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Bellmann L, Wiederhold AJ, Trübe L, Twerenbold R, Ückert F, Gottfried K. Introducing Attribute Association Graphs to Facilitate Medical Data Exploration: Development and Evaluation Using Epidemiological Study Data. JMIR Med Inform 2024; 12:e49865. [PMID: 39046780 PMCID: PMC11306949 DOI: 10.2196/49865] [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: 06/12/2023] [Revised: 10/11/2023] [Accepted: 05/04/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Interpretability and intuitive visualization facilitate medical knowledge generation through big data. In addition, robustness to high-dimensional and missing data is a requirement for statistical approaches in the medical domain. A method tailored to the needs of physicians must meet all the abovementioned criteria. OBJECTIVE This study aims to develop an accessible tool for visual data exploration without the need for programming knowledge, adjusting complex parameterizations, or handling missing data. We sought to use statistical analysis using the setting of disease and control cohorts familiar to clinical researchers. We aimed to guide the user by identifying and highlighting data patterns associated with disease and reveal relations between attributes within the data set. METHODS We introduce the attribute association graph, a novel graph structure designed for visual data exploration using robust statistical metrics. The nodes capture frequencies of participant attributes in disease and control cohorts as well as deviations between groups. The edges represent conditional relations between attributes. The graph is visualized using the Neo4j (Neo4j, Inc) data platform and can be interactively explored without the need for technical knowledge. Nodes with high deviations between cohorts and edges of noticeable conditional relationship are highlighted to guide the user during the exploration. The graph is accompanied by a dashboard visualizing variable distributions. For evaluation, we applied the graph and dashboard to the Hamburg City Health Study data set, a large cohort study conducted in the city of Hamburg, Germany. All data structures can be accessed freely by researchers, physicians, and patients. In addition, we developed a user test conducted with physicians incorporating the System Usability Scale, individual questions, and user tasks. RESULTS We evaluated the attribute association graph and dashboard through an exemplary data analysis of participants with a general cardiovascular disease in the Hamburg City Health Study data set. All results extracted from the graph structure and dashboard are in accordance with findings from the literature, except for unusually low cholesterol levels in participants with cardiovascular disease, which could be induced by medication. In addition, 95% CIs of Pearson correlation coefficients were calculated for all associations identified during the data analysis, confirming the results. In addition, a user test with 10 physicians assessing the usability of the proposed methods was conducted. A System Usability Scale score of 70.5% and average successful task completion of 81.4% were reported. CONCLUSIONS The proposed attribute association graph and dashboard enable intuitive visual data exploration. They are robust to high-dimensional as well as missing data and require no parameterization. The usability for clinicians was confirmed via a user test, and the validity of the statistical results was confirmed by associations known from literature and standard statistical inference.
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Affiliation(s)
- Louis Bellmann
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Leona Trübe
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg-Kiel-Lübeck, Hamburg, Germany
- University Center of Cardiovascular Science, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Ückert
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Gottfried
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Garzón-Orjuela N, Vornhagen H, Blake C, Vellinga A. Evaluation of different landing pages on behavioural engagement with the CARA dashboard: A user research protocol. BMC PRIMARY CARE 2024; 25:174. [PMID: 38769539 PMCID: PMC11103958 DOI: 10.1186/s12875-024-02420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND CARA set out to develop a data-visualisation platform to facilitate general practitioners to develop a deeper understanding of their patient population, disease management and prescribing through dashboards. To support the continued use and sustainability of the CARA dashboards, dashboard performance and user engagement have to be optimised. User research places people at the centre of the design process and aims to evaluate the needs, behaviours and attitudes of users to inform the design, development and impact of a product. OBJECTIVE To explore how different initial key messages impact the level of behavioural engagement with a CARA dashboard. METHODS Participating general practices can upload their practice data for analysis and visualisation in CARA dashboards. Practices will be randomised to one of three different initial landing pages: the full dashboard or one of two key messages: a between comparison (their practice prescribing with the average of all other practices) or within comparison (with practice data of the same month the previous year) with subsequent continuation to the full dashboard. Analysis will determine which of the three landing pages encourages user interaction, as measured by the number of 'clicks', 'viewings' and 'sessions'. Dashboard usage data will be collected through Google analytics. DISCUSSION This study will provide evidence of behavioural engagement and its metrics during the implementation of the CARA dashboards to optimise and sustain interaction. TRIAL REGISTRATION ISRCTN32783644 (Registration date: 02/01/2024).
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Affiliation(s)
- Nathaly Garzón-Orjuela
- CARA Network, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | - Heike Vornhagen
- Insight Centre for Data Analytics, University of Galway, Galway, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Akke Vellinga
- CARA Network, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Arsenault-Lapierre G, Lemay-Compagnat A, Guillette M, Couturier Y, Massamba V, Dufour I, Maubert E, Fournier C, Denis J, Morin C, Vedel I. Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations. JMIR Form Res 2024; 8:e55064. [PMID: 38717803 PMCID: PMC11112472 DOI: 10.2196/55064] [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: 12/01/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. OBJECTIVE The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. METHODS An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization's jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled "university/peripheral"; organizations for which only part of the territory is in rural areas, labeled "mixed"; and organizations in remote or isolated areas, labeled "remote/isolated") and according to different types of participants (managers, leading clinicians, and other participants). RESULTS Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. CONCLUSIONS These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards.
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Affiliation(s)
- Genevieve Arsenault-Lapierre
- Center for Research and Expertise in Social Gerontology, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Côte Saint-Luc, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra Lemay-Compagnat
- Lady Davis Institute for Medical Research, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Montreal, QC, Canada
| | - Maxime Guillette
- Department of Social Work, Sherbrooke University, Sherbrooke, QC, Canada
| | - Yves Couturier
- Department of Social Work, Sherbrooke University, Sherbrooke, QC, Canada
| | | | - Isabelle Dufour
- School of Nursing, Sherbrooke University, Sherbrooke, QC, Canada
- Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Eric Maubert
- Integrated University Health and Social Services Network of McGill University, Montreal, QC, Canada
| | - Christine Fournier
- Integrated University Health and Social Services Network of Université de Montréal, Montreal, QC, Canada
| | - Julie Denis
- Integrated University Health and Social Services Network of Université Laval, Quebec, QC, Canada
| | - Caroline Morin
- Integrated University Health and Social Services Network of Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Montreal, QC, Canada
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Cristian A, Rubens M, Orada R, DeVries K, Syrkin G, DePiero MT, Estenoz M, Kothakapu S, McGranaghan P, Lindeman PR. Development of a Cancer Rehabilitation Dashboard to Collect Data on Physical Function in Cancer Patients and Survivors. Am J Phys Med Rehabil 2024; 103:S36-S40. [PMID: 38364028 DOI: 10.1097/phm.0000000000002424] [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: 02/18/2024]
Abstract
OBJECTIVE The aim of the study is to describe the development of a cancer rehabilitation dashboard that collects data on physical function for cancer survivors in a cancer institute. METHODS This project was conducted at the Miami Cancer Institute. The cancer rehabilitation dashboard was developed by a team of physicians, biostatistician, and medical informatics teams to record, report and track the physical function of cancer survivors. A multimodal approach to the measurement of physical function was used and included the Patient-Reported Outcome Measurement Information System-Physical Function short form, Patient-Reported Outcome Measurement Information System-Fatigue short form, Timed Up and Go Test, Sit-to-Stand Test in 30-sec test, four-stage balance test, and grip strength. To develop this system, a Cerner Power Form was developed based on the physical function data. To display the data, a dedicated flowsheet was developed and placed within the Oncology Viewpoint in Cerner Millennium. Thus, from inside any patient record, the flowsheet could easily be accessed by providers without leaving normal clinician workflows. Using native functionality, the data can also be shown in graphical format to facilitate dialog with patients and oncology teams. All patient data from the Cerner Power Form discrete task assays were integrated into an existing Oncology Data Warehouse for all patients. The data elements in the Cerner Power Form were identified in the electronic medical record system, loaded into the Oncology Data Warehouse, and related to the other source systems to develop reports and data visualizations such as the cancer rehabilitation dashboard. The cancer rehabilitation dashboard allows visualization of numerous parameters of physical function in cancer survivors evaluated and treated and their change over time. Rendered in Tableau, the cancer rehabilitation dashboard acts as a centralized, interactive data source to analyze and connect clinicians to near real-time data. RESULTS The cancer rehabilitation dashboard was successfully developed and implemented into a cancer rehabilitation practice in a cancer institute and used to collect and track physical function data for cancer survivors receiving treatment and cancer survivors. This information has been used to direct the treatment plan and educate individual patients about the impact of the cancer and its treatment on physical function as well as oncology teams in a cancer institute. CONCLUSIONS The cancer rehabilitation dashboard provides an insight into the physical function of cancer survivors receiving treatment and cancer survivors using both self-reported and objective metrics. It can be customized to suit the interests of clinicians and researchers wishing to improve the quality of life of this population.
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Affiliation(s)
- Adrian Cristian
- From the Cancer Rehabilitation, Cancer Patient Support Center-Miami Cancer Institute, Miami, Florida (AC); Department of Oncology Research, Miami Cancer Institute, Miami, Florida (MR); Cancer Patient Support Center, Miami Cancer Institute, Miami, Florida (RO); New York Presbyterian Hospital, New York, New York (KD); Weill Cornell Medical College, New York, New York (KD); Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (GS); Informatics Analyst, Department of Oncology Informatics, Miami Cancer Institute, Miami, Florida (MTD, ME, PRIL); Baptist Health South Florida, Miami, Florida (SK, PM); and Department of Oncology Informatics
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Aldosari B. Information Technology and Value-Based Healthcare Systems: A Strategy and Framework. Cureus 2024; 16:e53760. [PMID: 38465150 PMCID: PMC10921131 DOI: 10.7759/cureus.53760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Value-based healthcare offers a pathway for enhancing patient satisfaction and population health and reducing healthcare costs. In addition, it provides a means to enhance physicians' perception and experience in healthcare delivery. The foundation of the said system is the notion that community wellness can only be benefited when the health effects of many people are also addressed. The provision of healthcare services incurs costs. However, a value-based model addresses this issue by establishing teams that cater to individuals with similar needs. This approach fosters expertise and efficiency, ultimately leading to cost savings without rationing. Furthermore, entrusting decision-making authority regarding healthcare delivery to the clinical team enhances doctors' professionalism and the integrity of clinician-patient interactions, resulting in more effective and relevant treatments. Currently, various information technology (IT)-based solutions are the main focus for accomplishing the desired value-based healthcare system. The establishment of a coordinated framework that can help organizations create value-based healthcare systems is covered in the current article. Additionally listed are many IT-based solutions used to create a value-based healthcare system.
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Affiliation(s)
- Bakheet Aldosari
- Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, SAU
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Breitenstein SM, Berteletti J, Smoske S, Barger C, Tipps K, Helsabeck NP. Administrative Dashboard for Monitoring Use of a Web-Based Parent Training Intervention: Usability Study. JMIR Form Res 2024; 8:e53439. [PMID: 38289675 PMCID: PMC10865193 DOI: 10.2196/53439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/14/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Web-based parent training (PT) programs can strengthen parent-child relationships by equipping caregivers with knowledge and evidence-based strategies to manage behavior. Hybrid facilitation of PT includes facilitator interaction paired with self-administered and web-based PT. Web-based administrative dashboards provide users (eg, administrators, facilitators, and researchers) with an integrated platform to monitor parent progress and activities within a PT program or website. Despite the utility and prevalence of administrative dashboards for web-based behavioral interventions, to our knowledge, no research studies have explored the perspectives and insights of dashboard users to enhance user experience and program delivery. OBJECTIVE The purpose of this study is to evaluate the usability of the administrative dashboard (ezDashboard) for the ezParent program, a 6-module web-based PT program for parents of children aged 2-5 years. METHODS This study used a descriptive, single-group design with administrators who were overseeing the implementation of the ezParent program and trained facilitators for hybrid ezParent delivery. Participants spent at least 30 minutes reviewing and evaluating the ezDashboard and then completed a survey of their experience with the dashboard. The survey included the validated 10-item System Usability Scale and open-ended questions focusing on user performance, navigation ease, and overall usefulness of the ezDashboard. RESULTS Participants (N=15) indicated high usability of the ezDashboard with System Usability Scale scoring a total mean score of 83.5 (SD 16.3). Most participants (n=13, 87%) rated the overall user-friendliness of the ezDashboard as good (n=3, 20%), excellent (n=9, 60%), or best imaginable (n=1, 7%). Open-ended questions revealed the ezDashboard is or would be useful to monitor parent progress and trends in engagement (n=8, 53%) and for reviewing topics for discussion and communicating with parents (n=5, 33%). ezParent administrators (n=4) identified that real-time data for ezParent use helps overall management of program uptake. Suggestions for features to add to the ezDashboard included the ability to track partial progress of program modules (4/14, 29%), total time spent per module (2/14, 14%), and exportable reports (4/14, 29%). Other ideas for improvement included direct messaging capabilities, videoconferencing platform integration, and being able to modify participant account and contact information. CONCLUSIONS Results indicate that the ezDashboard is easy to use and provides functional information to facilitators and administrators in delivering ezParent. Qualitative results indicate that integrating suggested features into the ezDashboard may help provide a smoother experience for facilitators, administrators, and ultimately the parents using the program. Providing resources for facilitators and administrators in real time to monitor intervention participants' progress in a program can be helpful in tracking progress and providing facilitated support in tailoring program content and program completion.
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Affiliation(s)
| | | | - Shea Smoske
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | | | - Kyrie Tipps
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Nathan P Helsabeck
- College of Nursing, The Ohio State University, Columbus, OH, United States
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McEvoy NL, Curley MAQ. Do ICU dashboards influence quality of care? Nurs Crit Care 2023. [PMID: 38063408 DOI: 10.1111/nicc.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Natalie L McEvoy
- Department of Anaesthesia and Critical care, Education and Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Martha A Q Curley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
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Burningham Z, Jackson GL, Kelleher JL, Morris I, Stevens MB, Cohen J, Maloney G, Sauer BC, Halwani AS, Chen W, Vaughan CP. Use of a Medication Safety Audit and Feedback Tool in the Emergency Department Is Affected by Prescribing Characteristics. Appl Clin Inform 2023; 14:684-692. [PMID: 37648222 PMCID: PMC10468720 DOI: 10.1055/s-0043-1771393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/17/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUIPPED) program developed an audit and feedback health information technology (IT) solution with the intent to replace the in-person academic detailing service provided by the program. The EQUIPPED dashboard provides emergency department (ED) providers with a personalized view of their prescribing performance. OBJECTIVES Here, we analyze the association between ED provider characteristics and viewership of the EQUIPPED dashboard, adding insight into strategies for addressing barriers to initial use. METHODS We performed a retrospective analysis of EQUIPPED dashboard viewership among four Veterans Affairs (VA) EDs. We extracted quantitative data from user interaction logs to determine evidence of dashboard use. Provider characteristics and baseline potentially inappropriate medication (PIM) prescribing rate were extracted from the VA's Corporate Data Warehouse. Logistic regression was used to examine the association between dashboard use and provider characteristics. RESULTS A total of 82 providers were invited to receive audit and feedback via the EQUIPPED dashboard. Among invited providers, 40 (48.7%) had evidence of at least 1 dashboard view during the 1-year feedback period. Adjusted analyses suggest that providers with a higher baseline PIM prescribing rate were more likely to use the dashboard (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.01-1.47). Furthermore, providers at ED site D were more likely to use the dashboard in comparison to the other sites (OR: 9.99; 95% CI: 1.72-58.04) and reportedly had the highest site-level baseline PIM rate. CONCLUSION Providers with lower PIM prescribing rates (i.e., <5%) receive communication from an integrated dashboard reminder system that they are "optimal prescribers" which may have discouraged initial attempts to view the dashboard. Site D had the highest baseline PIM rate, but further qualitative investigation is warranted to better understand why site D had the greatest users of the dashboard.
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Affiliation(s)
- Zach Burningham
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - George L. Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
- Medicine (Division of General Internal Medicine), and Family Medicine & Community Health, Departments of Population Health Sciences, Duke University, Durham, North Carolina, United States
| | - Jessica L. Kelleher
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia, United States
| | - Isis Morris
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
| | - Melissa B. Stevens
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia, United States
- Division of General Medicine and Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia, United States
| | - Joy Cohen
- Department of Emergency Medicine, New Orleans Veterans Affairs Medical Center, New Orleans, Louisiana, United States
| | - Gerald Maloney
- Department of Emergency Medicine, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States
| | - Brian C. Sauer
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
| | - Ahmad S. Halwani
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Wei Chen
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
| | - Camille P. Vaughan
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia, United States
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Katapally TR, Ibrahim ST. Digital Health Dashboards for Decision-Making to Enable Rapid Responses During Public Health Crises: Replicable and Scalable Methodology. JMIR Res Protoc 2023; 12:e46810. [PMID: 37389905 PMCID: PMC10365636 DOI: 10.2196/46810] [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: 03/03/2023] [Revised: 03/27/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has reiterated the need for cohesive, collective, and deliberate societal efforts to address inherent inefficiencies in our health systems and overcome decision-making gaps using real-time data analytics. To achieve this, decision makers need independent and secure digital health platforms that engage citizens ethically to obtain big data, analyze and convert big data into real-time evidence, and finally, visualize this evidence to inform rapid decision-making. OBJECTIVE The objective of this study is to develop replicable and scalable jurisdiction-specific digital health dashboards for rapid decision-making to ethically monitor, mitigate, and manage public health crises via systems integration beyond health care. METHODS The primary approach in the development of the digital health dashboard was the use of global digital citizen science to tackle pandemics like COVID-19. The first step in the development process was to establish an 8-member Citizen Scientist Advisory Council via Digital Epidemiology and Population Health Laboratory's community partnerships. Based on the consultation with the council, three critical needs of citizens were prioritized: (1) management of household risk of COVID-19, (2) facilitation of food security, and (3) understanding citizen accessibility of public services. Thereafter, a progressive web application (PWA) was developed to provide daily services that address these needs. The big data generated from citizen access to these PWA services are set up to be anonymized, aggregated, and linked to the digital health dashboard for decision-making, that is, the dashboard displays anonymized and aggregated data obtained from citizen devices via the PWA. The digital health dashboard and the PWA are hosted on the Amazon Elastic Compute Cloud server. The digital health dashboard's interactive statistical navigation was designed using the Microsoft Power Business Intelligence tool, which creates a secure connection with the Amazon Relational Database server to regularly update the visualization of jurisdiction-specific, anonymized, and aggregated data. RESULTS The development process resulted in a replicable and scalable digital health dashboard for decision-making. The big data relayed to the dashboard in real time reflect usage of the PWA that provides households the ability to manage their risk of COVID-19, request food when in need, and report difficulties and issues in accessing public services. The dashboard also provides (1) delegated community alert system to manage risks in real time, (2) bidirectional engagement system that allows decision makers to respond to citizen queries, and (3) delegated access that provides enhanced dashboard security. CONCLUSIONS Digital health dashboards for decision-making can transform public health policy by prioritizing the needs of citizens as well as decision makers to enable rapid decision-making. Digital health dashboards provide decision makers the ability to directly communicate with citizens to mitigate and manage existing and emerging public health crises, a paradigm-changing approach, that is, inverting innovation by prioritizing community needs, and advancing digital health for equity. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/46810.
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Affiliation(s)
- Tarun Reddy Katapally
- Digital Epidemiology and Population Health Laboratory (DEPtH Lab), School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Sheriff Tolulope Ibrahim
- Digital Epidemiology and Population Health Laboratory (DEPtH Lab), School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
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Sharma V, Cassetti O, Winning L, O'Sullivan M, Crowe M. Protocol for developing a dashboard for interactive cohort analysis of oral health-related data. BMC Oral Health 2023; 23:238. [PMID: 37095511 PMCID: PMC10124053 DOI: 10.1186/s12903-023-02895-2] [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: 12/12/2022] [Accepted: 03/17/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION A working knowledge of data analytics is becoming increasingly important in the digital health era. Interactive dashboards are a useful, accessible format for presenting and disseminating health-related information to a wide audience. However, many oral health researchers receive minimal data visualisation and programming skills. OBJECTIVES The objective of this protocols paper is to demonstrate the development of an analytical, interactive dashboard, using oral health-related data from multiple national cohort surveys. METHODS The flexdashboard package was used within the R Studio framework to create the structure-elements of the dashboard and interactivity was added with the Shiny package. Data sources derived from the national longitudinal study of children in Ireland and the national children's food survey. Variables for input were selected based on their known associations with oral health. The data were aggregated using tidyverse packages such as dplyr and summarised using ggplot2 and kableExtra with specific functions created to generate bar-plots and tables. RESULTS The dashboard layout is structured by the YAML (YAML Ain't Markup Language) metadata in the R Markdown document and the syntax from Flexdashboard. Survey type, wave of survey and variable selector were set as filter options. Shiny's render functions were used to change input to automatically render code and update output. The deployed dashboard is openly accessible at https://dduh.shinyapps.io/dduh/ . Examples of how to interact with the dashboard for selected oral health variables are illustrated. CONCLUSION Visualisation of national child cohort data in an interactive dashboard allows viewers to dynamically explore oral health data without requiring multiple plots and tables and sharing of extensive documentation. Dashboard development requires minimal non-standard R coding and can be quickly created with open-source software.
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Affiliation(s)
- Vinay Sharma
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - Oscar Cassetti
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - Lewis Winning
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - Michael O'Sullivan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - Michael Crowe
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland.
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Damschroder LJ, Sussman JB, Pfeiffer PN, Kurlander JE, Freitag MB, Robinson CH, Spoutz P, Christopher MLD, Battar S, Dickerson K, Sedgwick C, Wallace-Lacey AG, Barnes GD, Linsky AM, Ulmer CS, Lowery JC. Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients. Implement Sci Commun 2022; 3:53. [PMID: 35568903 PMCID: PMC9107220 DOI: 10.1186/s43058-022-00297-z] [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: 03/03/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background The adoption and sustainment of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of three EBPs: (1) a deprescribing approach intended to reduce potentially inappropriate polypharmacy; (2) appropriate dosing and drug selection of direct oral anticoagulants (DOACs); and (3) use of cognitive behavioral therapy as first-line treatment for insomnia before pharmacologic treatment. We describe the design and methods for a harmonized series of cluster-randomized control trials comparing two implementation strategies. Methods For each trial, we will recruit 8–12 clinics (24–36 total). All will have access to relevant clinical data to identify patients who may benefit from the target EBP at that clinic and provider. For each trial, clinics will be randomized to one of two implementation strategies to improve the use of the EBPs: (1) individual-level academic detailing (AD) or (2) AD plus the team-based Learn. Engage. Act. Process. (LEAP) quality improvement (QI) learning program. The primary outcomes will be operationalized across the three trials as a patient-level dichotomous response (yes/no) indicating patients with potentially inappropriate medications (PIMs) among those who may benefit from the EBP. This outcome will be computed using month-by-month administrative data. Primary comparison between the two implementation strategies will be analyzed using generalized estimating equations (GEE) with clinic-level monthly (13 to 36 months) percent of PIMs as the dependent variable. Primary comparative endpoint will be at 18 months post-baseline. Each trial will also be analyzed independently. Discussion MIDAS QUERI trials will focus on fostering sustained use of EBPs that previously had targeted but incomplete implementation. Our implementation approaches are designed to engage frontline clinicians in a dynamic optimization process that integrates the use of actional clinical data and making incremental changes, designed to be feasible within busy clinical settings. Trial registration ClinicalTrials.gov: NCT05065502. Registered October 4, 2021—retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00297-z.
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Affiliation(s)
- Laura J Damschroder
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
| | - Jeremy B Sussman
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Paul N Pfeiffer
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jacob E Kurlander
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Michelle B Freitag
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Claire H Robinson
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Patrick Spoutz
- Veterans Health Affairs VISN 20 Pharmacy Benefits Management, Vancouver, WA, USA
| | - Melissa L D Christopher
- Pharmacy Benefits Management Services, Veterans Health Administration, 810 Vermont Ave NW, Washington DC, 20420, USA
| | - Saraswathy Battar
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | | | - Christopher Sedgwick
- Department of Veterans Affairs, VA Heartland Network (VISN 15), Kansas City, MO, USA
| | | | - Geoffrey D Barnes
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Amy M Linsky
- Section of General Medicine, VA Boston Healthcare System, Boston, MA, USA.,Center for Health Organizations and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Christi S Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Julie C Lowery
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
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