67 TECHNOLOGY TO SUPPORT INDEPENDENT LIVING AT HOME: ONLINE SURVEY OF USER NEEDS AND REQUIREMENTS

Background

Technology can play a key role in supporting older adults to live independently at home. A User Needs and Requirements study including co-design workshops and an online survey was conducted to inform the development of a technological solution aimed at supporting older adults to remain living independently at home. The online survey component is reported here.

Methods

Eligibility criteria included that respondents were older adults living at home or caregiving stakeholders providing care to older adults at home e.g. family caregivers or health/social care professionals. Recruitment took place throughout Ireland through civil society organisations and age friendly networks in local councils. Quantitative and qualitative data were gathered from June to July 2020. Descriptive statistics were applied to quantitative data and inductive thematic analysis was performed on free text responses.

Results

In total, 380 respondents completed the survey (n= 235 older adults, n=77 family caregivers, n=47 healthcare professionals and n=21 home support workers). Older adults identified key issues where technology might support them to live independently, these included, home security (33% n=77), falls (30% n=69), reduced mobility (23% n=55) and loneliness (23% n=54). Thematic analysis highlighted key areas where technology could assist stakeholders in providing care for older adults living independently, these included, remote monitoring of family members (family caregivers), communication with clients (healthcare professionals) and falls (home support workers). Older adults reported that data privacy and the cost of technology were key concerns. All groups reported a high level of willingness to use technology such as ambient sensors, wearable devices and voice activated assistants to support independent living.

Conclusion

Results of this survey provide insights into user needs and requirements in combination with results from co-design workshops to inform the design, development and trial of a technology system to support independent living at home.

How ontology can be used to achieve semantic interoperability in healthcare

Semantic interoperability allows machines to share, interpret and use data without ambiguity. Semantic Interoperability is a major concern in healthcare (c.f. the EU commission 2021 report on electronic record exchange formats). The lack of interoperability with regard to electronic health record (EHR) leads to fragmentation and a lower quality of cross-institution and cross-border healthcare. The simple choice of an interchange language (HL7, FIHR etc.)is not sufficient to ensure interoperability. Healthcare interoperability is associated with multi-level and multi-sectoral complexity, and this cannot be addressed without consideration of a range of people and needs, from application design to knowledge sharing. Each transaction needs to be defined in unambiguous details as part of a complete, consistent, coherent, and machine-readable set of specifications for interoperability between the machines to minimize any potential error. We propose a systematic process to achieve healthcare interoperability, working with healthcare professionals starting from design level to implementation level. In our seminar we will explain with examples how ontology can be used to achieve semantic interoperability in healthcare. Technical requirements, including the choice of tools (e.g. Protégé); data base (e.g. GraphDB); data model (i.e. Web Ontology Language 2 (OWL2); formal specification (i.e. Description logics (DL)); and the right syntax (RDF/XML). Will be introduced.

Terminologies matter - the case of ICNP and SNOMED-CT

Terminologies can seem very abstract to end-users. While most health professionals will be familiar with some terminologies (for example MeSH (Medical Subject Headings), the controlled vocabulary thesaurus used for indexing articles for PubMed or ICD-10, WHO's terminology for disease coding), fewer will be aware of the depth and range of terminologies used in healthcare, nor of the central importance of multilingual standard terminologies in health care interoperability. Following a brief introduction to the use of terminologies, the integration of the International Classification for Nursing Practice (ICNP) the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) will be presented, as an example of the use of terminologies, and their ongoing curation, maintenance and development.

Case based approach to the application of standards and Interoperability in practice

Digital infrastructure and connectivity is layered and requires a number of defined viewpoints in order for safe data flow and use to occur. To address context specific challenges to support communication in health and social care, health informatics standards supporting interoperability are key. In this skills building seminar we will introduce participants to a standards based roadmap for interoperability. We will provide examples of projects and resources detailing the process of engagement to optimise system design for sustainability through a use case based approach.

How will provider-focused payment reform impact geographic variation in Medicare spending?

OBJECTIVES

The Institute of Medicine has recently argued against a value index as a mechanism to address geographic variation in spending and instead promoted payment reform targeted at individual providers. It is unknown whether such provider-focused payment reform reduces geographic variation in spending.

STUDY DESIGN

We estimated the potential impact of 3 Medicare provider-focused payment policies-pay-for-performance, bundled payment, and accountable care organizations-on geographic variation in Medicare spending across Hospital Referral Regions (HRRs). We compared geographic variation in spending, measured using the coefficient of variation (CV) across HRRs, between the baseline case and a simulation of each of the 3 policies.

METHODS

Policy simulation based on 2008 national Medicare data combined with other publicly available data.

RESULTS

Compared with the baseline (CV, 0.171), neither pay-for-performance nor accountable care organizations would change geographic variation in spending (CV, 0.171), while bundled payment would modestly reduce geographic variation (CV, 0.165).

CONCLUSIONS

In our models, the bundled payment for inpatient and post acute care services in Medicare would modestly reduce geographic variation in spending, but neither accountable care organizations nor pay-for-performance appear to have an impact.

Post-acute referral patterns for hospitals and implications for bundled payment initiatives

BACKGROUND

Under new bundled payment models, hospitals are financially responsible for post-acute care delivered by providers such as skilled nursing facilities (SNFs) and home health agencies (HHAs). The hope is that hospitals will use post-acute care more prudently and better coordinate care with post-acute providers. However, little is known about existing patterns in hospitals׳ referrals to post-acute providers.

METHODS

Post-acute provider referrals were identified using SNF and HHA claims within 14 days following hospital discharge. Hospital post-acute care network size and concentration were estimated across hospital types and regions. The 2008 Medicare Provider Analysis and Review claims for acute hospitals and SNFs, and the 100% HHA Standard Analytic Files were used.

RESULTS

The mean post-acute care network size for U.S. hospitals included 57.9 providers with 37.5 SNFs and 23.4 HHAs. The majority of these providers (65.7% of SNFs, 60.9% of HHAs) accounted for 1 percent or less of a hospital׳s referrals and classified as "low-volume". Other post-acute providers we classified as routine. The mean network size for routine providers was greater for larger hospitals, teaching hospitals and in regions with higher per capita post-acute care spending.

CONCLUSIONS

The average hospital works with over 50 different post-acute providers. Moreover, the size of post-acute care networks varies considerably geographically and by hospital characteristics. These results provide context on the complex task hospitals will face in coordinating care with post-acute providers and cutting costs under new bundled payment models.

A comparison of ambulatory perioperative times in hospitals and freestanding centers

BACKGROUND

The volume of surgical procedures performed in ambulatory surgical centers has increased rapidly.

METHODS

Ambulatory surgical visits of Medicare beneficiaries were compared for hospital-based and freestanding ambulatory surgical centers (ASCs). The main outcomes were time in surgery, time in operating room, time in postoperative care, and total perioperative time.

RESULTS

The mean total perioperative time for all procedures examined was 39% shorter in freestanding ASCs then in hospital-based ASCs (83 vs 135 min; P < .01); surgery time was 37% shorter (19 vs 30 min; P < .01), operating room time was 37% shorter (34 vs 54 min; P < .01), and postoperative time was 35% shorter (48 vs 74 min; P < .01).

CONCLUSIONS

Perioperative times were significantly shorter in freestanding ASCs than in hospital-based ASCs. It is unclear how much of the difference was the result of efficiency versus patient selection.

Installation and use of LabKey Server for proteomics

LabKey Server (formerly CPAS, the Computational Proteomics Analysis System) provides a Web-based platform for mining data from liquid chromatography-tandem mass spectrometry (LC-MS/MS) proteomic experiments. This open source platform supports systematic proteomic analyses and secure data management, integration, and sharing. LabKey Server incorporates several tools currently used in proteomic analysis, including the X! Tandem search engine, the ProteoWizard toolkit, and the PeptideProphet and ProteinProphet data mining tools. These tools and others are integrated into LabKey Server, which provides an extensible architecture for developing high-throughput biological applications. The LabKey Server analysis pipeline acts on data in standardized file formats, so that researchers may use LabKey Server with other search engines, including Mascot or SEQUEST, that follow a standardized format for reporting search engine results. Supported builds of LabKey Server are freely available at http://www.labkey.com/. Documentation and source code are available under the Apache License 2.0 at http://www.labkey.org.

LabKey Server: an open source platform for scientific data integration, analysis and collaboration

BACKGROUND

Broad-based collaborations are becoming increasingly common among disease researchers. For example, the Global HIV Enterprise has united cross-disciplinary consortia to speed progress towards HIV vaccines through coordinated research across the boundaries of institutions, continents and specialties. New, end-to-end software tools for data and specimen management are necessary to achieve the ambitious goals of such alliances. These tools must enable researchers to organize and integrate heterogeneous data early in the discovery process, standardize processes, gain new insights into pooled data and collaborate securely.

RESULTS

To meet these needs, we enhanced the LabKey Server platform, formerly known as CPAS. This freely available, open source software is maintained by professional engineers who use commercially proven practices for software development and maintenance. Recent enhancements support: (i) Submitting specimens requests across collaborating organizations (ii) Graphically defining new experimental data types, metadata and wizards for data collection (iii) Transitioning experimental results from a multiplicity of spreadsheets to custom tables in a shared database (iv) Securely organizing, integrating, analyzing, visualizing and sharing diverse data types, from clinical records to specimens to complex assays (v) Interacting dynamically with external data sources (vi) Tracking study participants and cohorts over time (vii) Developing custom interfaces using client libraries (viii) Authoring custom visualizations in a built-in R scripting environment. Diverse research organizations have adopted and adapted LabKey Server, including consortia within the Global HIV Enterprise. Atlas is an installation of LabKey Server that has been tailored to serve these consortia. It is in production use and demonstrates the core capabilities of LabKey Server. Atlas now has over 2,800 active user accounts originating from approximately 36 countries and 350 organizations. It tracks roughly 27,000 assay runs, 860,000 specimen vials and 1,300,000 vial transfers.

CONCLUSIONS

Sharing data, analysis tools and infrastructure can speed the efforts of large research consortia by enhancing efficiency and enabling new insights. The Atlas installation of LabKey Server demonstrates the utility of the LabKey platform for collaborative research. Stable, supported builds of LabKey Server are freely available for download at http://www.labkey.org. Documentation and source code are available under the Apache License 2.0.

Computational Proteomics Analysis System (CPAS): an extensible, open-source analytic system for evaluating and publishing proteomic data and high throughput biological experiments

The open-source Computational Proteomics Analysis System (CPAS) contains an entire data analysis and management pipeline for Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) proteomics, including experiment annotation, protein database searching and sequence management, and mining LC-MS/MS peptide and protein identifications. CPAS architecture and features, such as a general experiment annotation component, installation software, and data security management, make it useful for collaborative projects across geographical locations and for proteomics laboratories without substantial computational support.

Pricing health services for purchasers--a review of methods and experiences

This article reviews methodologies and international experience related to costing and pricing health services for health care purchasers. The main factors affecting price-setting methods are: (1) provider payment systems; (2) information available on actual costs, service volumes and outcomes; and (3) characteristics of providers and purchasers. These factors are strongly interrelated. Provider payment systems determine the unit of services to be priced. In order to minimize incentives for under- or over-utilization, the prices that purchasers pay for health care services should be related to the actual unit costs of services, but accurately calculating real unit costs is intensive in terms of resources and information. Pertinent provider characteristics influencing price-setting include provider autonomy, provider negotiating power, and the degree of competition. The article presents a series of examples that run through each of these three sets of factors. The examples are from Denmark, the UK, and Thailand (for capitation); Australia, Hungary, and the United States (for case-based payment); and Germany, Korea, and Taiwan (for fee-for-service payment mechanisms). From these experiences, the article concludes with appropriate lessons for low- and middle-income countries, where the principal constraint on the development of provider payments systems is the limited availability of information on costs, volumes, and patient characteristics.

A comparison of single- and multi-payer health insurance systems and options for reform

A major choice confronting many countries is between single-payer and multi-payer health insurance systems. This paper compares single-payer models in the areas of revenue collection, risk pooling, purchasing, and social solidarity. Single-payer and multi-payer systems each have advantages which may meet countries' priorities for their health insurance system. Single-payer systems are usually financed more progressively, and rely on existing taxation systems; they effectively distribute risks throughout one large risk pool; and they offer governments a high degree of control over the total expenditure on health. Multi-payer systems sacrifice this control for a greater ability to meet the diverse preferences of beneficiaries. Several major reforms of single-payer insurance systems--expansion of the role of private insurance and transformation to a multi-payer system--are then described and illustrated using specific country examples. These reforms have been implemented with some success in several countries but face several important challenges.

Microtubule-associated proteins in plants--why we need a MAP

Plants have four main microtubule assemblies. Three are involved in arranging when and where the cell wall is laid down and have no direct homologues in animals. Microtubule-associated proteins are important components of these assemblies, and we are now starting to uncover what these proteins are and how they might work.

Two kinesin-related proteins associated with the cold-stable cytoskeleton of carrot cells: characterization of a novel kinesin, DcKRP120-2

We have previously described the biochemical isolation of 65 kDa and 120 kDa microtubule-associated proteins from carrot cytoskeletons. The 65 kDa MAPs have subsequently been shown to be structural MAPs that reconstitute 30 nm cross-bridges of the kind that maintain cortical microtubules in parallel groups. By exploiting its avid binding to microtubules, we have now devised a method for isolating MAP120 from protoplast extracts, and shown that it has properties of a kinesin-related protein. MAP120 segregates with the cold stable pool of microtubules in carrot cytoskeletons, whilst the 65 kDa MAPs are also associated with the cold-sensitive microtubules. On gradient gels, MAP120 resolves as two kinesin-like bands. We report the isolation of a carrot cDNA, DcKRP120-2, corresponding to a novel kinesin of the BimC class known to move to the plus ends of microtubules. Antibodies raised against specific expressed sequences recognize the upper band, while the lower band is recognized by antibodies to the tobacco kinesin-related protein, TKRP125. We have also isolated a partial genomic carrot DNA, DcKRP120-1, homologous to the motor region of tobacco TKRP125. Immunofluorescence of the two proteins produces different staining patterns. Anti-TKRP125 labels the cortical microtubules and the pre-prophase band, but anti-DcKRP120-2 does so only weakly. Both clearly stain the spindle and the phragmoplast, but in a proportion of cells anti-DcKRP120-2 strongly decorates the phragmoplast mid-line where the plus ends of the microtubules overlap. We discuss the potential roles of these proteins during the microtubule cycle.