Conceptual Model of Clinical Governance Information System for Statistical Indicators by Using UML in Two Sample Hospitals

DM management in HIV patients: the adoption of population health management to transform the chronic management of HIV

BACKGROUND

The success of antiretroviral therapies has made human immunodeficiency virus (HIV) a chronic disease, changing the care scenario dramatically. This study aimed to measure adherence to diabetes mellitus standards of care provided for people living with HIV (PLWH). Diabetes represents a paradigmatic case for tackling chronic care management in this target group.

METHODS

This retrospective observational study was performed on administrative health data retrieved from 2014 to 2016, with a validated algorithm to identify patients with HIV using: (i) hospital discharge records (ICD9-CM codes); (ii) drug dispensing records (with ATC codes); and (iii) disease-specific exemptions from co-payments for healthcare services. HIV-related treatments, comorbidities and health service utilization were measured, as was adherence to clinical guidelines-recommended standards of care for diabetes.

RESULTS

A population of 738 cases were identified in two Local Health Authorities in Italy, representing a prevalence of 0.14% of the general population, in line with the expected prevalence. Thirty-one cases of HIV patients diagnosed with diabetes were identified, a prevalence ratio of 4.2% compared to the 8% in the overall population. Adherence to diabetes standards of care tested within the same population was low, with the exception of those tests commonly administered for standard HIV follow-up care.

CONCLUSIONS

The use of administrative data, combined with a Population Health Management approach represents a powerful tool for evaluating system capacity to manage HIV comorbidities. Study findings prove that it is time to design new care models for PLWH, affected by one or more chronic conditions, both to prevent their onset and to manage their comorbidities.

Behavioral Feasibility of the Clinical Nursing Information System

Background:

Analysis of humanitarian issues affecting the implementation time of information systems to increase the acceptance of these systems is essential.

Objective:

The aim of this study was to assess the behavioral feasibility of the clinical nursing information system.

Methods:

An applied cross-sectional study was conducted with 348 nurses in 2015. Data were collected by face to face interviews and a questionnaire containing 33 questions, which were rated on a 5-point Likert scale. Face and content validity of the questionnaire was confirmed, and its reliability was estimated 0.90 through Cronbach's alpha coefficient. Data were analyzed using chi-square tests and t-test.

Results:

An average score of behavioral feasibility was 67.44%. The rate of supply provided for implementing the clinical nursing information system was 55.2%, which was in a semi-favorable level. The necessity of system deployment in the clinical nursing sector had the highest frequency (88.2%) and interference of redesigning structures with the current work had the lowest frequency (43.6%).

Conclusion:

The possibility of implementation of the clinical nursing information system in a behavioral dimension is at a semi-favorable level. To increase the acceptance of the system, presenting a new system as a positive change and further training of the nurses is recommended.

Designing and evaluating functional laboratory information system requirements integrated to hospital information systems

RATIONALE, AIMS, AND OBJECTIVES

Laboratory information sub-systems play an important role in diagnosis and treatment of patients. This study aimed to determine functional requirements of users and assess the existence of these requirements in the laboratory information system.

METHOD

This descriptive cross-sectional study was conducted in 2016 in two phases. The first phase was done through three stages. First, based on an unsystematic review of related literature, an outline of functional laboratory information system requirements was identified. In the second stage, these requirements were identified in group meetings in the form of a semi-structured questionnaire and given to experts. Then, modified Delphi technique was used to reach agreement on each item. Then, based on experts' comments, the final version of the questionnaire was presented including 61 closed-ended items using Likert scale and an open-ended item. It was surveyed by 50 experts using Delphi technique. Responses were scored, and the requirements whose mean final score was 3 and above were finally confirmed. In the second phase, based on the confirmed requirements, a checklist comprising 68 requirements was prepared and adopted hospital information systems were evaluated through researcher observation. Data were analysed using descriptive statistics.

RESULTS

The final list of functional laboratory information system requirements was prepared with 68 items. The results of the evaluation revealed that confirmed requirements existed in 58.8% of hospital information systems.

CONCLUSION

Laboratory information system requirements were designed with 68 items. Evaluation results showed that the systems were moderate in terms of compliance with the requirements.

Towards a Comprehensive Quality Evaluation Model for Hospital Websites

Background:

Hospital websites are important sources for patients to access health information.

Aim:

The purpose of this study was to develop the quality evaluation model for hospital websites.

Methods:

The quantitative study was conducted through the modified Delphi method in 2014-2015. The population of the study includes 10 experts were chosen by targeting non-randomized method. A questionnaire was prepared based on the prototype that was developed by research papers and related models. The validity of the questionnaires was confirmed by face validity and CVI and CVR estimation. Reliability was obtained by split-half method (α = 0.8). Experts’ opinions were collected through interview. Then, their frequency and percentage were determined. Items with options completely agree and agree over 75% was approved, items below 50% were removed, and items 50%–75% were removed after three interviews repetitions.

Results:

Most of the experts agreed about the pleasant and harmonious colors, the readable and consistent fonts (100%). The least frequency was allocated to correct grammar and words, support for multilingual and rapidly changing of displaying pages in the website with a frequency of 2 (20%).

Conclusion:

The minimum qualitative criteria for a website are usability, efficiency, user friendly, service, reliability and interaction.

Administrative databases and clinical governance: The case of COPD

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. However, COPD is still underdiagnosed, undertreated, and not sufficiently prevented. Health administrative databases provide a powerful way of studying COPD in the population.

METHODS

This retrospective study used administrative data, collected during 2011 and 2012, retrieved from 3 Italian local health authorities (LHAs).

RESULTS

The analysis through administrative databases allowed firstly to identify patients with COPD receiving services by the 3 LHAs: The estimated average is ~3% of the population aged ≥40 years. Furthermore, it was also possible to stratify patients by investigating the health consumption in hospitalization for COPD and use of respiratory drugs. In all 3 LHA patients with moderate COPD were the majority of the population with COPD. Finally, it was possible to distinguish patients who made an appropriate use of SABA (76% of the total), patients who had a potentially inappropriate use (20%), and those with an overuse of SABA (4%).

CONCLUSION

The use of SABA consumption patterns can be a reliable proxy variable to detect subgroups who may necessitate therapy revision. Health administrative databases seem beneficial for planning health care interventions, including the COPD field. They are robust information systems subjected to regular data quality controls remaining the prevalent data source, reliable because of the amount of data and the population coverage, especially in countries with a National Health Service System.

Construction of mammographic examination process ontology using bottom-up hierarchical task analysis

Describing complex mammography examination processes is important for improving the quality of mammograms. It is often difficult for experienced radiologic technologists to explain the process because their techniques depend on their experience and intuition. In our previous study, we analyzed the process using a new bottom-up hierarchical task analysis and identified key components of the process. Leveraging the results of the previous study, the purpose of this study was to construct a mammographic examination process ontology to formally describe the relationships between the process and image evaluation criteria to improve the quality of mammograms. First, we identified and created root classes: task, plan, and clinical image evaluation (CIE). Second, we described an "is-a" relation referring to the result of the previous study and the structure of the CIE. Third, the procedural steps in the ontology were described using the new properties: "isPerformedBefore," "isPerformedAfter," and "isPerformedAfterIfNecessary." Finally, the relationships between tasks and CIEs were described using the "isAffectedBy" property to represent the influence of the process on image quality. In total, there were 219 classes in the ontology. By introducing new properties related to the process flow, a sophisticated mammography examination process could be visualized. In relationships between tasks and CIEs, it became clear that the tasks affecting the evaluation criteria related to positioning were greater in number than those for image quality. We developed a mammographic examination process ontology that makes knowledge explicit for a comprehensive mammography process. Our research will support education and help promote knowledge sharing about mammography examination expertise.