of PROM and PREM with their care professionals. The time spent on completing questionnaires and the comprehensiveness of the questions was scored 'good' by most of the survey participants. From the interviews, four main themes were identified: content of the PROM and PREM questionnaires, application of these outcomes in perinatal care, discussing PREM and data capture tool. Important facilitators included awareness of health status, receiving personalised care based on their outcomes and the relevance of discussing PREM 6 months post partum. Barriers were found in insufficient information about the goal of PROM and PREM for individual care, technical problems in data capture tools and discrepancy between the questionnaire topics and the care pathway. CONCLUSIONS This study showed that women found the PCB set an acceptable and useful instrument for symptom detection and personalised care up until 6 months post partum. This patient evaluation of the PCB set has several implications for practice regarding the questionnaire content, role of care professionals and congruity with care pathways.
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Affiliation(s)
- Lyzette T Laureij
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Anne L Depla
- Department of Obstetrics and Gynaecology, UMC Utrecht, Utrecht, The Netherlands
| | - Shariva S Kariman
- Department of Obstetrics and Gynaecology, UMC Utrecht, Utrecht, The Netherlands
| | - Marije Lamain-de Ruiter
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
- Department of Obstetrics and Gynaecology, UMC Utrecht, Utrecht, The Netherlands
| | - Hiske E Ernst-Smelt
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, UMC Utrecht, Utrecht, The Netherlands
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Depla AL, Pluut B, Lamain-de Ruiter M, Kersten AW, Evers IM, Franx A, Bekker MN. PROMs and PREMs in routine perinatal care: mixed methods evaluation of their implementation into integrated obstetric care networks. J Patient Rep Outcomes 2023; 7:26. [PMID: 36894797 PMCID: PMC9998006 DOI: 10.1186/s41687-023-00568-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND In the transition towards value-based healthcare, patient-reported outcome and experience measures (PROM and PREM) are recommended by international collaborations and government programs to guide clinical practice and quality improvement. For many conditions, using PROM/PREM over the complete continuum of care requires implementation across care organizations and disciplines. Along PROM/PREM implementation in obstetric care networks (OCN), we aimed to evaluate implementation outcomes and the processes influencing these outcomes in the complex context of care networks across the continuum of perinatal care. METHODS Three OCN in the Netherlands implemented PROM/PREM in routine practice, using an internationally developed outcomes set with care professionals and patient advocates. Their aim was to use PROM/PREM results individually to guide patient-specific care decisions and at group-level to improve quality of care. The implementation process was designed following the principles of action research: iteratively planning implementation, action, data generation and reflection to refine subsequent actions, involving both researchers and care professionals. During the one-year implementation period in each OCN, implementation outcomes and processes were evaluated in this mixed-methods study. Data generation (including observation, surveys and focus groups) and analysis were guided by two theoretical implementation frameworks: the Normalization Process Theory and Proctor's taxonomy for implementation outcomes. Qualitative findings were supplemented with survey data to solidify findings in a broader group of care professionals. RESULTS Care professionals in OCN found the use of PROM/PREM acceptable and appropriate, recognized their benefits and felt facilitated in their patient-centered goals and vision. However, feasibility for daily practice was low, mainly due to IT issues and time constraints. Hence PROM/PREM implementation did not sustain, but strategies for future PROM/PREM implementation were formulated in all OCN. Processes contributing positively to implementation outcomes were internalization (understand the value) and initiation (driven by key-participants), whereas challenges in relational integration (maintain confidence) and reconfiguration (refine activities) affected implementation negatively. CONCLUSION Although implementation did not sustain, network-broad PROM/PREM use in clinic and quality improvement matched professionals' motivation. This study provides recommendations to implement PROM/PREM meaningfully in practice in ways that support professionals in their drive towards patient-centered care. In order for PROM/PREM to fulfill their potential for value-based healthcare, our work highlights the need for sustainable IT infrastructures, as well as an iterative approach to refine their complex implementation into local contexts.
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Affiliation(s)
- Anne L Depla
- Department of Obstetrics and Gynecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Bettine Pluut
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marije Lamain-de Ruiter
- Department of Obstetrics and Gynecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Anna W Kersten
- Department of Public Health, Julius Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Inge M Evers
- Department of Obstetrics and Gynecology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Arie Franx
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
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Pham L, Moles RJ, O’Reilly CL, Carter S, Raynes-Greenow C, Chen TF, Raduescu C, Randall S, Bloomfield J, Strowel C, Murphy A, Gardner D, El-Den S. Perinatal Women's Views of Pharmacist-Delivered Perinatal Depression Screening: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16295. [PMID: 36498368 PMCID: PMC9738857 DOI: 10.3390/ijerph192316295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Internationally, 20% of women experience perinatal depression (PND). Healthcare providers including general practitioners and midwives are critical in providing PND screening and support; however, the current workforce is unable to meet growing demands for PND care. As accessible and trusted primary healthcare professionals, pharmacists could provide PND care to complement existing services, thereby contributing to early detection and intervention. This study aimed to explore perinatal women's views of community pharmacist-delivered PND screening and care, with a focus on their attitudes towards and acceptability of PND screening implementation in community pharmacy. Semi-structured interviews with women (n = 41) were undertaken, whereby interview data were transcribed verbatim and then inductively and thematically analysed. Five overarching themes emerged; "patient experience with existing PND support and screening services"; "familiarity with pharmacists' roles"; "pharmacist visibility in PND screening care"; "patient-pharmacist relationships" and "factors influencing service accessibility". Themes and subthemes were mapped to the Consolidated Framework for Implementation Research. Findings highlight participants' generally positive attitudes towards community pharmacist-delivered PND screening and care, and the potential acceptability of such services provided pharmacists are trained and referral pathways are established. Addressing perceived barriers and facilitators would allow community pharmacist-delivered PND screening and care to support existing PND care models.
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Affiliation(s)
- Lily Pham
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Rebekah J. Moles
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Claire L. O’Reilly
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Stephen Carter
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Timothy F. Chen
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Corina Raduescu
- The University of Sydney Business School, University of Sydney, Sydney, NSW 2050, Australia
| | - Sue Randall
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Jacqueline Bloomfield
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Clara Strowel
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Andrea Murphy
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - David Gardner
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Sarira El-Den
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
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Benning L, Das-Gupta Z, Sousa Fialho L, Wissig S, Tapela N, Gaunt S. Balancing adaptability and standardisation: insights from 27 routinely implemented ICHOM standard sets. BMC Health Serv Res 2022; 22:1424. [PMID: 36443786 PMCID: PMC9703690 DOI: 10.1186/s12913-022-08694-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthcare systems around the world experience increasing pressure to control future growth of healthcare expenditures. Among other initiatives, quality and value-based benchmarking has become an important field to inform clinical evaluation and reimbursement questions. The International Consortium for Health Outcomes Measurement (ICHOM) has become one of the driving forces to translate scientific evidence into standardized assessments that are routinely applicable in day-to-day care settings. These aim to provide a benchmarking tool that allows the comparison and competition of health care delivery on the basis of value-based health care principles. METHODS This work focuses on the consolidation of the ICHOM methodology and presents insights from 27 routinely implemented Standard Sets. The analysis is based on a literature review of the ICHOM literature repository, a process document review and key informant interviews with ICHOM's outcomes research and development team. RESULTS Key findings are that the scope of ICHOM Standard Sets shifted from a more static focus on burden of disease and poorly standardized care pathways to a more dynamic approach that also takes into account questions about the setting of care, feasibility of implementing a benchmarking tool and compatibility of different Standard Sets. Although certain overlaps exist with other initiatives in the field of patient reported outcomes (PRO), their scopes differ significantly and they hence rather complement each other. ICHOM pursues a pragmatic approach to enable the benchmarking and the analysis of healthcare delivery following the principles of value-based healthcare. CONCLUSION The ICHOM Standard Sets complement other initiatives in the field of patient-reported outcomes (PRO) and functional reporting by placing a particular focus on healthcare delivery, while other initiatives primarily focus on evaluation of academic endpoints. Although ICHOM promotes a pragmatic approach towards developing and devising its Standard Sets, the definition of standardized decision making processes emerged as one of the key challenges. Furthermore, the consolidation of core metrics across number of disease areas to enable the parallel implementation of different Standard Sets in the same care setting is an important goal that will enable the widespread implementation of patient-reported outcome measures (PROM).
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Affiliation(s)
- Leo Benning
- University Emergency Center, Medical Center - University of Freiburg, Freiburg, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Zofia Das-Gupta
- International Consortium for Health Outcomes Measurement, London, UK
| | - Luz Sousa Fialho
- International Consortium for Health Outcomes Measurement, London, UK
| | - Stephanie Wissig
- International Consortium for Health Outcomes Measurement, Boston, USA
| | - Neo Tapela
- International Consortium for Health Outcomes Measurement, London, UK
| | - Suzanne Gaunt
- International Consortium for Health Outcomes Measurement, Boston, USA
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11
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Smith PA, Kilgour C, Rice D, Callaway LK, Martin EK. Implementation barriers and enablers of midwifery group practice for vulnerable women: a qualitative study in a tertiary urban Australian health service. BMC Health Serv Res 2022; 22:1265. [PMID: 36261823 PMCID: PMC9583548 DOI: 10.1186/s12913-022-08633-8] [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: 02/04/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Maternity services have limited formalised guidance on planning new services such as midwifery group practice for vulnerable women, for example women with a history of substance abuse (alcohol, tobacco and other drugs), mental health challenges, complex social issues or other vulnerability. Continuity of care through midwifery group practice is mostly restricted to women with low-risk pregnancies and is not universally available to vulnerable women, despite evidence supporting benefits of this model of care for all women. The perception that midwifery group practice for vulnerable women is a high-risk model of care lacking in evidence may have in the past, thwarted implementation planning studies that seek to improve care for these women. We therefore aimed to identify the barriers and enablers that might impact the implementation of a midwifery group practice for vulnerable women. Methods A qualitative context analysis using the Consolidated Framework for Implementation Research was conducted at a single-site tertiary health facility in Queensland, Australia. An interdisciplinary group of stakeholders from a purposeful sample of 31 people participated in semi-structured interviews. Data were analysed using manual and then Leximancer computer assisted methods. Themes were compared and mapped to the Framework. Results Themes identified were the woman’s experience, midwifery workforce capabilities, identifying “gold standard care”, the interdisciplinary team and costs. Potential enablers of implementation included perceptions that the model facilitates a relationship of trust with vulnerable women, that clinical benefit outweighs cost and universal stakeholder acceptance. Potential barriers were: potential isolation of the interdisciplinary team, costs and the potential for vicarious trauma for midwives. Conclusion There was recognition that the proposed model of care is supported by research and a view that clinical benefits will outweigh costs, however supervision and support is required for midwives to manage and limit vicarious trauma. An interdisciplinary team structure is also an essential component of the service design. Attention to these key themes, barriers and enablers will assist with identification of strategies to aid successful implementation. Australian maternity services can use our results to compare how the perceptions of local stakeholders might be similar or different to the results presented in this paper. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08633-8.
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Affiliation(s)
- Patricia A Smith
- Women, Children and Families Stream Metro North Health, Butterfield Street, 4029, Herston, Brisbane, QLD, Australia.
| | - Catherine Kilgour
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, 4072, Brisbane, QLD, Australia
| | - Deann Rice
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia
| | - Leonie K Callaway
- Women, Children and Families Stream Metro North Health, Butterfield Street, 4029, Herston, Brisbane, QLD, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Herston Road, 4006, Herston, Brisbane, QLD, Australia
| | - Elizabeth K Martin
- Mater Research Institute, Faculty of Medicine, University of Queensland, Raymond Terrace, 4101, South Brisbane, Brisbane, QLD, Australia
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Depla AL, Lamain-de Ruiter M, Laureij LT, Ernst-Smelt HE, Hazelzet JA, Franx A, Bekker MN. Patient-Reported Outcome and Experience Measures in Perinatal Care to Guide Clinical Practice: Prospective Observational Study. J Med Internet Res 2022; 24:e37725. [PMID: 35787519 PMCID: PMC9297146 DOI: 10.2196/37725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background The International Consortium for Health Outcomes Measurement has published a set of patient-centered outcome measures for pregnancy and childbirth (PCB set), including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). To establish value-based pregnancy and childbirth care, the PCB set was implemented in the Netherlands, using the outcomes on the patient level for shared decision-making and on an aggregated level for quality improvement. Objective This study aims to report first outcomes, experiences, and practice insights of implementing the PCB set in clinical practice. Methods In total, 7 obstetric care networks across the Netherlands, each consisting of 1 or 2 hospitals and multiple community midwifery practices (ranging in number from 2 to 18), implemented the PROM and PREM domains of the PCB set as part of clinical routine. This observational study included all women participating in the clinical project. PROMs and PREMs were assessed with questionnaires at 5 time points: 2 during pregnancy and 3 post partum. Clinical threshold values (alerts) supported care professionals interpreting the answers, indicating possibly alarming outcomes per domain. Data collection took place from February 2020 to September 2021. Data analysis included missing (pattern) analysis, sum scores, alert rates, and sensitivity analysis. Results In total, 1923 questionnaires were collected across the 5 time points: 816 (42.43%) at T1 (first trimester), 793 (41.23%) at T2 (early third trimester), 125 (6.5%) at T3 (maternity week), 170 (8.84%) at T4 (6 weeks post partum), and 19 (1%) at T5 (6 months post partum). Of these, 84% (1615/1923) were filled out completely. Missing items per domain ranged from 0% to 13%, with the highest missing rates for depression, pain with intercourse, and experience with pain relief at birth. No notable missing patterns were found. For the PROM domains, relatively high alert rates were found both in pregnancy and post partum for incontinence (469/1798, 26.08%), pain with intercourse (229/1005, 22.79%), breastfeeding self-efficacy (175/765, 22.88%), and mother-child bonding (122/288, 42.36%). Regarding the PREM domains, the highest alert rates were found for birth experience (37/170, 21.76%), shared decision-making (101/982, 10.29%), and discussing pain relief ante partum (310/793, 39.09%). Some domains showed very little clinical variation; for example, role of the mother and satisfaction with care. Conclusions The PCB set is a useful tool to assess patient-reported outcomes and experiences that need to be addressed over the whole course of pregnancy and childbirth. Our results provide opportunities to improve and personalize perinatal care. Furthermore, we could propose several recommendations regarding methods and timeline of measurements based on our findings. This study supports the implementation of the PCB set in clinical practice, thereby advancing the transformation toward patient-centered, value-based health care for pregnancy and childbirth.
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Affiliation(s)
- Anne Louise Depla
- Department of Obstetrics and Gynecology, Wilhemina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marije Lamain-de Ruiter
- Department of Obstetrics and Gynecology, Wilhemina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus Medical Center Sophia, Rotterdam, Netherlands
| | - Lyzette T Laureij
- Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus Medical Center Sophia, Rotterdam, Netherlands
| | - Hiske E Ernst-Smelt
- Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus Medical Center Sophia, Rotterdam, Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus Medical Center Sophia, Rotterdam, Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, Wilhemina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
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Quigley M, Zoungas S, Zimbudzi E, Wischer N, Andrikopoulos S, Green SE. Making the most of audit and feedback to improve diabetes care: a qualitative study of the perspectives of Australian Diabetes Centres. BMC Health Serv Res 2022; 22:255. [PMID: 35209903 PMCID: PMC8876070 DOI: 10.1186/s12913-022-07652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes has high burden on the health system and the individual, and many people living with diabetes struggle to optimally manage their condition. In Australia, people living with diabetes attend a mixture of primary, secondary and tertiary care centres. Many of these Diabetes Centres participate in the Australian National Diabetes Audit (ANDA), a quality improvement (QI) activity that collects clinical information (audit) and feeds back collated information to participating sites (feedback). Despite receiving this feedback, many process and care outcomes for Diabetes Centres continue to show room for improvement. The purpose of this qualitative study was to inform improvement of the ANDA feedback, identify the needs of those receiving feedback and elicit the barriers to and enablers of optimal feedback use. METHODS Semi-structured interviews were conducted with representatives of Australian Diabetes Centres, underpinned by the Consolidated Framework for Implementation Research (CFIR). De-identified transcripts were analysed thematically, underpinned by the domains and constructs of the CFIR. RESULTS Representatives from 14 Diabetes centres participated in this study, including a diverse range of staff typical of the Diabetes Centres who take part in ANDA. In general, participants wanted a shorter report with a more engaging, simplified data visualisation style. Identified barriers to use of feedback were time or resource constraints, as well as access to knowledge about how to use the data provided to inform the development of QI activities. Enablers included leadership engagement, peer mentoring and support, and external policy and incentives. Potential cointerventions to support use include exemplars from clinical change champions and peer leaders, and educational resources to help facilitate change. CONCLUSIONS This qualitative study supported our contention that the format of ANDA feedback presentation can be improved. Healthcare professionals suggested actionable changes to current feedback to optimise engagement and potential implementation of QI activities. These results will inform redesign of the ANDA feedback to consider the needs and preferences of end users and to provide feedback and other supportive cointerventions to improve care, and so health outcomes for people with diabetes. A subsequent cluster randomised trial will enable us to evaluate the impact of these changes.
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Affiliation(s)
- Matthew Quigley
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, 3168, Australia
| | - Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Natalie Wischer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.,National Association of Diabetes Centres, Sydney, NSW, 2000, Australia
| | - Sofianos Andrikopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.,Australian Diabetes Society, Sydney, NSW, 2000, Australia
| | - Sally E Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
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