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Webb R, Ford E, Shakespeare J, Easter A, Alderdice F, Holly J, Coates R, Hogg S, Cheyne H, McMullen S, Gilbody S, Salmon D, Ayers S. Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-187. [PMID: 38317290 DOI: 10.3310/kqfe0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care. Objectives Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services. Methods Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders. Data sources Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews. Review methods In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway. Results Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women's economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels. Limitations In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English. Conclusions The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services. Recommendations for health policy and practice These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it. Future work Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries. Trial registration This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton & Sussex Medical School, Falmer, UK
| | | | - Abigail Easter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona Alderdice
- Oxford Population Health, National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Sally Hogg
- The Parent-Infant Foundation, London, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, York, UK
| | - Debra Salmon
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
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2
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Isaacs A, Bonsey A, Couch D. Centralized Intake Models and Recommendations for Their Use in Non-Acute Mental Health Services: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095747. [PMID: 37174264 PMCID: PMC10177908 DOI: 10.3390/ijerph20095747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
Centralized intake [CI] or single-entry models are utilized in health systems to facilitate service access by reducing waiting times. This scoping review aims to consolidate the Literature on CI service models to identify their characteristics and rationales for their use, as well as contexts in which they are used and challenges and benefits in implementing them. The review also aims to offer some lessons learned from the Literature and to make recommendations for its implementation in non-acute mental health services. The findings show that CI is mostly considered when there is increased demand for services and clients are required to navigate multiple services that operate individually. Successful models have meaningfully engaged all stakeholders from the outset and the telephone is the most common mode of intake. Recommendations are made for planning and preparation, for elements of the model, and for setting up the service network. When successfully implemented, CI has been shown to improve access and increase demand for services. However, if CI is not supported by a network of service providers who offer care that is acceptable to clients, the purpose of its implementation could be lost.
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Affiliation(s)
- Anton Isaacs
- School of Rural Health, Faculty of Medicine Nursing and Health Sciences, Monash University, Warragul, VIC 3820, Australia
| | - Alistair Bonsey
- Victorian and Tasmanian Primary Health Network Alliance, Parkville, VIC 3052, Australia
| | - Danielle Couch
- School of Rural Health, Faculty of Medicine Nursing and Health Sciences, Monash University, Warragul, VIC 3820, Australia
- Victorian and Tasmanian Primary Health Network Alliance, Parkville, VIC 3052, Australia
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3
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Gukova X, Hazlewood GS, Arbillaga H, MacMullan P, Zimmermann GL, Barnabe C, Choi MY, Barber MRW, Charlton A, Job B, Osinski K, Hartfeld NMS, Knott MW, Pirani P, Barber CEH. Development of an interdisciplinary early rheumatoid arthritis care pathway. BMC Rheumatol 2022; 6:35. [PMID: 35751106 PMCID: PMC9233314 DOI: 10.1186/s41927-022-00267-x] [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: 12/17/2021] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background To develop an interdisciplinary care pathway for early rheumatoid arthritis (RA) including referral triage, diagnosis, and management. Methods Our process was a four-phase approach. In Phase 1, an anonymous survey was electronically distributed to division rheumatologists. This provided data to a small interprofessional working group of rheumatology team members who drafted an initial care pathway informed by evidence-based practice in Phase 2. In Phase 3, an education day was held with approximately 40 physicians (rheumatologists and rheumatology residents), members of our interprofessional team, and two clinic managers to review the proposed care elements through presentations and small group discussions. The care pathway was revised for content and implementation considerations based on feedback received. Implementation of the care pathway and development of strategies for evaluation is ongoing across multiple practice sites (Phase 4). Results Our care pathway promotes an approach to patient-centered early RA care using an interdisciplinary approach. Care pathway elements include triage processes, critical diagnostics, pre-treatment screening and vaccinations, and uptake of suggested RA pharmacologic treatment using shared decision-making strategies. Pathway implementation has been facilitated by nursing protocols and evaluation includes continuous monitoring of key indicators. Conclusion The ‘Calgary Early RA Care Pathway’ emphasizes a patient-centered and interdisciplinary approach to early RA identification and treatment. Implementation and evaluation of this care pathway is ongoing to support, highest quality care for patients. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00267-x.
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Affiliation(s)
- Xenia Gukova
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - Hector Arbillaga
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Paul MacMullan
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Gabrielle L Zimmermann
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Learning Health System, Alberta SPOR SUPPORT Unit, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - May Y Choi
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - Megan R W Barber
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | | | - Becky Job
- Alberta Health Services, Calgary, Canada
| | | | - Nicole M S Hartfeld
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | | | | | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Arthritis Research Canada, Vancouver, Canada.
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4
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Arslan IG, Rozendaal RM, van Middelkoop M, Stitzinger SAG, Van de Kerkhove MP, Voorbrood VMI, Bindels PJE, Bierma-Zeinstra SMA, Schiphof D. Quality indicators for knee and hip osteoarthritis care: a systematic review. RMD Open 2021; 7:rmdopen-2021-001590. [PMID: 34039753 PMCID: PMC8164978 DOI: 10.1136/rmdopen-2021-001590] [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: 01/19/2021] [Accepted: 05/12/2021] [Indexed: 11/03/2022] Open
Abstract
To provide an overview of quality indicators (QIs) for knee and hip osteoarthritis (KHOA) care and to highlight differences in healthcare settings. A database search was conducted in MEDLINE (PubMed), EMBASE, CINAHL, Web of Science, Cochrane CENTRAL and Google Scholar, OpenGrey and Prospective Trial Register, up to March 2020. Studies developing or adapting existing QI(s) for patients with osteoarthritis were eligible for inclusion. Included studies were categorised into healthcare settings. QIs from included studies were categorised into structure, process and outcome of care. Within these categories, QIs were grouped into themes (eg, physical therapy). A narrative synthesis was used to describe differences and similarities between healthcare settings. We included 20 studies with a total of 196 QIs mostly related to the process of care in different healthcare settings. Few studies included patients’ perspectives. Rigorous methods for evidence synthesis to develop QIs were rarely used. Narrative analysis showed differences in QIs between healthcare settings with regard to exercise therapy, weight counselling, referral to laboratory tests and ‘do not do’ QIs. Differences within the same healthcare setting were identified on radiographic assessment. The heterogeneity in QIs emphasise the necessity to carefully select QIs for KHOA depending on the healthcare setting. This review provides an overview of QIs outlined to their healthcare settings to support healthcare providers and policy makers in selecting the contextually appropriate QIs to validly monitor the quality of KHOA care. We strongly recommend to review QIs against the most recent guidelines before implementing them into practice.
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Affiliation(s)
- Ilgin G Arslan
- General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rianne M Rozendaal
- General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | | | - Maarten-Paul Van de Kerkhove
- General Practice Pallion, Hulst, The Netherlands.,Orthopaedics ZorgSaam Zeeuws-Vlaanderen, Terneuzen, The Netherlands
| | - Vincent M I Voorbrood
- General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,General Practice Pallion, Hulst, The Netherlands
| | - Patrick J E Bindels
- General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dieuwke Schiphof
- General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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5
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Bodnar LM, Khodyakov D, Parisi SM, Himes KP, Burke JG, Hutcheon JA. Rating the seriousness of maternal and child health outcomes linked with pregnancy weight gain. Paediatr Perinat Epidemiol 2021; 35:459-468. [PMID: 33216402 PMCID: PMC8134513 DOI: 10.1111/ppe.12741] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/18/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current pregnancy weight gain guidelines were developed based on implicit assumptions of a small group of experts about the relative seriousness of adverse health outcomes. Therefore, they will not necessarily reflect the values of women. OBJECTIVE To estimate the seriousness of 11 maternal and child health outcomes that have been consistently associated with pregnancy weight gain by engaging patients and health professionals. METHODS We collected data using an online panel approach with a modified Delphi structure. We selected a purposeful sample of maternal and child health professionals (n = 84) and women who were pregnant or recently postpartum (patients) (n = 82) in the United States as panellists. We conducted three concurrent panels: professionals only, patients only, and patients and professionals. During a 3-round online modified Delphi process, participants rated the seriousness of health outcomes (Round 1), reviewed and discussed the initial results (Round 2), and revised their original ratings (Round 3). Panellists assigned seriousness ratings (0, [not serious] to 100 [most serious]) for infant death, stillbirth, preterm birth, gestational diabetes, preeclampsia, small-for-gestational-age (SGA) birth, large-for-gestational-age (LGA) birth, unplanned caesarean delivery, maternal obesity, childhood obesity, and maternal metabolic syndrome. RESULTS Each panel individually came to a consensus on all seriousness ratings. The final median seriousness ratings combined across all panels were highest for infant death (100), stillbirth (95), preterm birth (80), and preeclampsia (80). Obesity in children, metabolic syndrome in women, obesity in women, and gestational diabetes had median seriousness ratings ranging from 55 to 65. The lowest seriousness ratings were for SGA birth, LGA birth, and unplanned caesarean delivery (30-40). CONCLUSION Professionals and women rate some adverse outcomes as being more serious than others. These ratings can be used to establish the range of pregnancy weight gain associated with the lowest risk of a broad range of maternal and child health outcomes.
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Affiliation(s)
- Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States,Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Sara M. Parisi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Katherine P. Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jessica G. Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer A. Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
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6
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Liu X, Barber CEH, Katz S, Homik J, Bertazzon S, Patel AB, Robert J, Smith C, Mosher D, Marshall DA. Geographic Variation in the Prevalence of Rheumatoid Arthritis in Alberta, Canada. ACR Open Rheumatol 2021; 3:324-332. [PMID: 33793090 PMCID: PMC8126758 DOI: 10.1002/acr2.11251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Timely access to rheumatologists remains a challenge in Alberta, a Canadian province with vast rural areas, whereas rheumatologists are primarily clustered in metro areas. To address the goal of timely and equitable access to rheumatoid arthritis (RA) care, health planners require information at the regional and local level to determine the RA prevalence and the associated health care needs. METHODS Using Alberta Health administrative databases, we identified RA-prevalent cases (April 1, 2015-March 31, 2016) on the basis of a validated case definition. Age- and sex-standardized prevalence rates per 1000 population members and the standardized rates ratio (SRR) were calculated. We applied Global Moran's I and Gi* hotspot analysis using three different weight matrices to explore the geospatial pattern of RA prevalence in Alberta. RESULTS Among 38 350 RA cases (68% female; n = 26 236), the prevalence rate was 11.81 cases per 1000 population members (95% confidence interval [CI] 11.80-11.81) after age and sex standardization. Approximately 60% of RA cases resided in metro (Calgary and Edmonton) and moderate metro areas. The highest rate was observed in rural areas (14.46; 95% CI 14.45-14.47; SRR 1.28), compared with the lowest in metro areas (10.69; 95% CI 10.68-10.69; SRR 0.82). The RA prevalence across local geographic areas ranged from 4.7 to 30.6 cases. The Global Moran's I index was 0.15 using three different matrices (z-score 3.96-4.24). We identified 10 hotspots in the south and north rural areas and 18 cold spots in metro and moderate metro Calgary. CONCLUSION The findings highlight notable rural-urban variation in RA prevalence in Alberta. Our findings can inform strategies aimed at reducing geographic disparities by targeting areas with high health care needs.
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Affiliation(s)
| | - Claire E. H. Barber
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | | | | | | | - Alka B. Patel
- University of Calgary, Calgary, Alberta, Canada, and Alberta Health ServicesEdmontonAlbertaCanada
| | - Jill Robert
- Alberta Health ServicesEdmontonAlbertaCanada
| | | | | | - Deborah A. Marshall
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research CanadaRichmondBritish ColumbiaCanada
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Speerin R, Needs C, Chua J, Woodhouse LJ, Nordin M, McGlasson R, Briggs AM. Implementing models of care for musculoskeletal conditions in health systems to support value-based care. Best Pract Res Clin Rheumatol 2020; 34:101548. [PMID: 32723576 PMCID: PMC7382572 DOI: 10.1016/j.berh.2020.101548] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Models of Care (MoCs), and their local Models of Service Delivery, for people with musculoskeletal conditions are becoming an acceptable way of supporting effective implementation of value-based care. MoCs can support the quadruple aim of value-based care through providing people with musculoskeletal disease improved access to health services, better health outcomes and satisfactory experience of their healthcare; ensure the health professionals involved are experiencing satisfaction in delivering such care and health system resources are better utilised. Implementation of MoCs is relevant at the levels of clinical practice (micro), service delivery organisations (meso) and health system (macro) levels. The development, implementation and evaluation of MoCs has evolved over the last decade to more purposively engage people with lived experience of their condition, to operationalise the Chronic Care Model and to employ innovative solutions. This paper explores how MoCs have evolved and are supporting the delivery of value-based care in health systems.
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Affiliation(s)
- Robyn Speerin
- The Sydney University, Level 7, Department of Rheumatology, Royal North Shore Hospital, Reserve Road, ST LEONARDS, NSW, 2065, Australia.
| | - Christopher Needs
- Department of Rheumatology, Level 4, QEII Building, Royal Prince Alfred Hospital, 59 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Jason Chua
- Centre for Musculoskeletal Outcomes Research, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Linda J Woodhouse
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center (OIOC), New York University, New York, NY, USA.
| | - Rhona McGlasson
- Bone & Joint Canada, P.O. Box 1036, Toronto, ON, M5K 1P2, Canada.
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
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Barber CEH, Then KL, Bohm V, Hall M, Marshall DA, Rankin JA, Barnabe C, Hazlewood GS, Li LC, Mosher D, Homik J, MacMullan P, Tsui K, English K, Lacaille D. Development of a Patient-centered Quality Measurement Framework for Measuring, Monitoring, and Optimizing Rheumatoid Arthritis Care in Canada. J Rheumatol 2020; 48:326-334. [PMID: 33452175 DOI: 10.3899/jrheum.200688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to develop a patient-centered quality measurement framework to address a predefined vision statement and 7 strategic objectives for rheumatoid arthritis (RA) care that was developed in prior qualitative work with arthritis stakeholders. METHODS One hundred forty-seven RA-related performance measures (PMs) were identified from a systematic review. A candidate list of 26 PMs meeting predefined criteria and addressing the strategic objectives previously defined was then assessed during a 3-round (R) modified Delphi. Seventeen panelists with expertise in RA, quality measurement, and/or lived experience with RA rated each PM on a 1-9 scale based on the items of importance, feasibility, and priority for inclusion in the framework during R1 and R3, with a moderated discussion in R2. PMs with median scores ≥ 7 on all 3 items without disagreement were included in the final set, which then underwent public comment. RESULTS Twenty-one measures were included in the final framework (15 PMs from the Delphi and 6 published system-level measures on access to care and treatment). The measures included 4 addressing early access to care and timely diagnosis, 12 evidence-based care for RA and related comorbidities, 1 addressing patient participation as an informed partner in care, and 4 on patient outcomes. CONCLUSION The proposed framework builds upon existing measures capturing early access to care and treatment in RA and adds important PMs to promote high-quality RA care and outcome measurement. In the next phase, the authors will test the framework in clinical practice in addition to addressing certain areas where no suitable PMs were identified.
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Affiliation(s)
- Claire E H Barber
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada;
| | - Karen L Then
- K.L. Then, ACNP, CCN(C), PhD, Professor, M. Hall, MSc, CCRP, Research Associate, J.A. Rankin, ACNP, PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Victoria Bohm
- V. Bohm, MSc, MPH, Research Associate, D. Mosher, MD, FRCPC, Professor, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Marc Hall
- K.L. Then, ACNP, CCN(C), PhD, Professor, M. Hall, MSc, CCRP, Research Associate, J.A. Rankin, ACNP, PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Deborah A Marshall
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada
| | - James A Rankin
- K.L. Then, ACNP, CCN(C), PhD, Professor, M. Hall, MSc, CCRP, Research Associate, J.A. Rankin, ACNP, PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Cheryl Barnabe
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada
| | - Glen S Hazlewood
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada
| | - Linda C Li
- L.C. Li, PT, PhD, Professor, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, and Arthritis Research Canada
| | - Dianne Mosher
- V. Bohm, MSc, MPH, Research Associate, D. Mosher, MD, FRCPC, Professor, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Joanne Homik
- J. Homik, MD, FRCPC, MSc, Professor, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Paul MacMullan
- V. Bohm, MSc, MPH, Research Associate, D. Mosher, MD, FRCPC, Professor, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Karen Tsui
- K. Tsui, MScPT, ACPAC, Arthritis Patient Advisory Board (APAB) member, K. English, Arthritis Patient Advisory Board (APAB) member, Arthritis Patient Advisory Board
| | - Kelly English
- K. Tsui, MScPT, ACPAC, Arthritis Patient Advisory Board (APAB) member, K. English, Arthritis Patient Advisory Board (APAB) member, Arthritis Patient Advisory Board
| | - Diane Lacaille
- D. Lacaille, MD, FRCPC, MHSc, Professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and Scientific Director, Arthritis Research Canada
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9
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Carr ECJ, Ortiz MM, Patel JN, Barber CEH, Katz S, Robert J, Mosher D, Teare SR, Miller J, Homik J, Dinsmore K, Marshall DA. Models of Arthritis Care: A Systems-level Evaluation of Acceptability as a Dimension of Quality of Care. J Rheumatol 2020; 47:1431-1439. [PMID: 31732557 DOI: 10.3899/jrheum.190501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe a systems-level baseline evaluation of central intake (CI) and triage systems in arthritis care within Alberta, Canada. The specific objectives were to (1) describe a process for systems evaluation for the provision of arthritis care; (2) report the findings of the evaluation for different clinical sites that provide arthritis care; and (3) identify opportunities for improving appropriate and timely access based on the findings of the evaluation. METHODS The study used a convergent mixed methods design. Surveys and semistructured interviews were the main data collection methods. Participants were recruited through 2 rheumatology clinics and 1 hip and knee clinic providing CI and triage, and included patients, referring physicians, specialists, and clinic staff who experienced CI processes. RESULTS A total of 237 surveys were completed by patients (n = 169), referring physicians (n = 50), and specialists (n = 18). Interviews (n = 25) with care providers and patients provided insights to the survey data. Over 95% of referring physicians agreed that the current process of CI was satisfactory. Referring physicians and specialists reported issues with the referral process and perceived support in care for wait-listed patients. Patients reported positive experiences with access and navigation of arthritis care services but expressed concerns around communication and receiving minimal support for self-management of their arthritis before and after receiving specialist care. CONCLUSION This baseline evaluation of CI and triage for arthritis care indicates satisfaction with the service, but areas that require further consideration are referral completion, timely waiting lists, and further supporting patients to self-manage their arthritis.
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Affiliation(s)
- Eloise C J Carr
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada. .,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary.
| | - Mia M Ortiz
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jatin N Patel
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Claire E H Barber
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Steven Katz
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jill Robert
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Dianne Mosher
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Sylvia R Teare
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jean Miller
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Joanne Homik
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Kelly Dinsmore
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Deborah A Marshall
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
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Soo J, Eldeiry D, Katz S. Prevalence of rheumatoid arthritis in Edmonton and Northern Alberta. Clin Rheumatol 2020; 40:1245-1248. [PMID: 32822056 DOI: 10.1007/s10067-020-05352-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/09/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare and contrast the prevalence of rheumatoid arthritis in Northern Alberta estimated by health administrative data and data from a rheumatologist-based prescription database. METHODS The study was performed using administrative health data from the province of Alberta through the local health authority. The cases and population identified in the database were reported from the year 2016. Rheumatology prescribing data was accessed through the Physician Learning Program and based on Alberta health billing data of actively practicing rheumatologists between the years 2012 and 2016. Ethics was provided by the Conjoint Health Research Ethics Boards at the University of Calgary (REB 13-0459). RESULTS The total population of the area examined was determined to be 2,086,181. The administrative health database identified 42,354 cases of RA based on their case definition with a prevalence of 2.08%. Based on rheumatologist diagnosis and prescribing data, the number of cases identified was 11,273 cases of RA with a prevalence of 0.542%. The average percentage of identified RA patients being seen by a rheumatologist was determined to be 26.7% with the range of 19.8 to 39.9%. CONCLUSION In conclusion, this study compares and contrasts the prevalence of rheumatoid arthritis reported by administrative data versus identification by specialists. Our study again illustrates that accuracy of case definitions when studying chronic conditions such as rheumatoid arthritis is paramount. The results also suggest a lack of access to rheumatologist services in Northern Alberta and reiterate the need for ongoing recruitment of new rheumatologists as has been highlighted previously. Key Points • The main contribution of this paper is to compare and contrast the prevalence of rheumatoid arthritis as reported by administrative data versus identification by specialists. • Our study also shows the distribution of rheumatoid arthritis in a large geographical area and illustrates a lack of access to subspecialty care in certain regions.
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Affiliation(s)
- Jason Soo
- Department of Rheumatology, University of Alberta, 430-11044 82nd Avenue, Edmonton, Alberta, T6G0T2, Canada.
| | - David Eldeiry
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, D02 YN77, Ireland
| | - Steven Katz
- Department of Rheumatology, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton, Alberta, T6G 2G3, Canada
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Marshall DA, Pham T, Faris P, Chen G, O’Donnell S, Barber CEH, LeClercq S, Katz S, Homik J, Patel JN, Lopatina E, Roberts J, Mosher D. Determination of Rheumatoid Arthritis Incidence and Prevalence in Alberta Using Administrative Health Data. ACR Open Rheumatol 2020; 2:424-429. [PMID: 32567816 PMCID: PMC7368140 DOI: 10.1002/acr2.11158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The objective of the study was to estimate the incidence and prevalence of rheumatoid arthritis (RA) in Alberta using administrative health data. METHODS We identified RA cases in patients 16 years and older by applying a national case definition to linked administrative health data (ie, hospital discharge abstract records, physician claims, and health insurance registry records) using a unique personal identifier. Incidence and prevalence are reported for the 2015-2016 fiscal year and a trend analysis from 2011-2012 to 2015-2016. Incidence and prevalence estimates were standardized using the 2011 Canadian census population. RESULTS In 2015-2016, the overall crude incidence was 0.74 [95% confidence interval (CI): 0.71-0.77] per 1000 and crude prevalence was 1.08% (95% CI: 1.07-1.09). The women-to-men crude incidence and prevalence sex ratios were 2.04 and 2.19, respectively. People aged 65 to 79 years had the highest incidence of RA, and the highest prevalence was observed among those 80 years and older. From 2011-2012 to 2015-2016, the overall age-standardized incidence decreased [0.97 (95% CI: 0.94-1.01) to 0.79 (95% CI: 0.76-0.82) per 1000], whereas age-standardized prevalence remained constant [1.17 (95% CI: 1.15-1.18) to 1.18 (95% CI: 1.17-1.19)]. CONCLUSION In Alberta, there was a decreasing trend in RA incidence over the study period, whereas prevalence was stable. These estimates, combined with clinical data, will be used to measure system performance for quality improvement and to inform simulation modeling for planning the expected demand for health services for patients living with RA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jatin N. Patel
- University of Calgary, Calgary, Alberta and Alberta Health ServicesCalgaryAlbertaCanada
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Bodnar LM, Khodyakov D, Himes KP, Burke JG, Parisi S, Hutcheon JA. Engaging Patients and Professionals to Evaluate the Seriousness of Maternal and Child Health Outcomes: Protocol for a Modified Delphi Study. JMIR Res Protoc 2020; 9:e16478. [PMID: 32222699 PMCID: PMC7298634 DOI: 10.2196/16478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/19/2020] [Accepted: 03/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Maternal weight gain during pregnancy is one of the few potentially modifiable risk factors for many adverse maternal and child health outcomes. Defining the optimal pregnancy weight gain range is difficult because, while lower weight gain may prevent some outcomes, such as maternal and child obesity, it may increase the risk of others such as fetal growth restriction and infant death. These health outcomes vary in their seriousness to mothers and their health care providers, and these differences in seriousness should be taken into account when determining optimal weight gain ranges. However, the relative seriousness that women and their care providers place on different health outcomes is unknown. OBJECTIVE We will determine the seriousness of 11 maternal and child health outcomes that have been consistently associated with pregnancy weight gain. We will achieve this by engaging patients and maternal and child health professionals using an online modified Delphi panel process. METHODS We aim to recruit a racially/ethnically and geographically diverse group of 90 US maternal and child health professionals and 90 women who are pregnant or less than 2 years postpartum. We will conduct 3 concurrent panels using the ExpertLens system, a previously evaluated online modified Delphi system that combines 2 rounds of rating with 1 round of feedback and moderated online discussion. In Round 1, panelists are asked to rate the seriousness of each health outcome on a scale of 0-100 and to provide a rationale for their scores. In Round 2, panelists will review their responses relative to those of other panelists. They will discuss their seriousness ratings anonymously using a moderated online discussion board. In Round 3, participants will revise their Round 1 responses based on group feedback and discussion. Each round will be open for 1-2 weeks. RESULTS The study protocol was reviewed by our ethics boards and did not require approval as human research. A pilot study of 6 professionals and 7 patients was completed in December 2019. CONCLUSIONS Our numeric estimates of the seriousness of maternal and child health outcomes will enable future studies to determine pregnancy weight gain ranges that balance the risks of low and high weight gain for mothers and children. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16478.
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Affiliation(s)
- Lisa M Bodnar
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Magee-Womens Research Institute, Pittsburgh, PA, United States
| | | | - Katherine P Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Magee-Womens Research Institute, Pittsburgh, PA, United States
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Sara Parisi
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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Carr ECJ, Patel JN, Ortiz MM, Miller JL, Teare SR, Barber CEH, Marshall DA. Co-design of a patient experience survey for arthritis central intake: an example of meaningful patient engagement in healthcare design. BMC Health Serv Res 2019; 19:355. [PMID: 31164176 PMCID: PMC6549374 DOI: 10.1186/s12913-019-4196-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 05/28/2019] [Indexed: 01/18/2023] Open
Abstract
Background To describe the process of patient engagement to co-design a patient experience survey for people with arthritis referred to central intake. Methods We used a participatory design to engage with patients to co-design a patient experience survey that comprised three connected phases: 1) Identifying the needs of patients with arthritis, 2) Developing a set of key performance indicators, and 3) Determining the survey items for the patient experience survey. Results Patient recommendations for high quality healthcare care means support to manage arthritis, to live a meaningful life by providing the right knowledge, professional support, and professional relationship. The concept of integrated care was a core requirement from the patients’ perspective for the delivery of high quality arthritis care. Patients experience with care was ranked in the top 10 of 28 Key Performance Indicators for the evaluation of central intake, with 95% of stakeholders rating it as 9/10 for importance. A stakeholder team, including Patient and Community Engagement Researchers (PaCER), mapped and rated 41 survey items from four validated surveys. The final patient experience survey had 23 items. Conclusion The process of patient engagement to co-design a patient experience survey, for people with arthritis, identified aspects of care that had not been previously recognized. The linear organization of frameworks used to report patient engagement in research does not always capture the complexity of reality. Additional resources of cost, time and expertise for patient engagement in co-design activity are recognized and should be included, where possible, to ensure high quality data is captured. Electronic supplementary material The online version of this article (10.1186/s12913-019-4196-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eloise C J Carr
- Faculty of Nursing, University of Calgary, PF2237, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Jatin N Patel
- Pan-SCN Manager, Strategic Clinical Networks™, Alberta Health Services, 10030 - 107 Street NW, Edmonton, Alberta, T5J 3E4, Canada
| | - Mia M Ortiz
- Faculty of Nursing, University of Calgary, PF2237, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Jean L Miller
- O'Brien Institute for Public Health, University of Calgary, 3280, Hospital Dr. NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Sylvia R Teare
- O'Brien Institute for Public Health, University of Calgary, 3280, Hospital Dr. NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Claire E H Barber
- Arthritis Research Center, University of Calgary, HRIC 3AA20, 3280, Hospital Dr. NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Deborah A Marshall
- Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC) - 3C56, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
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Neufeld ME, Masri BA. Can the Oxford Knee and Hip Score identify patients who do not require total knee or hip arthroplasty? Bone Joint J 2019; 101-B:23-30. [DOI: 10.1302/0301-620x.101b6.bjj-2018-1460.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to determine if the Oxford Knee and Hip Score (OKHS) can accurately predict when a primary knee or hip referral is deemed nonsurgical versus surgical by the surgeon during their first consultation, and to identify nonsurgical OKHS screening thresholds. Patients and Methods We retrospectively reviewed pre-consultation OKHS for all consecutive primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) consultations of a single surgeon over three years. The 1436 knees (1016 patients) and 478 hips (388 patients) included were categorized based on the surgeon’s decision into those offered surgery during the first consultation versus those not (nonsurgical). Spearman’s rank correlation coefficients and receiver operating characteristic (ROC) curve analysis were performed. Results Oxford Scores were better for the nonsurgical cohorts (p < 0.001) and correlated with the surgical decision (p < 0.001). ROC area under the curve values for knees (0.83, 95% confidence intervals (CI) 0.81 to 0.85) and hips (0.87, 95% CI 0.84 to 0.91) were excellent. A conservative and effective threshold for knees is Oxford Knee Score (OKS) > 32 points (sensitivity = 0.997, negative predictive value (NPV) = 0.992) and for hips is Oxford Hip Score (OHS) > 34 points (sensitivity = 0.997, NPV = 0.978). Severable potential lower OKHS thresholds were identified. Conclusion Pre-consultation OKHS demonstrate good ability to predict when a primary TKA or THA referral will be deemed nonsurgical in a single surgeon’s practice. Multiple OKHS thresholds can effectively screen out nonsurgical referrals. Cite this article: Bone Joint J 2019;101-B(6 Supple B):23–30.
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Affiliation(s)
- M. E. Neufeld
- Department of Orthopaedics, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, Canada
| | - B. A. Masri
- Department of Orthopaedics, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, Canada
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Huijben JA, Wiegers EJA, de Keizer NF, Maas AIR, Menon D, Ercole A, Citerio G, Lecky F, Wilson L, Cnossen MC, Polinder S, Steyerberg EW, van der Jagt M, Lingsma HF. Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury. Crit Care 2019; 23:95. [PMID: 30902117 PMCID: PMC6431034 DOI: 10.1186/s13054-019-2377-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
Background We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators. Methods A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool. Results The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%). Conclusions This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future. Electronic supplementary material The online version of this article (10.1186/s13054-019-2377-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jilske A Huijben
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Eveline J A Wiegers
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam Public Health research institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Neuro-Intensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST, Monza, Italy
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Maryse C Cnossen
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Mathieu van der Jagt
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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16
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Lopatina E, Miller JL, Teare SR, Marlett NJ, Patel J, Barber CEH, Mosher DP, Wasylak T, Woodhouse LJ, Marshall DA. The voice of patients in system redesign: A case study of redesigning a centralized system for intake of referrals from primary care to rheumatologists for patients with suspected rheumatoid arthritis. Health Expect 2018; 22:348-363. [PMID: 30520175 PMCID: PMC6543166 DOI: 10.1111/hex.12855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/24/2018] [Accepted: 11/14/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The published literature demands examples of health-care systems designed with the active engagement of patients to explore the application of this complex phenomenon in practice. METHODS This case study explored how the voice of patients was incorporated into the process of redesigning an element of the health-care system, a centralized system for intake of referrals from primary care to rheumatologists for patients with suspected rheumatoid arthritis (RA)-centralized intake. The phenomenon of patient engagement using "patient and community engagement researchers" (PaCERs) in research and the process of redesigning centralized intake were selected as the case. In-depth evaluation of the case was undertaken through the triangulation of findings from the document review and participants' reflection on the case. RESULTS In this case, patients and PaCERs participated in multiple activities including an initial meeting of key stakeholders to develop the project vision; a patient-to-patient PaCERs study to gather perspectives of patients with RA on the challenges they face in accessing and navigating the health-care system, and what they see as key elements of an effective system that would be responsive to their needs; the development of an evaluation framework for future centralized intake; and the choice of candidate centralized intake strategies to be evaluated. CONCLUSIONS The described feasible multistep approach to active patient engagement in health-care system redesign contributes to an understanding of the application of this complex phenomenon in practice. Therefore, the manuscript serves as one more step towards a patient-centred health-care system that is redesigned with active patient engagement.
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Affiliation(s)
- Elena Lopatina
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Jean L Miller
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sylvia R Teare
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Nancy J Marlett
- Community Rehabilitation and Disability Studies, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jatin Patel
- Strategic Clinical Networks™, Alberta Health Services, Edmonton, Alberta, Canada
| | - Claire E H Barber
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Dianne P Mosher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks™, Alberta Health Services, Edmonton, Alberta, Canada.,Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Linda J Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Strategic Clinical Networks™, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada.,Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
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Abstract
OBJECTIVE All healthcare systems require valid ways to evaluate service delivery. The objective of this study was to identify existing content validated quality indicators (QIs) for responsible use of medicines (RUM) and classify them using multiple frameworks to identify gaps in current quality measurements. DESIGN Systematic review without meta-analysis. SETTING All care settings. SEARCH STRATEGY CINAHL, Embase, Global Health, International Pharmaceutical Abstract, MEDLINE, PubMed and Web of Science databases were searched up to April 2018. An internet search was also conducted. Articles were included if they described medication-related QIs developed using consensus methods. Government agency websites listing QIs for RUM were also included. ANALYSIS Several multidimensional frameworks were selected to assess the scope of QI coverage. These included Donabedian's framework (structure, process and outcome), the Anatomical Therapeutic Chemical (ATC) classification system and a validated classification for causes of drug-related problems (c-DRPs; drug selection, drug form, dose selection, treatment duration, drug use process, logistics, monitoring, adverse drug reactions and others). RESULTS 2431 content validated QIs were identified from 131 articles and 5 websites. Using Donabedian's framework, the majority of QIs were process indicators. Based on the ATC code, the largest number of QIs pertained to medicines for nervous system (ATC code: N), followed by anti-infectives for systemic use (J) and cardiovascular system (C). The most common c-DRPs pertained to 'drug selection', followed by 'monitoring' and 'drug use process'. CONCLUSIONS This study was the first systematic review classifying QIs for RUM using multiple frameworks. The list of the identified QIs can be used as a database for evaluating the achievement of RUM. Although many QIs were identified, this approach allowed for the identification of gaps in quality measurement of RUM. In order to more effectively evaluate the extent to which RUM has been achieved, further development of QIs may be required.
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Affiliation(s)
- Kenji Fujita
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah J Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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18
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Freitas Â, Santana P, Oliveira MD, Almendra R, Bana E Costa JC, Bana E Costa CA. Indicators for evaluating European population health: a Delphi selection process. BMC Public Health 2018; 18:557. [PMID: 29703176 PMCID: PMC5922019 DOI: 10.1186/s12889-018-5463-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/13/2018] [Indexed: 01/07/2023] Open
Abstract
Background Indicators are essential instruments for monitoring and evaluating population health. The selection of a multidimensional set of indicators should not only reflect the scientific evidence on health outcomes and health determinants, but also the views of health experts and stakeholders. The aim of this study is to describe the Delphi selection process designed to promote agreement on indicators considered relevant to evaluate population health at the European regional level. Methods Indicators were selected in a Delphi survey conducted using a web-platform designed to implement and monitor participatory processes. It involved a panel of 51 experts and 30 stakeholders from different areas of knowledge and geographies. In three consecutive rounds the panel indicated their level of agreement or disagreement with indicator’s relevance for evaluating population health in Europe. Inferential statistics were applied to draw conclusions on observed level of agreement (Scott’s Pi interrater reliability coefficient) and opinion change (McNemar Chi-square test). Multivariate analysis of variance was conducted to check if the field of expertise influenced the panellist responses (Wilk’s Lambda test). Results The panel participated extensively in the study (overall response rate: 80%). Eighty indicators reached group agreement for selection in the areas of: economic and social environment (12); demographic change (5); lifestyle and health behaviours (8); physical environment (6); built environment (12); healthcare services (11) and health outcomes (26). Higher convergence of group opinion towards agreement on the relevance of indicators was seen for lifestyle and health behaviours, healthcare services, and health outcomes. The panellists’ field of expertise influenced responses: statistically significant differences were found for economic and social environment (p < 0.05 in round 1 and 2), physical environment (p < 0.01 in round 1) and health outcomes (p < 0.01 in round 3). Conclusions The high levels of participation observed in this study, by involving experts and stakeholders and ascertaining their views, underpinned the added value of using a transparent Web-Delphi process to promote agreement on what indicators are relevant to appraise population health. Electronic supplementary material The online version of this article (10.1186/s12889-018-5463-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ângela Freitas
- Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, Coimbra, Portugal.
| | - Paula Santana
- Department of Geography and Tourism, Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, Coimbra, Portugal
| | - Mónica D Oliveira
- Centre for Management Studies of Instituto Superior Técnico (CEG-IST), Universidade de Lisboa, Lisbon, Portugal
| | - Ricardo Almendra
- Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, Coimbra, Portugal
| | | | - Carlos A Bana E Costa
- Centre for Management Studies of Instituto Superior Técnico (CEG-IST), Universidade de Lisboa, Lisbon, Portugal
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19
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Cooper M, Rouhi A, Barber CEH. A Systematic Review of Quality Measures for Inflammatory Arthritis. J Rheumatol 2017; 45:274-283. [PMID: 29142026 DOI: 10.3899/jrheum.170157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a systematic review and quality appraisal of quality measures for inflammatory arthritis, including rheumatoid arthritis (RA), spondyloarthritis, psoriatic arthritis (PsA), and juvenile idiopathic arthritis (JIA). METHODS Embase, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from January 1, 2000, to October 23, 2016, using Medical Subject Headings terms for inflammatory arthritis and quality measures. A "grey literature" search of international arthritis organizations and quality measure libraries was also conducted. Two reviewers independently considered the papers for inclusion, with disagreements resolved by consensus. A modified guideline appraisal tool (AGREE II) was used to appraise the measure development process, which determined final inclusion. Measures were abstracted in duplicate and categorized into themes, measure type, and domains of quality. RESULTS Thirteen measurement sets were included from 4 countries (United States, Canada, United Kingdom, Netherlands) and 1 European consortium. They included 10 sets on RA and 1 each for PsA, inflammatory arthritis, and JIA. There were 161 unique individual measures (136 process, 20 structure, and 5 outcome). Major themes included assessment, medications, and comorbidities. Measure development methods were varied, including RAND/University of California, Los Angeles appropriateness methodology, prioritization exercises, or other modified-Delphi methods. Inclusion of patients occurred in 77% of development groups. Discussion of barriers to measurement was infrequent. CONCLUSION Inflammatory arthritis quality measures cover a diversity of themes encompassing process, structure, and outcomes of care across the 6 domains of quality. However, between organizations, measure development is not standardized. Local assessment of measurement feasibility before use outside the original development context is recommended.
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Affiliation(s)
- Matthew Cooper
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada
| | - Azin Rouhi
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada
| | - Claire E H Barber
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada. .,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada.
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20
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Slater H, Dear BF, Merolli MA, Li LC, Briggs AM. Use of eHealth technologies to enable the implementation of musculoskeletal Models of Care: Evidence and practice. Best Pract Res Clin Rheumatol 2017; 30:483-502. [PMID: 27886943 DOI: 10.1016/j.berh.2016.08.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/05/2016] [Accepted: 08/22/2016] [Indexed: 01/26/2023]
Abstract
Musculoskeletal (MSK) conditions are the second leading cause of morbidity-related burden of disease globally. EHealth is a potentially critical factor that enables the implementation of accessible, sustainable and more integrated MSK models of care (MoCs). MoCs serve as a vehicle to drive evidence into policy and practice through changes at a health system, clinician and patient level. The use of eHealth to implement MoCs is intuitive, given the capacity to scale technologies to deliver system and economic efficiencies, to contribute to sustainability, to adapt to low-resource settings and to mitigate access and care disparities. We follow a practice-oriented approach to describing the 'what' and 'how' to harness eHealth in the implementation of MSK MoCs. We focus on the practical application of eHealth technologies across care settings to those MSK conditions contributing most substantially to the burden of disease, including osteoarthritis and inflammatory arthritis, skeletal fragility-associated conditions and persistent MSK pain.
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Affiliation(s)
- Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
| | - Blake F Dear
- eCentreClinic, Department of Psychology, Macquarie University, NSW, Australia.
| | - Mark A Merolli
- Health and Biomedical Informatics Centre, The University of Melbourne, VIC, Australia.
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Arthritis Research Canada, Vancouver, British Columbia, Canada.
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
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21
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Briggs AM, Jordan JE, Jennings M, Speerin R, Bragge P, Chua J, Woolf AD, Slater H. Supporting the Evaluation and Implementation of Musculoskeletal Models of Care: A Globally Informed Framework for Judging Readiness and Success. Arthritis Care Res (Hoboken) 2017; 69:567-577. [PMID: 27273891 DOI: 10.1002/acr.22948] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/16/2016] [Accepted: 05/31/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To develop a globally informed framework to evaluate readiness for implementation and success after implementation of musculoskeletal models of care (MOCs). METHODS Three phases were undertaken: 1) a qualitative study with 27 Australian subject matter experts (SMEs) to develop a draft framework; 2) an eDelphi study with an international panel of 93 SMEs across 30 nations to evaluate face validity, and refine and establish consensus on the framework components; and 3) translation of the framework into a user-focused resource and evaluation of its acceptability with the eDelphi panel. RESULTS A comprehensive evaluation framework was developed for judging the readiness and success of musculoskeletal MOCs. The framework consists of 9 domains, with each domain containing a number of themes underpinned by detailed elements. In the first Delphi round, scores of "partly agree" or "completely agree" with the draft framework ranged 96.7%-100%. In the second round, "essential" scores ranged 58.6%-98.9%, resulting in 14 of 34 themes being classified as essential. SMEs strongly agreed or agreed that the final framework was useful (98.8%), usable (95.1%), credible (100%) and appealing (93.9%). Overall, 96.3% strongly supported or supported the final structure of the framework as it was presented, while 100%, 96.3%, and 100% strongly supported or supported the content within the readiness, initiating implementation, and success streams, respectively. CONCLUSION An empirically derived framework to evaluate the readiness and success of musculoskeletal MOCs was strongly supported by an international panel of SMEs. The framework provides an important internationally applicable benchmark for the development, implementation, and evaluation of musculoskeletal MOCs.
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Affiliation(s)
| | | | - Matthew Jennings
- New South Wales Agency for Clinical Innovation, Chatswood, New South Wales, Australia, and Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Robyn Speerin
- New South Wales Agency for Clinical Innovation, Chatswood, New South Wales, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Jason Chua
- Department of Health, Government of Western Australia, Perth, Western Australia, Australia, and Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin Hospital, Dunedin, New Zealand
| | | | - Helen Slater
- Curtin University, Perth, Western Australia, Australia
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22
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Robertson-Preidler J, Biller-Andorno N, Johnson TJ. What is appropriate care? An integrative review of emerging themes in the literature. BMC Health Serv Res 2017; 17:452. [PMID: 28666438 PMCID: PMC5493089 DOI: 10.1186/s12913-017-2357-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 06/06/2017] [Indexed: 01/16/2023] Open
Abstract
Background Health care improvement efforts should be aligned in order to make a meaningful impact on health systems. Appropriate care delivery could be a unifying goal to help coordinate efforts to improve health outcomes and ensure system sustainability. A more complete understanding of how appropriate care is currently conceived in research and clinical practice could help inform a more integrated and holistic concept of appropriate care that could guide health care policy and delivery practices. We examined the current understanding of appropriate care by identifying its use and definitions in recently published literature. Methods An integrated review of the practices, goals and perspectives of appropriate care in English language peer-reviewed articles published from 2011 to 2016. Inductive content analysis was used to describe emerging themes of appropriate care in articles meeting inclusion criteria. Results This integrative review included empirical studies, reviews, and commentaries with various health care settings, cultural contexts, and perspectives. Conceptualizations of appropriate care varied, however most descriptions fell into five main categories: evidence-based care, clinical expertise, patient-centeredness, resource use, and equity. These categories were often used in combination, indicating an integrated understanding of appropriate care. Conclusions An understanding of how appropriate care is conceptualized in research and policy can help inform an integrated approach to appropriate care delivery in policy and practice according to the relevant priorities and circumstances.
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Affiliation(s)
- Joelle Robertson-Preidler
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zürich, Switzerland.
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zürich, Switzerland
| | - Tricia J Johnson
- Department of Health Systems Management, Rush University, 1700 W. Van Buren Street, Suite 126B, Chicago, IL, 60612, USA
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Xing F, Lu B, Kuang MJ, Wang Y, Zhao YL, Zhao J, Sun L, Wang Y, Ma JX, Ma XL. A systematic review and meta-analysis into the effect of lateral wedge arch support insoles for reducing knee joint load in patients with medial knee osteoarthritis. Medicine (Baltimore) 2017; 96:e7168. [PMID: 28614253 PMCID: PMC5478338 DOI: 10.1097/md.0000000000007168] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the immediate effects of lateral wedge arch support insoles (LWAS) on reducing the knee joint load in patients with medial knee osteoarthritis (OA) compared with an appropriate control. METHODS Databases including Medline, EMBASE, Web of Science, Wiley Online Library, Cochrane library, and Google Scholar were searched with no limits on study date or language, from the earliest available date to October 31, 2016. The included studies had to have the aim of reducing knee load and have an appropriate control. The main measured values were the first and second peak external knee adduction moments (EKAM) and the knee adduction angular impulse (KAAI). The random-effects model was used for analyzing the eligible studies. RESULTS Nine studies met the inclusion criteria with a total of 356 participants of whom 337 received LWAS treatment. The risk of methodological bias scores (quality index) ranged from 21 to 27 of 32. Treatment with LWAS resulted in statistically significant reductions in the first peak EKAM (P = .005), the second peak EKAM (P = .01), and the KAAI (P = .03). However, among trials in which the control treatment was control shoes, the LWAS showed no associations on the first peak EKAM (P = .10) or the KAAI (P = .06); among trials in which the control treatment was neutral insoles, the LWAS showed no associations on the second peak EKAM (P = .21) or the KAAI (P = .23). At the same time, the LWAS showed no statistically significant reduction on the first peak EKAM (P = .39) when compared with flat insoles. CONCLUSION Although meta-analysis outcomes of all studies indicated statistically significant associations between LWAS and reductions of the first peak EKAM, second peak EKAM and KAAI in people with medial knee OA while walking, different results existed in subgroups using various control conditions for comparison. These findings do not support the use of LWAS insoles for reducing knee load. An optimal LWAS treatment should provide the appropriate height of arch support and amount of lateral wedging. Further research should investigate the best combination of these 2 parameters to achieve efficacy without altered comfort.
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Affiliation(s)
- Fei Xing
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Bin Lu
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Ming-jie Kuang
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Ying Wang
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Yun-long Zhao
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Jie Zhao
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Lei Sun
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Yan Wang
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Jian-xiong Ma
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Xin-long Ma
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Department of Orthopedics, Tianjin Hospital, Tianjin, People's Republic of China
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Khodyakov D, Grant S, Meeker D, Booth M, Pacheco-Santivanez N, Kim KK. Comparative analysis of stakeholder experiences with an online approach to prioritizing patient-centered research topics. J Am Med Inform Assoc 2017; 24:537-543. [PMID: 28011596 PMCID: PMC7651951 DOI: 10.1093/jamia/ocw157] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Little evidence exists about effective and scalable methods for meaningful stakeholder engagement in research. We explored patient/caregiver experiences with a high-tech online engagement approach for patient-centered research prioritization, compared their experiences with those of professional stakeholders, and identified factors associated with favorable participant experiences. METHODS We conducted 8 online modified-Delphi (OMD) panels. Panelists participated in 2 rating rounds with a statistical feedback/online discussion round in between. Panels focused on weight management/obesity, heart failure, and Kawasaki disease. We recruited a convenience sample of adults with any of the 3 conditions (or parents/guardians of Kawasaki disease patients), clinicians, and researchers. Measures included self-reported willingness to use OMD again, the panelists' study participation and online discussion experiences, the system's perceived ease of use, and active engagement metrics. RESULTS Out of 349 panelists, 292 (84%) completed the study. Of those, 46% were patients, 36% were clinicians, and 19% were researchers. In multivariate models, patients were not significantly more actively engaged (Odds ratio (OR) = 1.69, 95% confidence interval (CI), 0.94-3.05) but had more favorable study participation (β = 0.49; P ≤ .05) and online discussion (β = 0.18; P ≤ .05) experiences and were more willing to use OMD again (β = 0.36; P ≤ .05), compared to professional stakeholders. Positive perceptions of the OMD system's ease of use (β = 0.16; P ≤ .05) and favorable study participation (β = 0.26; P ≤ .05) and online discussion (β = 0.57; P ≤ .05) experiences were also associated with increased willingness to use OMD in the future. Active engagement was not associated with online experience indices or willingness to use OMD again. CONCLUSION Online approaches to engaging large numbers of stakeholders are a promising and efficient adjunct to in-person meetings.
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Affiliation(s)
- Dmitry Khodyakov
- RAND Corporation, Santa Monica, CA, USA,Corresponding Author: Dmitry Khodyakov, RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA. E-mail: ; Tel: 310-393-0411, ext. 6159
| | | | - Daniella Meeker
- RAND Corporation, Santa Monica, CA, USA,University of Southern California, Los Angeles, CA, USA
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Khodyakov D, Kinnett K, Grant S, Lucas A, Martin A, Denger B, Peay H, Coulter I, Fink A. Engaging Patients and Caregivers Managing Rare Diseases to Improve the Methods of Clinical Guideline Development: A Research Protocol. JMIR Res Protoc 2017; 6:e57. [PMID: 28455279 PMCID: PMC5429434 DOI: 10.2196/resprot.6902] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical guidelines provide systematically developed recommendations for deciding on appropriate health care options for specific conditions and clinical circumstances. Up until recently, patients and caregivers have rarely been included in the process of developing care guidelines. OBJECTIVE This project will develop and test a new online method for including patients and their caregivers in this process using Duchenne muscular dystrophy (DMD) care guidelines as an example. The new method will mirror and complement the RAND/UCLA Appropriateness Method (RAM)-the gold standard approach for conducting clinical expert panels that uses a modified Delphi format. RAM is often used in clinical guideline development to determine care appropriateness and necessity in situations where existing clinical evidence is uncertain, weak, or unavailable. METHODS To develop the new method for engaging patients and their caregivers in guideline development, we will first conduct interviews with experts on RAM, guideline development, patient engagement, and patient-centeredness and engage with Duchenne patients and caregivers to identify how RAM should be modified for the purposes of patient engagement and what rating criteria should patients and caregivers use to provide their input during the process of guideline development. Once the new method is piloted, we will test it by conducting two concurrently run patient/caregiver panels that will rate patient-centeredness of a subset of DMD care management recommendations already deemed clinically appropriate and necessary. The ExpertLens™ system-a previously evaluated online modified Delphi system that combines two rounds of rating with a round of feedback and moderated online discussions-will be used to conduct these panels. In addition to developing and testing the new engagement method, we will work with the members of our project's Advisory Board to generate a list of best practices for enhancing the level of patient and caregiver involvement in the guideline development process. We will solicit input on these best practice from Duchenne patients, caregivers, and clinicians by conducting a series of round-table discussions and making a presentation at an annual conference on Duchenne. RESULTS The study protocol was reviewed by RAND's Human Subjects Protection Committee, which determined it to be exempt from review. Interviews with RAM experts have been completed. The projected study completion date is May 2020. CONCLUSIONS We expect that the new method will make it easier to engage large numbers of patients and caregivers in the process of guideline development in a rigorous and culturally appropriate manner that is consistent with the way clinicians participate in guideline development. Moreover, this project will develop best practices that could help involve patients and caregivers in the clinical guideline development process in other clinical areas, thereby facilitating the work of guideline developers.
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Affiliation(s)
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Hackensack, NJ, United States
| | - Sean Grant
- RAND Health, Santa Monica, CA, United States
| | - Ann Lucas
- Parent Project Muscular Dystrophy, Hackensack, NJ, United States
| | - Ann Martin
- Parent Project Muscular Dystrophy, Hackensack, NJ, United States
| | - Brian Denger
- Parent Project Muscular Dystrophy, Hackensack, NJ, United States
| | - Holly Peay
- RTI International, Research Triangle Park, NC, United States
| | | | - Arlene Fink
- University of California Los Angeles, Los Angeles, CA, United States
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26
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Khodyakov D, Ochoa A, Olivieri-Mui BL, Bouwmeester C, Zarowitz BJ, Patel M, Ching D, Briesacher B. Screening Tool of Older Person's Prescriptions/Screening Tools to Alert Doctors to Right Treatment Medication Criteria Modified for U.S. Nursing Home Setting. J Am Geriatr Soc 2016; 65:586-591. [PMID: 28008599 DOI: 10.1111/jgs.14689] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To develop a set of prescribing indicators measurable with available data from electronic nursing home (NH) databases by adapting the European-based 2014 Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tools to Alert Doctors to Right Treatment (START) criteria of potentially inappropriate and underused medications for the U.S. SETTING DESIGN A two-stage expert panel process. In the first stage, the investigator team reviewed 114 criteria for compatibility and measurability. In the second stage, an online modified e-Delphi (OMD) panel was convened to rate the validity of criteria, and two webinars were held to identify criteria with highest relevance to U.S. NHs. PARTICIPANTS Seventeen experts with recognized reputations in NH care participated in the e-Delphi panel and 12 in the webinar. MEASUREMENTS Compatibility and measurability were assessed by comparing criteria with U.S. terminology and setting standards and data elements in NH databases. Validity was rated using a 9-point Likert-type scale (1 = not valid at all, 9 = highly valid). Mean, median, interpercentile ranges, and agreement were determined for each criterion score. Relevance was determined by ranking the mean panel ratings on criteria that reached agreement; the webinar participants reviewed and approved half of the criteria with the highest mean values. RESULTS Fifty-three STOPP/START criteria were deemed to be compatible with the U.S. NH setting and measurable using data from electronic NH databases. E-Delphi panelists rated 48 criteria as valid for U.S. NHs. Twenty-four criteria were deemed to be most relevant, consisting of 22 measures of potentially inappropriate medications and two measures of underused medications. CONCLUSION This study created the first explicit criteria for assessing the quality of prescribing in U.S. NHs.
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Affiliation(s)
- Dmitry Khodyakov
- RAND Corporation and RAND Pardee Graduate School, Santa Monica, California
| | - Aileen Ochoa
- School of Pharmacy, Northeastern University, Boston, Massachusetts
| | | | | | | | - Meenakshi Patel
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Diana Ching
- School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - Becky Briesacher
- School of Pharmacy, Northeastern University, Boston, Massachusetts
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Wittmeier KDM, Restall G, Mulder K, Dufault B, Paterson M, Thiessen M, Lix LM. Central intake to improve access to physiotherapy for children with complex needs: a mixed methods case report. BMC Health Serv Res 2016; 16:455. [PMID: 27578196 PMCID: PMC5006453 DOI: 10.1186/s12913-016-1700-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/23/2016] [Indexed: 12/01/2022] Open
Abstract
Background Children with complex needs can face barriers to system access and navigation related to their need for multiple services and healthcare providers. Central intake for pediatric rehabilitation was developed and implemented in 2008 in Winnipeg Manitoba Canada as a means to enhance service coordination and access for children and their families. This study evaluates the process and impact of implementing a central intake system, using pediatric physiotherapy as a case example. Methods A mixed methods instrumental case study design was used. Interviews were completed with 9 individuals. Data was transcribed and analyzed for themes. Quantitative data (wait times, referral volume and caregiver satisfaction) was collected for children referred to physiotherapy with complex needs (n = 1399), and a comparison group of children referred for orthopedic concerns (n = 3901). Wait times were analyzed using the Kruskal-Wallis test, caregiver satisfaction was analyzed using Fisher exact test and change point modeling was applied to examine referral volume over the study period. Results Interview participants described central intake implementation as creating more streamlined processes. Factors that facilitated successful implementation included 1) agreement among stakeholders, 2) hiring of a central intake coordinator, 3) a financial commitment from the government and 4) leadership at the individual and organization level. Mean (sd) wait times improved for children with complex needs (12.3(13.1) to 8.0(6.9) days from referral to contact with family, p < 0.0001; 29.8(17.9) to 24.3(17.0) days from referral to appointment, p < 0.0001) while referral volumes remained consistent. A small but significant increase in wait times was observed for the comparison group (9.6(8.6) to 10.1(6.6) days from referral to contact with family, p < 0.001; 20.4(14.3) to 22.1(13.1) days from referral to appointment, p < 0.0001), accompanied by an increasing referral volume for this group. Caregiver satisfaction remained high throughout the process (p = 0.48). Conclusions Central intake implementation achieved the intended outcomes of streamlining processes and improving transparency and access to pediatric physiotherapy (i.e., decreasing wait times) for families of children with complex needs. Future research is needed to build on this single discipline case study approach to examine changes in wait times, therapy coordination and stakeholder satisfaction within the context of continuing improvements for pediatric therapy services within the province. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1700-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristy D M Wittmeier
- George and Fay Yee Centre for Healthcare Innovation, 375-753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada. .,Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, Health Sciences Centre, University of Manitoba, CE208-840 Sherbrook St., Winnipeg, MB, R3A 1S1, Canada. .,Physiotherapy, Health Sciences Centre, CH246-840 Sherbrook St., Winnipeg, MB, R3A 1S1, Canada.
| | - Gayle Restall
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, R106-771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada
| | - Kathy Mulder
- Physiotherapy, Health Sciences Centre, CH246-840 Sherbrook St., Winnipeg, MB, R3A 1S1, Canada
| | - Brenden Dufault
- George and Fay Yee Centre for Healthcare Innovation, 375-753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
| | - Marie Paterson
- Physiotherapy, Health Sciences Centre, CH246-840 Sherbrook St., Winnipeg, MB, R3A 1S1, Canada
| | - Matthew Thiessen
- Physiotherapy, Health Sciences Centre, CH246-840 Sherbrook St., Winnipeg, MB, R3A 1S1, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Rady Faculty of Health Sciences, S113-750 Bannatyne Avenue, Winnipeg, MB, R3E OW6, Canada
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Models of Care for musculoskeletal health: Moving towards meaningful implementation and evaluation across conditions and care settings. Best Pract Res Clin Rheumatol 2016; 30:359-374. [DOI: 10.1016/j.berh.2016.09.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/16/2016] [Indexed: 12/31/2022]
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29
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Khodyakov D, Mikesell L, Schraiber R, Booth M, Bromley E. On using ethical principles of community-engaged research in translational science. Transl Res 2016; 171:52-62.e1. [PMID: 26773561 PMCID: PMC4833614 DOI: 10.1016/j.trsl.2015.12.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/20/2015] [Accepted: 12/16/2015] [Indexed: 11/20/2022]
Abstract
The transfer of new discoveries into both clinical practice and the wider community calls for reliance on interdisciplinary translational teams that include researchers with different areas of expertise, representatives of health care systems and community organizations, and patients. Engaging new stakeholders in research, however, calls for a reconsideration or expansion of the meaning of ethics in translational research. We explored expert opinion on the applicability of ethical principles commonly practiced in community-engaged research (CEnR) to translational research. To do so, we conducted 2 online, modified-Delphi panels with 63 expert stakeholders who iteratively rated and discussed 9 ethical principles commonly used in CEnR in terms of their importance and feasibility for use in translational research. The RAND/UCLA appropriateness method was used to analyze the data and determine agreement and disagreement among participating experts. Both panels agreed that ethical translational research should be "grounded in trust." Although the academic panel endorsed "culturally appropriate" and "forthcoming with community about study risks and benefits," the mixed academic-community panel endorsed "scientifically valid" and "ready to involve community in interpretation and dissemination" as important and feasible principles of ethical translational research. These findings suggest that in addition to protecting human subjects, contemporary translational science models need to account for the interests of, and owe ethical obligations to, members of the investigative team and the community at large.
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Affiliation(s)
- Dmitry Khodyakov
- Behavioral/Social Scientist, The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, Phone: +1-310-393-0411x 6159
| | - Lisa Mikesell
- Assistant Professor, Communication Department, School of Communication and Information, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 4 Huntington Street, New Brunswick, NJ 08901-1071
| | - Ron Schraiber
- Executive Director, The Well-Being Programs, Inc., 644 Knoll Drive, P.O. Box 1104, Crestline, CA 92324
| | - Marika Booth
- Statistical Project Associate, The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, Phone: +1-310-393-0411x 6338
| | - Elizabeth Bromley
- Assistant Professor in Residence, Semel Institute Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Research Psychiatrist, Desert Pacific MIRECC, West Los Angeles VA Healthcare Center, 10920 Wilshire Blvd, Los Angeles, CA 90024
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Support for Living a Meaningful Life with Osteoarthritis: A Patient-to-Patient Research Study. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 9:457-64. [DOI: 10.1007/s40271-016-0169-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Khodyakov D, Stockdale SE, Smith N, Booth M, Altman L, Rubenstein LV. Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health-care System: findings from an online expert panel. Health Expect 2016; 20:130-145. [PMID: 26914249 PMCID: PMC5217877 DOI: 10.1111/hex.12444] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 11/28/2022] Open
Abstract
CONTEXT There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. METHODS We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens™ . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient-centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. FINDINGS Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient-centredness and health-care quality criteria. CONCLUSIONS Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as-needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient-centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high-quality, patient-centred care.
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Affiliation(s)
| | - Susan E Stockdale
- VISN 22 Veterans Assessment and Improvement PACT Demonstration Laboratory, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Nina Smith
- Center for Implementation Practice and Research Support (CIPRS), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA
| | | | - Lisa Altman
- VA Greater Los Angeles Healthcare System (GLA), Office of Healthcare Transformation and Innovation, Los Angeles, CA, USA.,The David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Lisa V Rubenstein
- RAND Corporation, Santa Monica, CA, USA.,VISN 22 Veterans Assessment and Improvement PACT Demonstration Laboratory, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA.,Center for Implementation Practice and Research Support (CIPRS), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA
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