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Gruiskens JRJH, van Hoef LFM, Theunissen MM, Courtens AM, Gidding-Slok AHM, van Schayck OCP, van den Beuken-van Everdingen MMHJ. Recommendations for Improving Chronic Care in Times of a Pandemic Based on Patient Experiences. J Am Med Dir Assoc 2024; 25:623-632.e5. [PMID: 38000443 DOI: 10.1016/j.jamda.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 08/24/2023] [Accepted: 10/14/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES The COVID-19 pandemic had a profound and pervasive impact on the health of chronic care patients and disrupted care systems worldwide. Our research aimed to assess the impact of the pandemic on chronic care provision and provide recommendations for improving care provision, based on patient experiences. DESIGN Qualitative semi-structured interviews were held among patients with chronic obstructive pulmonary disease (COPD) or heart failure. SETTING AND PARTICIPANTS Using stratified sampling, 23 patients with COPD, heart failure, or both were recruited to participate in semi-structured interviews. In the summer of 2021, online interviews were conducted. METHODS An iterative process was adopted to analyze the data. Going back and forth through the data and our analytical structure, we first coded the data, and subsequently developed categories, themes, and aggregate dimensions. The data were synthesized in a data structure and a data table, which were analyzed using an interpretative approach. RESULTS We found 3 dimensions through which care might be improved: (1) proactive and adaptive health care organization and use of innovative technologies, (2) assistance in maintaining patient resilience and coping strategies, and (3) health care built on outreaching and person-centered care enabling identification of individual patient needs. Experiences of impaired accessibility to care, altered and unmet care demands and patient needs, and the negative impact of national containment strategies on patient resilience support the need for improvement in these dimensions. CONCLUSIONS AND IMPLICATIONS The in-depth insight gained on the impact of the pandemic on chronic care provision was used to propose recommendations for improving care, supported by not only the what and how but also the why developments require additional efforts made by policymakers and change agents, augmented by structural use and development of innovations. Health care organizations should be enabled to rapidly respond to changing internal and external environments, develop and implement innovations, and match care to patient needs.
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Affiliation(s)
- Jeroen R J H Gruiskens
- Department of Family Medicine, CAPHRI School of Public Health and Preventive Medicine, Maastricht University, Maastricht, The Netherlands.
| | - Liesbeth F M van Hoef
- Expertise Centre for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Maurice M Theunissen
- Expertise Centre for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Annemie M Courtens
- Expertise Centre for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Annerika H M Gidding-Slok
- Department of Family Medicine, CAPHRI School of Public Health and Preventive Medicine, Maastricht University, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, CAPHRI School of Public Health and Preventive Medicine, Maastricht University, Maastricht, The Netherlands
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2
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Njuguna C, Tola H, Maina BN, Magambo KN, Namukose S, Kamau S, Tegegn YW. Roles of health system leadership under emergency in drought-affected districts in northeast Uganda: a mixed-method study. BMJ Open 2024; 14:e080374. [PMID: 38503408 PMCID: PMC10953004 DOI: 10.1136/bmjopen-2023-080374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE Health system leadership plays a critical role in sustaining healthcare delivery during emergencies. Thus, we aimed to assess the contribution of health system leadership in sustaining healthcare delivery under emergency conditions based on adaptive leadership theoretical framework. DESIGN We employed a concurrent mixed-methods study approach to assess health system leadership roles during emergency. This involved a quantitative survey administered to 150 health facilities managers/service focal persons selected via multistage sampling method from 15 districts, and qualitative interviews with 48 key informants who purposively selected. PARTICIPANTS We interviewed health facility managers, services focal persons, district health officers and residential district commissioners. We also reviewed weekly emergency situation reports and other relevant documents related to the emergency response. We used structured questionnaire, observation checklist and semistructured questionnaire to collect data. We employed descriptive statistics to analyse quantitative data and thematic analysis for qualitative data. MAIN OUTCOME Health system leadership contributions in sustaining healthcare delivery during emergencies. RESULTS Health system leadership was effective in leading emergency response and ensuring the continuity of health service during emergencies. Community engagement, partners coordination and intersectoral collaboration were effectively used in the emergency response and ensuring continuity of healthcare delivery. Deployment of experienced personnel and essential medical and non-medical supplies played a critical role in the continuity of health service. Availability of incidence management teams across health system significantly contributed to health system leadership. Participation of village health teams in community engagement and information communication helped in the success of health system leadership under emergency. CONCLUSION Adaptive health system leadership played a crucial role in managing health services delivery under emergency conditions. Effective partnership coordination and collaboration across sectors, frequent information communication, building local actor capacity and implementing scheduled supportive supervisions emerged as key strategies for sustaining health services during emergencies.
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Affiliation(s)
- Charles Njuguna
- World Health Organization Country Office for Uganda, Kampala, Uganda
- Kenyatta University, School of Business, Nairobi, Nairobi, Kenya
| | - Habteyes Tola
- World Health Organization Country Office for Uganda, Kampala, Uganda
| | | | | | | | - Sarah Kamau
- Kenyatta University, School of Business, Nairobi, Nairobi, Kenya
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3
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Gautier L, Gabet M, Duhoux A, Traverson L, Ridde V, Zinszer K, David PM. Supporting Reassigned Hospital Staff During the COVID-19 Pandemic in the Montreal Region: What Does it say About Leadership Styles? Can J Nurs Res 2023; 55:472-485. [PMID: 37587875 PMCID: PMC10619168 DOI: 10.1177/08445621231192044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Globally, the COVID-19 pandemic took a high toll on health human resources, especially in contexts where these resources were already fragile. In Quebec, to make up for the shortage of health human resources, and to contain the COVID-19 outbreaks in long-term care facilities, many hospital staff (including a majority of nurses) were sent to those facilities, with varying degrees of support. Building on the body of evidence linking leadership style and resilience, we conducted a qualitative comparative analysis of two hospitals in the Montreal Metropolitan Area, Quebec. We explored respondents' experience of psychosocial support tools provided to hospital staff reassigned to COVID-affected facilities. Data from 27 in-depth interviews with high- and mid-level managers, and front-line workers, was analyzed through the lens of leadership styles. Our findings highlighted how the design and implementation of support tools revealed major differences across the two hospitals' leadership styles (i.e., one hospital expressing leader-centered styles vs. the other expressing follower-centered leadership styles). The expression of these leadership styles was largely shaped by recent policies, notably a major political reform of 2015, which enforced more centralized decision-making. Our study offered additional empirical evidence that leadership styles fostering the recovery of health human resources may be a key indicator of successful response to crises.
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Affiliation(s)
- Lara Gautier
- School of Public Health, University of Montréal, Montréal, Canada
- Centre de recherche en santé publique (CReSP), University of Montréal and CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Canada
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Morgane Gabet
- School of Public Health, University of Montréal, Montréal, Canada
| | - Arnaud Duhoux
- Faculty of nursing, University of Montréal, Montréal, Canada
| | - Lola Traverson
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Kate Zinszer
- School of Public Health, University of Montréal, Montréal, Canada
- Centre de recherche en santé publique (CReSP), University of Montréal and CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Canada
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Agostini L, Onofrio R, Piccolo C, Stefanini A. A management perspective on resilience in healthcare: a framework and avenues for future research. BMC Health Serv Res 2023; 23:774. [PMID: 37468875 DOI: 10.1186/s12913-023-09701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/14/2023] [Indexed: 07/21/2023] Open
Abstract
Recent major health shocks, such as the 2014-16 Ebola, the Zika outbreak, and, last but not least, the COVID-19 pandemic, have strongly contributed to drawing attention to the issue of resilience in the healthcare domain. Nevertheless, the scientific literature appears fragmented, creating difficulties in developing incremental research in this relevant managerial field.To fill this gap, this systematic literature review aims to provide a clear state of the art of the literature dealing with resilience in healthcare. Specifically, from the analysis of the theoretical articles and reviews, the key dimensions of resilience are identified, and a novel classification framework is proposed. The classification framework is then used to systematize extant empirical contributions. Two main dimensions of resilience are identified: the approach to resilience (reactive vs. proactive) and the type of crisis to deal with (acute shocks vs. chronic stressors). Four main streams of research are thus identified: (i) proactive approaches to acute shocks; (ii) proactive approaches to chronic stressors; (iii) reactive approaches to acute shocks; and (iv) reactive approaches to chronic stressors. These are scrutinised considering three additional dimensions: the level of analysis, the resources to nurture resilience, and the country context. The classification framework and the associated mapping contribute to systematising the fragmented literature on resilience in healthcare, providing a clear picture of the state of the art in this field and drawing a research agenda that opens interesting paths for future research.
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Affiliation(s)
- L Agostini
- Department of Management and Engineering, University of Padova, Stradella San Nicola 3, Padua, Italy.
| | - R Onofrio
- Department of Management, Economics and Industrial Engineering, Politecnico Di Milano, Piazza Leonardo da Vinci, 32, Milano, Italy
| | - C Piccolo
- Department of Industrial Engineering, University of Naples Federico II, C.So Umberto I, 40, Naples, Italy
| | - A Stefanini
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Lungarno Antonio Pacinotti, 43, Pisa, Italy
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Cousins K, Hertelendy AJ, Chen M, Durneva P, Wang S. Building resilient hospital information technology services through organizational learning: Lessons in CIO leadership during an international systemic crisis in the United States and Abu Dhabi, United Arab Emirates. Int J Med Inform 2023; 176:105113. [PMID: 37290271 DOI: 10.1016/j.ijmedinf.2023.105113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The COVID-19 pandemic was an international systemic crisis which required an unprecedented response to quickly drive the digital transformation of hospitals and health care systems to support high quality health care while adhering to contagion management protocols. OBJECTIVE To identify and assess the best practices during the COVID-19 pandemic by Chief Information Officers (CIOs) about how to build resilient healthcare IT (HIT) to improve pandemic preparedness and response across global settings and to develop recommendations for future pandemics. METHODS We conducted a qualitative, interview-based study to sample CIOs in hospitals. We interviewed 16 CIOs from hospitals and health systems in the United States and Abu Dhabi, United Arab Emirates. We used in-depth interviews to capture their perspectives of the preparedness of hospitals' information technology departments for the pandemic and how they lead their IT department out of the pandemic. RESULTS Results showed that healthcare CIOs were ambidextrous IT leaders who built resilient HIT by rapidly improving existing digital business practices and creating innovative IT solutions. Ambidextrous IT leadership involved exploiting existing IT resources as well as exploring and innovating for continuous growth. IT resiliency focused on four inter-related capabilities: ambidextrous leadership, governance, innovation and learning, and HIT infrastructure. CONCLUSIONS We propose conceptual frameworks to guide the development of healthcare IT resilience and highlight the importance of organizational learning as an integral component of HIT resiliency.
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Affiliation(s)
- Karlene Cousins
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, USA
| | - Attila J Hertelendy
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, USA.
| | - Min Chen
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, USA
| | - Polina Durneva
- Department of Business Information and Technology, Fogelman College of Business and Economics, University of Memphis, Memphis, TN, USA
| | - Shangjun Wang
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, USA
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6
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Powell JE, Orttung RW, Topkok SA, Akselrod H, Little J, Wilcox P. Juneau, Alaska’s Successful Response to COVID-19: A Case Study of
Adaptive Leadership in a Complex System. STATE AND LOCAL GOVERNMENT REVIEW 2023; 55:41-61. [PMCID: PMC9806194 DOI: 10.1177/0160323x221136504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Juneau, Alaska, kept COVID-19 deaths lower than in other similar jurisdictions. We argue that adaptive leadership—the early decisions and actions of Juneau’s leaders, effective communications, and emergent new collaborative structures—in the context of municipal ownership of key assets enabled Juneau’s success. The result of 61 interviews and follow-up research, this case study contributes a better understanding of which institutional design, communication, and collaborative factors mattered in responding to the pandemic. Adaptive leadership provides a better explanation for Juneau’s success than alternatives that focus on its isolation, home-rule status, and socio-economic structure.
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Affiliation(s)
- James E. Powell
- Alaska Coastal Rainforest Center,
University of Alaska Southeast, Juneau, AK, USA
- International Arctic Reseach Center,
University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Robert W. Orttung
- Elliott School of International
Affairs, The George Washington University, Washington, DC, USA
| | - Sean Asikłuk Topkok
- Center for Cross-Cultural Studies,
Indigenous Studies Graduate Programs, University of Alaska Fairbanks, Fairbanks, AK,
USA
| | - Hana Akselrod
- Division of Infectious Diseases, School
of Medicine & Health Sciences, The George Washington University, Washington, DC,
USA
| | - Joseph Little
- W. A. Franke College of Business,
Northern Arizona University, Flagstaff, USA
| | - Peggy Wilcox
- Pardee RAND Graduate School, Santa
Monica, CA, USA
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7
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White DG, O'Brien MA, Cornacchi SD, Freeman R, Grunfeld E. COVID-19: A Qualitative Analysis of Academic Family Physician Leaders' Crisis Response. Fam Med 2023; 55:38-44. [PMID: 36656886 PMCID: PMC10681343 DOI: 10.22454/fammed.55.421082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The onset of the COVID-19 pandemic severely threatened all aspects of academic family medicine, constituting a crisis. Multiple publications have identified recommendations and documented the creative responses of primary care and academic organizations to address these challenges, but there is little research on how decisions came about. Our objective was to gain insight into the context, process, and nature of family medicine leaders' discussions in pivoting to address a crisis. METHODS We used a qualitative descriptive design to explore new dimensions of existing concepts. The setting was the academic family medicine department at the University of Toronto. To identify leadership themes, we used the constant comparative method to analyze transcripts of monthly meetings of the departmental executive: three meetings immediately before and three following the declaration of a state emergency in Ontario. RESULTS Six themes were evident before and after the onset of the pandemic: building capacity in academic family medicine; developing leadership; advancing equity, diversity, and inclusion; learner safety and wellness; striving for excellence; and promoting a supportive and collegial environment. Five themes emerged as specific responses to the crisis: situational awareness; increased multidirectional communication; emotional awareness; innovation in education and patient care; and proactive planning for extended adaptation to the pandemic. CONCLUSION Existing cultural and organizational approaches formed the foundation for the crisis response, while crisis-specific themes reflected skills and attitudes that are essential in clinical family medicine, including adapting to community needs, communication, and emotional awareness.
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Affiliation(s)
- David G. White
- Department of Family and Community Medicine, University of TorontoToronto, ONCanada
- North York General HospitalNorth York, ONCanada
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of TorontoToronto, ONCanada
| | - Sylvie D. Cornacchi
- Department of Family and Community Medicine, University of TorontoToronto, ONCanada
| | - Risa Freeman
- Department of Family and Community Medicine, University of TorontoToronto, ONCanada
- North York General HospitalNorth York, ONCanada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of TorontoToronto, ONCanada
- Ontario Institute for Cancer ResearchToronto, ONCanada
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8
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Lee K, Bolton SL, Shterenberg R, Bolton JM, Hensel JM. Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study. JMIR Form Res 2022; 6:e39861. [PMID: 36252139 PMCID: PMC9640197 DOI: 10.2196/39861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/26/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic was accompanied by the accelerated uptake of virtual care, leading to a proliferation of virtual ward models as alternatives to facility-based care. Early in the pandemic, our program implemented a virtual mental health crisis ward (vWard) to provide options for individuals requiring intense psychiatric and/or crisis support but who preferred to remain in the community and were deemed safe to do so. Objective The aim of this study was to identify early learnings from the vWard, which was implemented rapidly in a resource-constrained environment, to inform the future state should it be sustained beyond the pandemic. Methods Mixed methods of data collection were used to evaluate provider perspectives on the vWard, develop archetypes for individuals who are a good fit for the vWard model, and create a driver diagram. Data sources included an anonymous survey of clinical and managerial staff involved in the vWard, a service planning workshop, and program discharge forms for all individuals admitted between March 2020 and April 2021. Survey responses were coded for themes under categories of “benefits” and “challenges.” Discharge forms where the team indicated that the vWard was a good fit for an individual were examined for characteristics common to these admissions. These findings were reviewed in the service planning workshop and refined with input from the participants into patient archetypes. A driver diagram was created for the future state. Results Survey respondents (N=60) represented diverse roles in crisis services and the vWard team. Ten providers took part in the service planning workshop. A total of 467 discharge forms were reviewed. The vWard was felt to be a model that worked by 39 survey respondents, one respondent felt it did not work, and the remaining participants had no response. Several benefits for the individual and the system were identified alongside challenges, including certain processes and materials related to the nature of rapid implementation during the pandemic, and others due to lack of fit for certain individuals. The model was felt to be a good fit for 67.5% of admissions. Four patient archetypes representing a good fit with the model were developed. The driver diagram connected the program aim with primary drivers of (1) reduce barriers to care; (2) improve outcomes; and (3) provide collaborative, patient- and family-centered care to secondary drivers and interventions that leveraged virtual technology among other crisis care interventions. Conclusions Despite some challenges, the vWard demonstrated high levels of provider acceptance and a range of mechanisms by which the model works for a variety of patient archetypes. These early learnings provide a foundation for growth, sustainability, and spread of this model going forward beyond the pandemic.
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Affiliation(s)
- Katherine Lee
- Max Rady School of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Shay-Lee Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Ravit Shterenberg
- Max Rady School of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
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Assefa Y, Woldeyohannes S, Cullerton K, Gilks CF, Reid S, Van Damme W. Attributes of national governance for an effective response to public health emergencies: Lessons from the response to the COVID-19 pandemic. J Glob Health 2022; 12:05021. [PMID: 35787525 PMCID: PMC9258903 DOI: 10.7189/jogh.12.05021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The Coronavirus Disease 2019 (COVID-19) pandemic takes variable shapes and forms in different regions and countries. This variability is explained by several factors, including the governance of the epidemic. We aimed to identify the key attributes of governance in response to the COVID-19 pandemic and gain lessons for an effective response to public health emergencies. Methods We employed a mixed-methods design. We mapped the attributes of governance from well-established governance frameworks. A negative binomial regression was conducted to identify the effect of the established governance measures on the epidemiology of the COVID-19 pandemic. We used publicly available data on COVID-19 cases and deaths in countries around the world. Document review was conducted to identify the key approaches and attributes of governance during the pre-vaccine era of the response to the COVID-19 pandemic. We conducted a thematic analysis to identify key attributes for effective governance. Results The established governance measures, including generation of intelligence, strategic direction, regulation, partnership, accountability, transparency, rule of law, control of corruption, responsiveness, effectiveness, efficiency, equity, ethics, and inclusiveness, are necessary but not sufficient to effectively respond to and contain the COVID-19 pandemic. Additional attributes of national governance were identified: 1) agile, adaptive, and transformative governance; 2) collective (collaborative, inclusive, cooperative, accountable, and transparent) governance; 3) multi-level governance; 4) smart and ethical governance: sensible, pragmatic, evidence-based, political, learner, and ethical. Conclusions The current governance frameworks and their attributes are not adequate to contain the COVID-19 pandemic. We argue that countries need agile, adaptable, and transformational, collaborative, multi-level, smart and ethical governance to effectively respond to emerging and re-emerging public health threats. In addition, an effective response to public health emergencies depends not only on national governance but also on global governance. Hence, global health governance should be urgently renewed through a paradigm shift towards universal health coverage and health security to all populations and in all countries. This requires enhanced and consistent global health diplomacy based on knowledge, solidarity, and negotiation.
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Affiliation(s)
- Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
| | | | | | - Charles F Gilks
- School of Public Health, the University of Queensland, Brisbane, Australia
| | - Simon Reid
- School of Public Health, the University of Queensland, Brisbane, Australia
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10
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Laur C, Agarwal P, Thai K, Kishimoto V, Kelly S, Liang K, Bhatia RS, Bhattacharyya O, Martin D, Mukerji G. Implementation and Evaluation of COVIDCare@Home, a Family Medicine Led Remote Monitoring Program for COVID-19 Patients: a multi-method cross-sectional study. JMIR Hum Factors 2022; 9:e35091. [PMID: 35499974 PMCID: PMC9239565 DOI: 10.2196/35091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background COVIDCare@Home (CC@H) is a multifaceted, interprofessional team-based remote monitoring program led by family medicine for patients diagnosed with COVID-19, based at Women’s College Hospital (WCH), an ambulatory academic center in Toronto, Canada. CC@H offers virtual visits (phone and video) to address the clinical needs and broader social determinants of the health of patients during the acute phase of COVID-19 infection, including finding a primary care provider (PCP) and support for food insecurity. Objective The objective of this evaluation is to understand the implementation and quality outcomes of CC@H within the Quadruple Aim framework of patient experience, provider experience, cost, and population health. Methods This multimethod cross-sectional evaluation follows the Quadruple Aim framework to focus on implementation and service quality outcomes, including feasibility, adoption, safety, effectiveness, equity, and patient centeredness. These measures were explored using clinical and service utilization data, patient experience data (an online survey and a postdischarge questionnaire), provider experience data (surveys, interviews, and focus groups), and stakeholder interviews. Descriptive analysis was conducted for surveys and utilization data. Deductive analysis was conducted for interviews and focus groups, mapping to implementation and quality domains. The Ontario Marginalization Index (ON-Marg) measured the proportion of underserved patients accessing CC@H. Results In total, 3412 visits were conducted in the first 8 months of the program (April 8-December 8, 2020) for 616 discrete patients, including 2114 (62.0%) visits with family physician staff/residents and 149 (4.4%) visits with social workers/mental health professionals. There was a median of 5 (IQR 4) visits per patient, with a median follow-up of 7 days (IQR 27). The net promoter score was 77. In addition, 144 (23.3%) of the patients were in the most marginalized populations based on the residential postal code (as per ON-Marg). Interviews with providers and stakeholders indicated that the program continued to adapt to meet the needs of patients and the health care system. Conclusions Future remote monitoring should integrate support for addressing the social determinants of health and ensure patient-centered care through comprehensive care teams.
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Affiliation(s)
- Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA
| | - Payal Agarwal
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Department of Family and Community Medicine, University of Toronto, Toronto, CA
| | - Kelly Thai
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA
| | - Vanessa Kishimoto
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA
| | | | | | - R Sacha Bhatia
- Population Health and Values Based Health Systems, Ontario Health, Toronto, CA.,Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Temerty Faculty of Medicine, University of Toronto, Toronto, CA.,Peter Munk Cardiac Centre, University Health Network, Toronto, CA
| | - Onil Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Department of Family and Community Medicine, University of Toronto, Toronto, CA
| | - Danielle Martin
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Department of Family and Community Medicine, University of Toronto, Toronto, CA.,Women's College Hospital, Toronto, CA.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, CA
| | - Geetha Mukerji
- Women's College Hospital, Toronto, CA.,Temerty Faculty of Medicine, University of Toronto, Toronto, CA.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, CA
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11
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Peyroteo M, Ferreira IA, Elvas LB, Ferreira JC, Lapão LV. Remote Monitoring Systems for Patients With Chronic Diseases in Primary Health Care: Systematic Review. JMIR Mhealth Uhealth 2021; 9:e28285. [PMID: 34932000 PMCID: PMC8734917 DOI: 10.2196/28285] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/25/2021] [Accepted: 10/08/2021] [Indexed: 01/19/2023] Open
Abstract
Background The digital age, with digital sensors, the Internet of Things (IoT), and big data tools, has opened new opportunities for improving the delivery of health care services, with remote monitoring systems playing a crucial role and improving access to patients. The versatility of these systems has been demonstrated during the current COVID-19 pandemic. Health remote monitoring systems (HRMS) present various advantages such as the reduction in patient load at hospitals and health centers. Patients that would most benefit from HRMS are those with chronic diseases, older adults, and patients that experience less severe symptoms recovering from SARS-CoV-2 viral infection. Objective This paper aimed to perform a systematic review of the literature of HRMS in primary health care (PHC) settings, identifying the current status of the digitalization of health processes, remote data acquisition, and interactions between health care personnel and patients. Methods A systematic literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify articles that explored interventions with HRMS in patients with chronic diseases in the PHC setting. Results The literature review yielded 123 publications, 18 of which met the predefined inclusion criteria. The selected articles highlighted that sensors and wearables are already being used in multiple scenarios related to chronic disease management at the PHC level. The studies focused mostly on patients with diabetes (9/26, 35%) and cardiovascular diseases (7/26, 27%). During the evaluation of the implementation of these interventions, the major difficulty that stood out was the integration of information into already existing systems in the PHC infrastructure and in changing working processes of PHC professionals (83%). Conclusions The PHC context integrates multidisciplinary teams and patients with often complex, chronic pathologies. Despite the theoretical framework, objective identification of problems, and involvement of stakeholders in the design and implementation processes, these interventions mostly fail to scale up. Despite the inherent limitations of conducting a systematic literature review, the small number of studies in the PHC context is a relevant limitation. This study aimed to demonstrate the importance of matching technological development to the working PHC processes in interventions regarding the use of sensors and wearables for remote monitoring as a source of information for chronic disease management, so that information with clinical value is not lost along the way.
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Affiliation(s)
- Mariana Peyroteo
- NOVA School of Science and Technology, NOVA University of Lisbon, Setúbal, Portugal.,Inov Inesc Inovação, Instituto de Novas Tecnologias, Lisbon, Portugal
| | - Inês Augusto Ferreira
- Instituto Universitário de Lisboa (ISCTE-IUL), ISTAR, Lisbon, Portugal.,School of Biology, St Leonard's Postgraduate College, The University of St Andrews, St Andrews, United Kingdom
| | - Luís Brito Elvas
- Inov Inesc Inovação, Instituto de Novas Tecnologias, Lisbon, Portugal.,Instituto Universitário de Lisboa (ISCTE-IUL), ISTAR, Lisbon, Portugal
| | - João Carlos Ferreira
- Inov Inesc Inovação, Instituto de Novas Tecnologias, Lisbon, Portugal.,Instituto Universitário de Lisboa (ISCTE-IUL), ISTAR, Lisbon, Portugal
| | - Luís Velez Lapão
- Unidade de Investigação e Desenvolvimento em Engenharia Mecanica e Industrial, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Setúbal, Portugal.,Comprehensive Health Research Center, NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal
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Integrated Care's New Protagonist: The Expanding Role of Digital Health. Int J Integr Care 2021; 21:1. [PMID: 34712108 PMCID: PMC8516005 DOI: 10.5334/ijic.6437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
Digital health technologies hold significant promise to advance both functional and normative health and social care integration. The COVID-19 pandemic has created a window of opportunity to rapidly advance the adoption of digital solutions which can improve activities that support integration at clinical, professional, organizational and system levels. Global examples demonstrate how the pandemic has also created opportunities to use technology to address core values of integrated care like person-centredness and coordination. However, rapid and reactive changes could lead to increased fragmentation and exacerbate health inequity. This perspective paper outlines some of the opportunities and threats to advancing integrated care presented by the rapid adoption of digital health tools, suggesting we maintain a long view to ensure the stage we set today will mean greater integration tomorrow.
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13
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Willems SH, Rao J, Bhambere S, Patel D, Biggins Y, Guite JW. Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity. JMIR Mhealth Uhealth 2021; 9:e25021. [PMID: 34033575 PMCID: PMC8202659 DOI: 10.2196/25021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/01/2021] [Accepted: 05/18/2021] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has generated unprecedented and sustained health management challenges worldwide. Health care systems continue to struggle to support the needs of the majority of infected individuals that are either asymptomatic or have mild symptoms. In addition, long-term effects in the form of long-lasting COVID-19 symptoms or widespread mental health issues aggravated by the pandemic pose a burden on health care systems worldwide. This viewpoint article considers aspects of digital health care solutions and how they can play an ongoing role in safely addressing gaps in the health care support available from initially and repeatedly overwhelmed providers and systems. Digital solutions can be readily designed to address this need and can be flexible enough to adapt to the evolving management requirements of various stakeholders to reduce COVID-19 infection rates, acute hospitalizations, and mortality. Multiplatform solutions provide a hybrid model of care, which can include mobile and online platforms accompanied by direct clinician input and feedback. Desirable components to be included are discussed, including symptom tracking, patient education, well-being support, and bidirectional communication between patients and clinicians. Customizable and scalable digital health platforms not only can be readily adapted to further meet the needs of employers and public health stakeholders during the ongoing pandemic, but also hold relevance for flexibly meeting broader care management needs into the future.
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Affiliation(s)
- Sofie H Willems
- DayToDay Health, Health Innovators Inc, Boston, MA, United States
| | - Jyotsna Rao
- DayToDay Health, Health Innovators Inc, Boston, MA, United States
| | - Sailee Bhambere
- DayToDay Health, Health Innovators Inc, Boston, MA, United States
| | - Dipu Patel
- DayToDay Health, Health Innovators Inc, Boston, MA, United States
| | - Yvonne Biggins
- DayToDay Health, Health Innovators Inc, Boston, MA, United States
| | - Jessica W Guite
- DayToDay Health, Health Innovators Inc, Boston, MA, United States.,Center for Advancement in Managing Pain, School of Nursing, The University of Connecticut, Storrs, CT, United States
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