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Silva-Cardoso J, Santos J, Araújo I, Andrade A, Morais Sarmento P, Santos P, Moura B, Marques I, Peres M, Ferreira JP, Agostinho J, Pimenta J. conTemporary reflectiOns regarding heart failure manaGEmenT - How to ovERcome the PorTuguese barriers (TOGETHER-PT). Rev Port Cardiol 2024; 43:225-235. [PMID: 37689388 DOI: 10.1016/j.repc.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/11/2023] [Accepted: 05/02/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a complex clinical syndrome that is a significant burden in hospitalisations, morbidity, and mortality. Although a significant effort has been made to better understand its consequences and current barriers in its management, there are still several gaps to address. The present work aimed to identify the views of a multidisciplinary group of health care professionals on HF awareness and literacy, diagnosis, treatment and organization of care, identifying current challenges and providing insights into the future. METHODS A steering committee was established, including members of the Heart Failure Study Group of the Portuguese Society of Cardiology (GEIC-SPC), the Heart Failure Study Group of the Portuguese Society of Internal Medicine (NEIC-SPMI) and the Cardiovascular Study Group (GEsDCard) of the Portuguese Association of General and Family Medicine (APMGF). This steering committee produced a 16-statement questionnaire regarding different HF domains that was answered to by a diversified group of 152 cardiologists, internists, general practitioners, and nurses with an interest or dedicated to HF using a five-level Likert scale. Full agreement was defined as ≥80% of level 5 (fully agree) responses. RESULTS Globally, consensus was achieved in all but one of the 16 statements. Full agreement was registered in seven statements, namely 3 of 4 statements for patient education and HF awareness and 2 in 4 statements of both HF diagnosis and healthcare organization, with proportions of fully agree responses ranging from 82.9% to 96.7%. None of the HF treatment statements registered full agreement but 3 of 4 achieved ≥80% of level 4 (agree) responses. CONCLUSION This document aims to be a call-to-action to improve HF patients' quality of life and prognosis, by promoting a change in HF care in Portugal.
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Affiliation(s)
- José Silva-Cardoso
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; RISE - Health Research Network, Portugal.
| | - Jonathan Santos
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; ARS Norte, ACES Vale Sousa Norte, USF Torrão, Portugal
| | - Inês Araújo
- Clínica de Insuficiência Cardíaca, Serviço de Medicina III, Hospital S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Aurora Andrade
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Pedro Morais Sarmento
- Departamento de Medicina Interna e Hospital de Dia de Insuficiência Cardíaca do Hospital da Luz de Lisboa, Lisboa, Portugal
| | - Paulo Santos
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; RISE - Health Research Network, Portugal; MEDCIDS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Brenda Moura
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Irene Marques
- Serviço de Medicina Interna, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica - Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Marisa Peres
- Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal
| | - João Pedro Ferreira
- Unic@RISE, Serviço de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Université de Lorraine, Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Joao Agostinho
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Pimenta
- Serviço de Medicina Interna, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; UnIC@RISE, Departamento de Medicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Eklund A, Skyvell Nilsson M. Program coordinators' perspectives on implementing a transition program for newly graduated nurses: a qualitative interview study. J Health Organ Manag 2024; 38:143-156. [PMID: 38584370 DOI: 10.1108/jhom-01-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
PURPOSE While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators' perspectives on implementing a transition program for newly graduated nurses. DESIGN/METHODOLOGY/APPROACH An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding. FINDINGS The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation. ORIGINALITY/VALUE This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.
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Affiliation(s)
- Annika Eklund
- Department of Social and Behavioural Studies, University West, Trollhättan, Sweden
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Trincanato E, Vagnoni E. Business intelligence and the leverage of information in healthcare organizations from a managerial perspective: a systematic literature review and research agenda. J Health Organ Manag 2024; ahead-of-print. [PMID: 38551408 DOI: 10.1108/jhom-02-2023-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
PURPOSE Business intelligence (BI) systems and tools are deemed to be a transformative source with the potential to contribute to reshaping the way different healthcare organizations' (HCOs) services are offered and managed. However, this emerging field of research still appears underdeveloped and fragmented. Hence, this paper aims to reconciling, analyzing and synthesizing different strands of managerial-oriented literature on BI in HCOs and to enhance both theoretical and applied future contributions. DESIGN/METHODOLOGY/APPROACH A literature-based framework was developed to establish and guide a three-stage state-of-the-art systematic literature review (SLR). The SLR was undertaken adopting a hybrid methodology that combines a bibliometric and a content analysis. FINDINGS In total, 34 peer-review articles were included. Results revealed significant heterogeneity in theoretical basis and methodological strategies. Nonetheless, the knowledge structure of this research's stream seems to be primarily composed of five clusters of interconnected topics: (1) decision-making, relevant capabilities and value creation; (2) user satisfaction and quality; (3) process management, organizational change and financial effectiveness; (4) decision-support information, dashboard and key performance indicators; and (5) performance management and organizational effectiveness. ORIGINALITY/VALUE To the authors' knowledge, this is the first SLR providing a business and management-related state-of-the-art on the topic. Besides, the paper offers an original framework disentangling future research directions from each emerged cluster into issues pertaining to BI implementation, utilization and impact in HCOs. The paper also discusses the need of future contributions to explore possible integrations of BI with emerging data-driven technologies (e.g. artificial intelligence) in HCOs, as the role of BI in addressing sustainability challenges.
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Affiliation(s)
- Edoardo Trincanato
- Department of Economics and Management, University of Ferrara, Ferrara, Italy
| | - Emidia Vagnoni
- Department of Economics and Management, University of Ferrara, Ferrara, Italy
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Boukebous B, Gao F, Biau D. Hip fractures after 60 years of age in France in 2005-2017: Nationwide sample of statutory-health-insurance beneficiaries. Orthop Traumatol Surg Res 2023; 109:103677. [PMID: 37678611 DOI: 10.1016/j.otsr.2023.103677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Proximal femoral factures (PFFs) constitute a heavy medical, social, and economic burden. Overall, orthopaedic conditions vary widely in France regarding the patients involved and treatments applied. For PFFs specifically, data are limited. Moreover, the ongoing expansion of geriatric orthopaedics holds promise for improving overall postoperative survival. The objectives of this retrospective study of a nationwide French database were: 1) to describe the pathway of patients with PFFs regarding access to care, healthcare institutions involved, and times to management; 2) to look for associations linking these parameters to post-operative mortality. HYPOTHESIS Across France, variations exist in healthcare service availability and time to management for patients with PFFs. MATERIAL AND METHODS A retrospective analysis of data in a de-identified representative sample of statutory-health-insurance beneficiaries in France (Échantillon généraliste des bénéficiaires, EGB, containing data for 1/97 beneficiaries) was conducted. All patients older than 60 years of age who were managed for PFFs between 2005 and 2017 were included. The following data were collected for each patient: age, management method, Charlson's Comorbidity Index (CCI), home-to-hospital distance by road, and type of hospital (public, non-profit private, or for-profit private), and time to surgery were collected. The study outcomes were the incidence of PFF, mortality during the first postoperative year, changes in mortality between 2005 and 2017, and prognostic factors. RESULTS In total 8026 fractures were included. The 7561 patients had a median age of 83.8 years and a mean CCI of 4.6; both parameters increased steadily over time, by 0.18 years and 0.06 points per year, respectively (p<10-4 for both comparisons). Management was by total hip replacement in 3299 cases and internal fixation in 4262 cases; this information was not available for 465 fractures. The overall incidence increased from 90/100,000 in 2008 to 116/100,000 in 2017 (p=0.03). Of the 8026 fractures, 5865 (73.1%) were managed in public hospitals (and this proportion increased significantly over time), 1629 (20.3%) in non-profit private hospitals (decrease over time), and 264 (3.3%) in for-profit private hospitals. The home-to-hospital distance ranged from 7.5 to 38.5km and increased over time by 0.26km/year (95% confidence interval [95%CI]: 0.15-0.38) (p<10-4). Median time to surgery was 1 day [1-3 days], with no significant difference across hospital types. Mortality rates at 90 days and 1 year were 10.5% (843/8026) and 20.8% (1673/8026), respectively. Two factors were significantly associated with day-90 mortality: the CCI (hazard ratio [HR], 1.087 [95%CI: 1.07-1.10] [p<10-4]) and time to surgery>1 day (HR 1.35 [95%CI: 1.15-1.50] [p<0.0001]). Day-90 mortality decreased significantly from 2005 to 2017 (HR 0.95 [95%CI: 0.92-0.97] [p<10-4]), with no centre effect. CONCLUSION The management of PFF in patients older than 60 varied widely across France. Time to surgery longer than 1 day was a major adverse prognostic factor whose effects persisted throughout the first year. This factor was present in over half the patients. Day-90 mortality decreased significantly from 2005 to 2017 despite increases in age and comorbidities. LEVEL OF EVIDENCE IV Retrospective cohort study.
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Affiliation(s)
- Baptiste Boukebous
- Équipe Ecamo, CRESS (Centre of Research in Epidemiology, Statistics), Inserm, UMR 1153, université Paris-Cité, Paris, France; Service de chirurgie orthopédique et traumatologique, Beaujon-Bichat, University Hospital, Assistance publique-Hôpitaux de Paris, université Paris-Cité, Paris, France.
| | - Fei Gao
- Université de Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS (Research on Services, Management in Health), U 1309, Rennes, France
| | - David Biau
- Équipe Ecamo, CRESS (Centre of Research in Epidemiology, Statistics), Inserm, UMR 1153, université Paris-Cité, Paris, France; Service de chirurgie orthopédique et traumatologique, Cochin University Hospital, Assistance publique-Hôpitaux de Paris, université Paris-Cité, Paris, France
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Legrand MA, Bagouet F, Merle B, Gensburger D, Chapurlat R. Value of rare diseases reference centers: impact on diagnosis and access to specialized care in fibrous dysplasia of bone. Eur J Med Genet 2023; 66:104849. [PMID: 37739062 DOI: 10.1016/j.ejmg.2023.104849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/22/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Reference Centers and Rare Disease Health Networks aim to improve the management of patients with rare diseases. The French reference center for Fibrous Dysplasia was certified in 2006. OBJECTIVE The objective of our study was to assess the effectiveness of our reference center since its constitution. METHODS In a retrospective cohort study, we compared the activity of our center, including the time elapsed between access to the center and the diagnostic delay of patients with Fibrous Dysplasia between two periods, 1994-2006 (before certification) and 2007-2019 (after certification). Data were extracted from patients' records (Easily®). Wilcoxon and Fisher tests were performed, using R®. RESULTS Our cohort included 527 patients with Fibrous Dysplasia/Mc Cune Albright syndrome. The activity of the Fibrous Dysplasia center increased from 139 patients in the first period (1994-2006) to an additional 388 patients for the second period (2007-2019). Mean time elapsed to diagnosis of Fibrous Dysplasia was 1.5 years before 2007 and 1.9 years after 2007 (p = 0.12). Diagnosis was made before referral in over 80% of patients. There was a non-significant decrease in the number of patients with delayed diagnosis: 37 patients (44%) in the first period had a diagnostic delay and 94 patients (33%) in the second period (p = 0.07). Patients were referred to our center on average 6.8 years (before 2007) and 7.9 years (after 2007) after their diagnosis (p = 0.77). CONCLUSION Healthcare organization with reference centers significantly impacted the management of patients with Fibrous Dysplasia/Mc Cune Albright syndrome, with a substantial increase in the activity of our center, that roughly tripled since certification. This healthcare organization was also associated with a trend toward decreasing diagnostic delay. However, diagnostic delay affected more than a third of patients and the time to access to the center remained extended (≈7-8 years after diagnosis). The current challenge lies in informing primary care providers and patients about education to rare diseases and existence of reference centers for earlier and more effective specialized management.
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Affiliation(s)
- M A Legrand
- French Reference Center for Fibrous Dysplasia, Rheumatology Department, Hôpital E.Herriot, Lyon, France; INSERM UMR 1033, Université Lyon 1, Hôpital E Herriot, Lyon, France.
| | - F Bagouet
- French Reference Center for Fibrous Dysplasia, Rheumatology Department, Hôpital E.Herriot, Lyon, France
| | - B Merle
- INSERM UMR 1033, Université Lyon 1, Hôpital E Herriot, Lyon, France
| | - D Gensburger
- French Reference Center for Fibrous Dysplasia, Rheumatology Department, Hôpital E.Herriot, Lyon, France; INSERM UMR 1033, Université Lyon 1, Hôpital E Herriot, Lyon, France
| | - R Chapurlat
- French Reference Center for Fibrous Dysplasia, Rheumatology Department, Hôpital E.Herriot, Lyon, France; INSERM UMR 1033, Université Lyon 1, Hôpital E Herriot, Lyon, France
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Homauni A, Markazi-Moghaddam N, Mosadeghkhah A, Noori M, Abbasiyan K, Jame SZB. Budgeting in Healthcare Systems and Organizations: A Systematic Review. Iran J Public Health 2023; 52:1889-1901. [PMID: 38033850 PMCID: PMC10682572 DOI: 10.18502/ijph.v52i9.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/16/2023] [Indexed: 12/02/2023]
Abstract
Background Budgeting is the process resource allocation to produce the best output according to the revenue levels involved. Among the constraints that healthcare organizations, including hospitals, both in the public and private sectors, grapple with is budgetary constraints. Therefore, cost control and resource management should be considered in healthcare organizations under such circumstances. Methods We aimed to identify methods of budgeting in healthcare systems and organizations as a systematic review. To extract and analyze the data, a form was designed by the researcher to define budgeting methods proposed in the literature and to identify their strengths, weaknesses, and dimensions. The search was conducted in Google Scholar, Web of science, Pub med and Scopus databases covering the period 1990-2022. Results Overall, 33 articles were included in the study for extraction and final analysis. The study results were reported in four main themes: healthcare system budgeting, capital budgeting, global budgeting, and performance-based budgeting. Conclusion Each budgeting approach has its own pros and cons and requires meeting certain requirements. These approaches are selected and implemented depending on each country's infrastructure and conditions as well as its organizations. These infrastructures need to be thoroughly examined before implementing any budgeting method, and then a budgeting method should be selected accordingly.
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Affiliation(s)
- Abbas Homauni
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Nader Markazi-Moghaddam
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
- Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Mosadeghkhah
- Department of Endocrinology, Aja University of Medical Science, Tehran, Iran
| | - Majid Noori
- Infectious Diseases Research Center, Aja University of Medical Sciences, Tehran, Iran
| | - Kourosh Abbasiyan
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Sanaz Zargar Balaye Jame
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
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Sofi F, Dinu M, Reboldi G, Lotti S, Genovese L, Tritto I, Gensini G, Gibson CM, Ambrosio G. Worldwide impact of COVID-19 on hospital admissions for non-ST-elevation acute coronary syndromes (NSTACS): a systematic review with meta-analysis of 553,038 cases. Eur Heart J Qual Care Clin Outcomes 2023:qcad048. [PMID: 37580157 DOI: 10.1093/ehjqcco/qcad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND How COVID-19 impacted non-ST-segment elevation acute coronary syndromes (NSTACS) is object of controversial reports. AIM To systematically review studies reporting NSTACS hospitalizations during COVID-19 pandemic, and analyze whether differences in COVID-19 epidemiology, methodology of report, or public health-related factors could contribute to discrepant findings. METHODS Comprehensive search (MedLine, Embase, Scopus, Web-of-Science, Cochrane Register), of studies reporting NSTACS hospitalizations during COVID-19 pandemic compared with a reference period, following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Data were independently extracted by multiple investigators and pooled using a random-effects model. Health-related metrics were from publicly available sources, and analyzed through multiple meta-regression modelling. RESULTS We retrieved 102 articles (553 038 NSTACS cases, 40 countries). During peak COVID-19 pandemic, overall Incidence Rate-Ratio (IRR) of NSTACS hospitalizations over reference period decreased (0.70, 95% CI 0.66-0.75; p < 0.00001). Significant heterogeneity was detected among studies (I2= 98%; p < 0.00001). Importantly, wide variations were observed among, and within, countries. No significant differences were observed by study quality, whereas comparing different periods within 2020 resulted in greater decrease ((IRR: 0.61; CI: 0.53-0.71) than comparing 2020 vs previous years (IRR: 0.74; CI 0.69-0.79). Among many variables, major predictors of heterogeneity were: Sars-Cov-2 reproduction rate/country, number of hospitals queried, reference period length; country stringency index and socio-economical indicators did not significantly contribute. CONCLUSIONS During COVID-19 pandemic NSTACS hospitalizations decreased significantly worldwide. However, substantial heterogeneity emerged among countries, and within the same country. Factors linked to public health management, but also to methodologies to collect results may have contributed to this heterogeneity. Trial registration: The protocol was registered in PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42022308159).
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Affiliation(s)
- Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - GianPaolo Reboldi
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
- Center for Clinical and Translational Research-CERICLET, University of Perugia School of Medicine, Perugia, Italy
| | - Sofia Lotti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Isabella Tritto
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | | | - C Michael Gibson
- Baim Institute for Clinical Research, Harvard Medical School, Boston, MS, U.S.A
| | - Giuseppe Ambrosio
- Center for Clinical and Translational Research-CERICLET, University of Perugia School of Medicine, Perugia, Italy
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
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Giannopoulos G, Silkaitis C, Zembower T, Bolon M, Robinson K. Carbapenem-resistant Enterobacterales standardization across a large health care system. Am J Infect Control 2023; 51:958-960. [PMID: 36273518 DOI: 10.1016/j.ajic.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 11/22/2022]
Abstract
Carbapenem-resistant Enterobacterales (CRE) are multidrug resistant organisms that pose a significant risk in the health care setting. Standardized identification ensures prompt isolation and is imperative to maintain patient safety.
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Miranda R, Oliveira MD, Baptista FM, Albuquerque I. Telemonitoring in Portugal: where do we stand and which way forward? Health Policy 2023; 131:104761. [PMID: 36905784 DOI: 10.1016/j.healthpol.2023.104761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/25/2023] [Accepted: 03/04/2023] [Indexed: 03/07/2023]
Abstract
Following the pandemic, there is growing pressure in Portugal to adopt new practices that promote more efficient, sustainable, and equitable healthcare. Telemonitoring (TM) has been identified as a valuable solution, particularly for chronically ill, long-term or socially isolated patients. Several initiatives have since emerged. Thus, Portuguese stakeholders recognise the need to reflect upon TM's current state and prospects. This study aims to provide a comprehensive analysis of the TM landscape in Portugal. We begin by analysing the underlying conditions for telehealth development. Then, we describe the governmental strategy and priorities towards TM - the National Strategic Plan for Telehealth development and NHS reimbursement opportunities for TM. To understand TM implementation, adoption, and dissemination in Portugal, we analyse 46 reported initiatives and adoption studies focusing on providers' perspectives. Finally, a structured reflection on current challenges and the way forward is provided, according to the seven domains of the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework. The adoption of TM by Portuguese institutions has been growing, leveraged by the telehealth governance model and public reimbursement mechanisms, proving particularly relevant during the pandemic. However, monitored patients are still few. Low digital literacy among patients and providers, lack of care integration and resource scarcity represent barriers hampering pilot TM initiatives' scale-up.
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Montagna M, Morici N, Tritschler T, Rovere Querini P. Fostering the intersection between primary care and hospital: hints from a survey and the PRIME (PRIMary care-hospital Embedding) project. Eur J Intern Med 2023; 109:131-134. [PMID: 36334984 DOI: 10.1016/j.ejim.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Marco Montagna
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Hospital-Primary Care Integration, San Raffaele Hospital, Milan, Italy
| | - Nuccia Morici
- IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Tobias Tritschler
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrizia Rovere Querini
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Hospital-Primary Care Integration, San Raffaele Hospital, Milan, Italy.
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Sanders L, Giannopoulos G, Mikolajczak A, Sotelo MA, Bardowski L, Silkaitis C, Helms A. Incorporating structured linen oversight into an infection prevention program. Am J Infect Control 2023; 51:343-345. [PMID: 35896131 DOI: 10.1016/j.ajic.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/01/2022]
Abstract
Hospital linen is a potential source for health care acquired infections. The elements of cleaning, transport and storage should be part of an Infection Prevention (IP) consult. The incorporation of linen reprocessing into the IP program ensures compliance with linen standards and patient safety.
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Affiliation(s)
- Lisa Sanders
- Infection Prevention Department, Northwestern Memorial HealthCare, Chicago, IL
| | - Gina Giannopoulos
- Infection Prevention Department, Northwestern Memorial HealthCare, Chicago, IL.
| | - Anessa Mikolajczak
- Infection Prevention Department, Northwestern Memorial HealthCare, Chicago, IL
| | - Mary Anne Sotelo
- Infection Prevention Department, Northwestern Memorial HealthCare, Chicago, IL
| | - Laura Bardowski
- Infection Prevention Department, Northwestern Memorial HealthCare, Chicago, IL
| | - Christina Silkaitis
- Infection Prevention Department, Northwestern Memorial HealthCare, Chicago, IL
| | - Angela Helms
- Infection Prevention Department, Northwestern Memorial HealthCare, Chicago, IL
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Pitocco D, Laurenzi A, Tomaselli L, Assaloni R, Consoli A, Di Bartolo P, Guardasole V, Lombardo F, Maffeis C, Rossi A, Gesuita R, Di Molfetta S, Rigamonti A, Scaramuzza A, Irace C, Cherubini V. Health care organization and use of technological devices in people with diabetes in Italy: Results from a survey of the Working Group on Diabetes and Technology. Nutr Metab Cardiovasc Dis 2022; 32:2392-2398. [PMID: 35970683 DOI: 10.1016/j.numecd.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIM The use of technology offers recognized benefits to persons with diabetes. The aim of this study was to evaluate the organization of healthcare facilities, the composition of the diabetes team, and the use of Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM) in Italy. METHODS AND RESULTS Diabetes care centers were asked to complete a web survey based on information collected in 2018. Sixty-one pediatric and 243 adult centers participated in the survey, accounting for 507,386 patients, mostly with type 2 diabetes (86.4%). Fifty-three percent of pediatric centers and 11% of adult centers reported a team composed of diabetologists, nurses, and psychologists. Overall, 13,204 patients (2.6%) were using CSII (95% with type 1 diabetes), and 28,936 (5.7%), were using CGM (74% with type 1 diabetes). When stratifying for the type of diabetes, 24% and 40.8% of patients with type 1 were using CSII and CGM, respectively, whereas low use of technology was reported for patients with type 2 and women with gestational diabetes. The percentage of adult and pediatric patients with type 1 diabetes on CSII and CGM was respectively 21% and 32%, and 35% and 57%. CONCLUSIONS The spread of CGM and CSII increased in Italy between 2013 and 2018. However, the percentage of users is still lower than what is expected based on clinical indications for use of technology. The inadequate number of professionals in the diabetes care team and insufficient economic resources are relevant barriers to disseminating technology for diabetes management.
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Affiliation(s)
- Dario Pitocco
- Diabetes Care Unit, UOSD Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Andrea Laurenzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Roberta Assaloni
- Diabetes Unit ASS2 Bassa-Friulana Isontina, Udine, Monfalcone [GO], Italy
| | - Agostino Consoli
- Endocrinology and Metabolic Diseases, University of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Guardasole
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Rigamonti
- Division of Pediatrics, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Andrea Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy.
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
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De Simone S, Franco M, Servillo G, Vargas M. Implementations and strategies of telehealth during COVID-19 outbreak: a systematic review. BMC Health Serv Res 2022; 22:833. [PMID: 35764980 PMCID: PMC9238134 DOI: 10.1186/s12913-022-08235-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/15/2022] [Indexed: 01/05/2023] Open
Abstract
Background Telehealth is an effective option to fight the outbreak of COVID-19. This review aims to systematically characterize the utilization and applications of telehealth during the COVID-19 pandemic focusing mainly on technology implementations. Methods This study was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The literature search was conducted in Science Direct, IEEE XPLORE, Scopus, and Web of Science databases from January 2020 until July 2021, with an English language restriction. A quality assessment was based on the Critical Appraisal Skills Programs checklist. Results The included studies focused on the implementation of technology for telehealth, multidisciplinary approach, service satisfaction, guidelines, and medical training. They provided illustrative insight into the strategy of telehealth in different medical specialties, such as pediatric gastroenterology, oncology, ophthalmology, and laryngology. Nonsurgical specialties had the greatest number of telehealth visits. Clinicians showed positive attitudes toward the implementation of video telehealth visits; patients report high levels of satisfaction with this care and strong interest in continuing this modality as a significant portion of clinical practice. Conclusions This systematic review provided an illustrative insight into the strategy of telehealth for different purposes. According to our findings, telehealth may be used in different medical area with a clear strategy of intervention according to patients’ and doctors’ needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08235-4.
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Affiliation(s)
- Stefania De Simone
- Department of Political Sciences, University of Naples Federico II, Largo S. Marcellino, Naples, Italy.
| | - Massimo Franco
- Department of Political Sciences, University of Naples Federico II, Largo S. Marcellino, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosurgical, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, Naples, Italy
| | - Maria Vargas
- Department of Neurosurgical, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, Naples, Italy
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Cozzoli N, Salvatore FP, Faccilongo N, Milone M. How can big data analytics be used for healthcare organization management? Literary framework and future research from a systematic review. BMC Health Serv Res 2022; 22:809. [PMID: 35733192 PMCID: PMC9213639 DOI: 10.1186/s12913-022-08167-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/06/2022] [Indexed: 12/11/2022] Open
Abstract
Background Multiple attempts aimed at highlighting the relationship between big data analytics and benefits for healthcare organizations have been raised in the literature. The big data impact on health organization management is still not clear due to the relationship’s multi-disciplinary nature. This study aims to answer three research questions: a) What is the state of art of big data analytics adopted by healthcare organizations? b) What about the benefits for both health managers and healthcare organizations? c) What about future directions on big data analytics research in healthcare? Methods Through a systematic literature review the impact of big data analytics on healthcare management has been examined. The study aims to map extant literature and present a framework for future scholars to further build on, and executives to be guided by. Results The positive relationship between big data analytics and healthcare organization management has emerged. To find out common elements in the studies reviewed, 16 studies have been selected and clustered into 4 research areas: 1) Potentialities of big data analytics. 2) Resource management. 3) Big data analytics and management of health surveillance systems. 4) Big data analytics and technology for healthcare organization. Conclusions In conclusion is identified how the big data analytics solutions are considered a milestone for managerial studies applied to healthcare organizations, although scientific research needs to investigate standardization and integration of the devices as well as the protocol in data analysis to improve the performance of the healthcare organization. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08167-z.
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Affiliation(s)
- Nicola Cozzoli
- Department of Economics, University of Foggia, Via Caggese n.1, Foggia, Italy
| | | | - Nicola Faccilongo
- Department of Economics, University of Foggia, Via Caggese n.1, Foggia, Italy
| | - Michele Milone
- Department of Economics, University of Foggia, Via Caggese n.1, Foggia, Italy
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15
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Ljungholm L, Edin-Liljegren A, Ekstedt M, Klinga C. What is needed for continuity of care and how can we achieve it? - Perceptions among multiprofessionals on the chronic care trajectory. BMC Health Serv Res 2022; 22:686. [PMID: 35606787 PMCID: PMC9125858 DOI: 10.1186/s12913-022-08023-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background Continuity of care (CoC) implies delivery of services in a coherent, logical and timely fashion. Continuity is conceptualized as multidimensional, encompassing three specific domains – relational, management and informational continuity – with emphasis placed on their interrelations, i.e., how they affect and are affected by each other. This study sought to investigate professionals’ perceptions of the prerequisites of CoC within and between organizations and how CoC can be realized for people with complex care needs. Methods This study had a qualitative design using individual, paired and focus group interviews with a purposeful sample of professionals involved in the chain of care for patients with chronic conditions across healthcare and social care services from three different geographical areas in Sweden, covering both urban and rural areas. Transcripts from interviews with 34 informants were analysed using conventional content analysis. Results CoC was found to be dependent on professional and cross-disciplinary cooperation at the micro, meso and macro system levels. Continuity is dependent on long-term and person-centred relationships (micro level), dynamic stability in organizational structures (meso level) and joint responsibility for cohesive care and enabling of uniform solutions for knowledge and information exchange (macro level). Conclusions Achieving CoC that creates coherent and long-term person-centred care requires knowledge- and information-sharing that transcends disciplinary and organizational boundaries. Collaborative accountability is needed both horizontally and vertically across micro, meso and macro system levels, rather than a focus on personal responsibility and relationships at the micro level. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08023-0.
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Affiliation(s)
- Linda Ljungholm
- Department of Health and Caring Sciences, Linnaeus University, Pedalstråket 13, S-39182, Kalmar, Sweden.
| | - Anette Edin-Liljegren
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,The Centre for Rural Medicine, Research and Development Unit, Region Västerbotten, Storuman, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Pedalstråket 13, S-39182, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Klinga
- Department of Health and Caring Sciences, Linnaeus University, Pedalstråket 13, S-39182, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Research and Development Unit for Elderly Persons (FOU Nu) Region Stockholm, Stockholm, Sweden
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16
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Sofi F, Dinu M, Reboldi G, Stracci F, Pedretti RFE, Valente S, Gensini G, Gibson CM, Ambrosio G. Worldwide differences of hospitalization for ST-segment elevation myocardial infarction during COVID-19: A systematic review and meta-analysis. Int J Cardiol 2021; 347:89-96. [PMID: 34740717 PMCID: PMC8561779 DOI: 10.1016/j.ijcard.2021.10.156] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/04/2021] [Accepted: 10/29/2021] [Indexed: 12/30/2022]
Abstract
Background Discrepant data were reported about hospital admissions for ST-segment elevation myocardial infarction (STEMI) during COVID-19 pandemic. We reviewed studies reporting STEMI hospitalizations during COVID-19 pandemic, investigating whether differences in COVID-19 epidemiology or public health-related factors could explain discrepant findings in different countries. Methods Search through MedLine, Embase, Scopus, Web-of-Science, Cochrane Register of Controlled Trials, of studies comparing STEMI admissions during COVID-19 pandemic with a reference period, without language restrictions, as registered in PROSPERO International Prospective Register of Systematic Reviews. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. Data independently extracted by multiple investigators were pooled using a random-effects model. Health-related metrics were from publicly-available sources. Results We included 79 articles (111,557 STEMI cases, from 57 countries). During peak COVID-19 pandemic, overall incidence rate-ratio (IRR) of STEMI hospitalizations over reference period decreased (0.80; 95% CI 0.76–0.84; p < 0.05). Although wide variations and significant heterogeneity were detected among studies (I2 = 89%; p < 0.0001), no significant differences were observed by report methodology (survey vs registry), or observation/reference period. However, large differences emerged at country level not explained by COVID-related epidemiological data, nor by public health strategies. Instead, IRRs for STEMI admissions were inversely related to hospital bed availability in each country (p < 0.05). Conclusions During COVID-19 pandemic hospitalization for STEMI significantly decreased, although to a smaller extent than initially reported. Large variability emerged across countries, unrelated to COVID-related epidemiology or social containment measures. Disparities in healthcare organization likely contributed, indicating that proper organization of emergency medicine should be preserved during pandemics.
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Affiliation(s)
- Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - GianPaolo Reboldi
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy; Center for Clinical and Translational Research-CERICLET, University of Perugia School of Medicine, Perugia, Italy
| | - Fabrizio Stracci
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | | | | | | | - C Michael Gibson
- Baim Institute for Clinical Research, Harvard Medical School, Boston, MS, United States of America
| | - Giuseppe Ambrosio
- Center for Clinical and Translational Research-CERICLET, University of Perugia School of Medicine, Perugia, Italy; Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy.
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17
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Alassafi MO. Success indicators for an efficient utilization of cloud computing in healthcare organizations: Saudi healthcare as case study. Comput Methods Programs Biomed 2021; 212:106466. [PMID: 34736170 DOI: 10.1016/j.cmpb.2021.106466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
The population in Saudi Arabia is expected to reach 40 million by 2025. Consequently, healthcare information will become critical to manage. Despite the fact that adopting cloud computing in the Saudi healthcare organizations can facilitate cost reduction, capacity building, institutional interoperability, and get access to data analytics, the adoption rate is very low. Hence, a new model is proposed to adopt cloud computing in the Saudi healthcare organization. The novelty of this work comes from using a quantitative method to test users' attitudes, data security, data control, data privacy, compliance, and reliability influence on the cloud computing adoption intention in the context of Saudi Arabian healthcare organizations. Partial Least Squares (PLS) method based Structural Equation Modeling (SEM) was used for model development. About 160 respondents from the relevant health organizations participated. The result shows that the attitude towards using technology, data security, compliance, and reliability of the cloud computing services are important determining factors in the adoption of cloud computing in Saudi healthcare organizations. However, the distinction in the findings regarding Data privacy and Data control in the Saudi healthcare organizational context is a clear manifestation of the fact that there is a need for policy formation for data privacy, data control, and data protection legislation in Saudi Arabia. Therefore, raising awareness regarding the practice of data privacy and data control policies among IT managers is essential. Future study should use a more holistic and industry-specific framework such as the technology-organization-environment (TOE) framework to find new influencing factors from the domains of technological context, the organizational context, and the environmental context.
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Affiliation(s)
- Madini O Alassafi
- Information Technology Department, Faculty of Computing and Information Technology King Abdulaziz University, Saudi Arabia.
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18
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Rogers HL, Pablo Hernando S, Núñez-Fernández S, Sanchez A, Martos C, Moreno M, Grandes G. Barriers and facilitators in the implementation of an evidence-based health promotion intervention in a primary care setting: a qualitative study. J Health Organ Manag 2021; ahead-of-print. [PMID: 34464035 PMCID: PMC9136863 DOI: 10.1108/jhom-12-2020-0512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aims to elucidate the health care organization, management and policy barriers and facilitators associated with implementation of an evidence-based health promotion intervention in primary care centers in the Basque Country, Spain. DESIGN/METHODOLOGY/APPROACH Seven focus groups were conducted with 49 health professionals from six primary care centers participating in the Prescribing Healthy Life program. Text was analyzed using the Consolidated Framework for Implementation Research (CFIR) focusing on those constructs related to health care organization, management and policy. FINDINGS The health promotion intervention was found to be compatible with the values of primary care professionals. However, professionals at all centers reported barriers to implementation related to: (1) external policy and incentives, (2) compatibility with existing workflow and (3) available resources to carry out the program. Specific barriers in these areas related to lack of financial and political support, consultation time constraints and difficulty managing competing day-to-day demands. Other barriers and facilitators were related to the constructs networks and communication, culture, relative priority and leadership engagement. A set of six specific barrier-facilitator pairs emerged. ORIGINALITY/VALUE Implementation science and, specifically, the CFIR constructs were used as a guide. Barriers and facilitators related to the implementation of a health promotion program in primary care were identified. Healthcare managers and policy makers can modify these factors to foster a more propitious implementation environment. These factors should be appropriately monitored, both in pre-implementation phases and during the implementation process, in order to ensure effective integration of health promotion into the primary care setting.
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Affiliation(s)
- Heather L Rogers
- Psychology and Health Research Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Ikerbasque Basque Foundation for Science, Bilbao, Spain
| | - Susana Pablo Hernando
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Basque Healthcare Service-Osakidetza, Barakaldo, Spain
| | - Silvia Núñez-Fernández
- Psychology and Health Research Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Basque Healthcare Service-Osakidetza, Barakaldo, Spain
| | - Carlos Martos
- Arrigorriaga Health Center, Integrated Health Organization Barrualde-Galdakao, Osakidetza, Arrigorriaga, Spain
| | - Maribel Moreno
- Integrated Health Organization Barrualde-Galdakao, Osakidetza, Galdakao, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Basque Healthcare Service-Osakidetza, Barakaldo, Spain
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Boonstra A, Jonker TL, van Offenbeek MAG, Vos JFJ. Persisting workarounds in Electronic Health Record System use: types, risks and benefits. BMC Med Inform Decis Mak 2021; 21:183. [PMID: 34103041 PMCID: PMC8186102 DOI: 10.1186/s12911-021-01548-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/31/2021] [Indexed: 11/18/2022] Open
Abstract
Background Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences? Methods This single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol). Results Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system. Conclusion This study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01548-0.
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Affiliation(s)
- Albert Boonstra
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
| | - Tess L Jonker
- Customer Service ERP, AFAS Software, Leusden, The Netherlands
| | | | - Janita F J Vos
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
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Markaki A, Malhotra S, Billings R, Theus L. Training needs assessment: tool utilization and global impact. BMC Med Educ 2021; 21:310. [PMID: 34059018 PMCID: PMC8167940 DOI: 10.1186/s12909-021-02748-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Global demand for standardized assessment of training needs and evaluation of professional continuing education programs across the healthcare workforce has led to various instrumentation efforts. The Hennessy-Hicks Training Needs Analysis (TNA) questionnaire is one of the most widely used validated tools. Endorsed by the World Health Organization, the tool informs the creation of tailored training to meet professional development needs. The purpose of this project was to describe TNA tool utilization across the globe and critically appraise the evidence of its impact in continuous professional development across disciplines and settings. METHODS A systematic integrative literature review of the state of the evidence across PubMed, Scopus, CINAHL, and Google Scholar databases was carried out. Full-text, peer reviewed articles and published dissertations/theses in English language that utilized the original, adapted or translated version of the TNA tool were included. Selected articles were appraised for type and level of evidence. RESULTS A total of 33 articles were synthesized using an inductive thematic approach, which revealed three overarching themes: individual, team/interprofessional, and organizational level training needs. Included articles represented 18 countries, with more than two thirds involving high-income countries, and one third middle-income countries. Four studies (12.1%) used the original English version instrument, 23 (69.7%) adapted the original version, and 6 (18.2%) translated and culturally adapted the tool. Twenty-three studies targeted needs at the individual level and utilized TNA to determine job roles and responsibilities. Thirteen articles represented the team/interprofessional theme, applying the TNA tool to compare training needs and perceptions among professional groups. Last, three articles used the tool to monitor the quality of care across an institution or healthcare system, demonstrating the organizational training needs theme. CONCLUSIONS Overall evidence shows that the TNA survey is widely used as a clinical practice and educational quality improvement tool across continents. Translation, cultural adaptation, and psychometric testing within a variety of settings, populations, and countries consistently reveals training gaps and outcomes of targeted continuous professional development. Furthermore, it facilitates prioritization and allocation of limited educational resources based on the identified training needs. The TNA tool effectively addresses the "know-do" gap in global human resources for health by translating knowledge into action.
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Affiliation(s)
- Adelais Markaki
- PAHO/WHO Collaborating Center for International Nursing, Birmingham, AL USA
- School of Nursing, University of Alabama at Birmingham, 1701 University Boulevard, Birmingham, AL 35294 USA
| | | | - Rebecca Billings
- School of Nursing, University of Alabama at Birmingham, 1701 University Boulevard, Birmingham, AL 35294 USA
| | - Lisa Theus
- PAHO/WHO Collaborating Center for International Nursing, Birmingham, AL USA
- School of Nursing, University of Alabama at Birmingham, 1701 University Boulevard, Birmingham, AL 35294 USA
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21
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Mazzini E, Soncini F, Cerullo L, Genovese L, Apolone G, Ghirotto L, Mazzi G, Costantini M. A focused ethnography in the context of a European cancer research hospital accreditation program. BMC Health Serv Res 2021; 21:446. [PMID: 33975580 PMCID: PMC8111912 DOI: 10.1186/s12913-021-06466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/28/2021] [Indexed: 05/31/2023] Open
Abstract
Background A quality accreditation program (AP) is designed to guarantee predefined quality standards of healthcare organizations. Evidence of the impact of quality standards remains scarce and somewhat challenging to document. This study aimed to investigate the accreditation of a cancer research hospital (Italy), promoted by the Organization of European Cancer Institutes (OECI), by focusing on the individual, group, and organizational experiences resulting from the OECI AP. Methods A focused ethnography study was carried out to analyze the relevance of participation in the accreditation process. Twenty-nine key informants were involved in four focus group meetings, and twelve semistructured interviews were conducted with professionals and managers. Inductive qualitative content analysis was applied to examine all transcripts. Results Four main categories emerged: a) OECI AP as an opportunity to foster diversity within professional roles; b) OECI AP as a possibility for change; c) perceived barriers; and d) OECI AP-solicited expectations. Conclusions The accreditation process is an opportunity for improving the quality and variety of care services for cancer patients through promoting an interdisciplinary approach to care provision. Perceiving accreditation as an opportunity is a prerequisite for overcoming the barriers that professionals involved in the process may report. Critical to a positive change is sharing the values and the framework, which are at the basis of accreditation programs. Improving the information-sharing process among managers and professionals may limit the risk of unmet expectations and prevent demotivation by future accreditation programs. Finally, we found that positive changes are more likely to happen when an accreditation process is considered an activity whose results depend on managers’ and professionals’ joint work.
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Affiliation(s)
- Elisa Mazzini
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Francesco Soncini
- Istituto Ortopedico Rizzoli - IRCCS, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Loredana Cerullo
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Lucia Genovese
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Giovanni Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Luca Ghirotto
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Giorgio Mazzi
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Massimo Costantini
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy.
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Pavlov M, Klobučar L, Klobučar I, Žgela K, Degoricija V. Does shifting to professional emergency department staffing affect the decision for chest radiography? World J Emerg Med 2021; 12:87-92. [PMID: 33727999 DOI: 10.5847/wjem.j.1920-8642.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The study aims to determine whether shifting to professional emergency department (ED) teams leads to a higher rate of radiologic workup. METHODS We retrospectively analyzed a total of 2,000 patients presenting to the ED of a tertiary teaching hospital in two time periods: group 1 (G1) comprised 1,000 consecutive patients enrolled from December 21, 2012 to January 5, 2013 (all patients were examined by an internal medicine specialist); group 2 (G2) comprised 1,000 consecutive patients enrolled from December 21, 2018 to January 3, 2019 (all patients were examined by an emergency physician). RESULTS The chest X-ray (CXR) was performed in 40.6% of all patients. There was no difference in the frequency of CXR (38.9% in G1 vs. 42.3% in G2, P=0.152). More CXRs were performed in G2 patients older than 65 years, in female patients older than 65 years, in patients presenting during the evening and night shifts or off-hours, in patients with a history of malignancy, in patients with gastrointestinal bleeding, and in patients with bradycardia, but fewer in patients presenting with arrhythmia. No difference in the rates of pathological CXR was found (47.3% in G1 vs. 52.2% in G2, P=0.186). Compared with G2, higher sensitivity and specificity were obtained for the binary logistic regression model predicting pathological findings in G1. CONCLUSIONS Shifting to professional ED teams does not increase radiologic workup. By implementing deliberate usage of ultrasound, some self-governing procedures, case-oriented investigations, and center-specific recommendations, unnecessary radiologic workup can be avoided. Professional ED teams could lead to a higher standard of emergency care.
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Affiliation(s)
- Marin Pavlov
- Department of Cardiology, Sestre Milosrdnice University Hospital Centre, Zagreb 10000, Croatia
| | - Lucija Klobučar
- Institute of Emergency Medicine, Osijek-Baranja County, Osijek 31000, Croatia
| | - Iva Klobučar
- Department of Cardiology, Sestre Milosrdnice University Hospital Centre, Zagreb 10000, Croatia
| | - Kristina Žgela
- University of Zagreb School of Medicine, Zagreb 10000, Croatia
| | - Vesna Degoricija
- University of Zagreb School of Medicine, Zagreb 10000, Croatia.,Department of Medicine, Sestre milosrdnice University Hospital Centre, Zagreb 10000, Croatia
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Dumont A, Betrán AP, Kaboré C, de Loenzien M, Lumbiganon P, Bohren MA, Mac QNH, Opiyo N, Carroli G, Annerstedt KS, Ridde V, Escuriet R, Robson M, Hanson C. Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: protocol for a multisite hybrid effectiveness-implementation type III trial. Implement Sci 2020; 15:72. [PMID: 32887669 PMCID: PMC7650262 DOI: 10.1186/s13012-020-01029-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background While cesarean sections (CSs) are a life-saving intervention, an increasing number are performed without medical reasons in low- and middle-income countries (LMICs). Unnecessary CS diverts scarce resources and thereby reduces access to healthcare for women in need. Argentina, Burkina Faso, Thailand, and Vietnam are committed to reducing unnecessary CS, but many individual and organizational factors in healthcare facilities obstruct this aim. Nonclinical interventions can overcome these barriers by helping providers improve their practices and supporting women’s decision-making regarding childbirth. Existing evidence has shown only a modest effect of single interventions on reducing CS rates, arguably because of the failure to design multifaceted interventions effectively tailored to the context. The aim of this study is to design, adapt, and test a multifaceted intervention for the appropriate use of CS in Argentina, Burkina Faso, Thailand, and Vietnam. Methods We designed an intervention (QUALIty DECision-making—QUALI-DEC) with four components: (1) opinion leaders at heathcare facilities to improve adherence to best practices among clinicians, (2) CS audits and feedback to help providers identify potentially avoidable CS, (3) a decision analysis tool to help women make an informed decision on the mode of birth, and (4) companionship to support women during labor. QUALI-DEC will be implemented and evaluated in 32 hospitals (8 sites per country) using a pragmatic hybrid effectiveness-implementation design to test our implementation strategy, and information regarding its impact on relevant maternal and perinatal outcomes will be gathered. The implementation strategy will involve the participation of women, healthcare professionals, and organizations and account for the local environment, needs, resources, and social factors in each country. Discussion There is urgent need for interventions and implementation strategies to optimize the use of CS while improving health outcomes and satisfaction in LMICs. This can only be achieved by engaging all stakeholders involved in the decision-making process surrounding birth and addressing their needs and concerns. The study will generate robust evidence about the effectiveness and the impact of this multifaceted intervention. It will also assess the acceptability and scalability of the intervention and the capacity for empowerment among women and providers alike. Trial registration ISRCTN67214403
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Affiliation(s)
- Alexandre Dumont
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France.
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Charles Kaboré
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Myriam de Loenzien
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Meghan A Bohren
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Newton Opiyo
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | | | - Valéry Ridde
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
| | | | - Michael Robson
- University College Dublin, National University of Ireland, Dublin, Ireland
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,London School of Hygiene and Tropical Medicine, London, UK
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Hitz MF, Arup S, Holm JP, Soerensen AL, Gerds TA, Jensen JEB. Outcome of osteoporosis evaluation, treatment, and follow-up in patients referred to a specialized outpatient clinic compared to patients in care of general practitioners. Arch Osteoporos 2020; 15:97. [PMID: 32588150 DOI: 10.1007/s11657-020-00774-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/19/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED In Denmark, osteoporosis treatment is either handled by general practitioners or at more resource demanding specialist clinics. We evaluated the treatment adherence and persistence in the two settings, which were overall similar. The type of medical support did, however, differ and was provided to two very different patient populations. PURPOSE The study aimed to investigate the effect of patient care by general practitioners (GPs) or specialists on treatment adherence among osteoporosis patients initiating treatment with oral bisphosphonates (OB). METHODS Dual-energy X-ray absorption (DXA)-scanning data from 2005 to 2013 were extracted. Treatment naïve patients with a T-score ≤ - 2.5 (spine or hip) were included. Information on medical treatment, comorbidities, and socio-economic status was extracted from Danish registries. Scanning results were evaluated by a specialist. Subsequent treatment initiation and follow-up was either handled by GPs or specialists: GP population (GPP) vs. specialist population (SP). Primary adherence was defined as treatment initiating within 12 months from diagnosis and secondary adherence as days with medicine possession rates (MPR) > 80%. RESULTS Of 11,201 DXA-scanned patients, 3685 met the inclusion criteria (GPP = 2177, SP = 1508). The GPP consisted of relatively more men, was older, had shorter education, lower income, and more comorbidities. There was no difference in baseline T-score or prior incidence of major osteoporotic fractures (MOFs). The GPP was primarily treated with OB and had better primary adherence (adjusted ORGPP/SP = 1.52 [1.31-1.75], p < 0.0001) than the SP that to a higher degree received another treatment. Secondary adherence was similar (adjusted ORGPP/SP: OR12 months = 1.02 [0.83-1.26]; OR24 months = 0.90 [0.73-1.10]; OR4 years = 0.88 [0.71-1.07]; OR5 years = 0.91 [0.74-1.13]. CONCLUSION Patients in care of specialists were most likely to receive a treatment other than OB. Primary adherence was highest in the GPP, whereas short- and long-term persistence was similar for up to 5 years whether treated by a specialist or a GP.
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Affiliation(s)
- Mette Friberg Hitz
- National Center for Bone Health, Medical Department, Endocrinology, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark. .,Institute of Clinical Medicine, University of Copenhagen, Blegdansvej 3B, 2200, Copenhagen N, Denmark.
| | - Sofie Arup
- National Center for Bone Health, Medical Department, Endocrinology, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark
| | - Jakob Praest Holm
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Kettegaards Alle 30, 2650, Hvidovre, Denmark
| | - Anne Lyngholm Soerensen
- Department of Biostatistics, University of Copenhagen, Oster Farigmagsgade 5, 1014, Copenhagen K, Denmark
| | - Thomas Alexander Gerds
- Department of Biostatistics, University of Copenhagen, Oster Farigmagsgade 5, 1014, Copenhagen K, Denmark
| | - Jens-Erik Beck Jensen
- Institute of Clinical Medicine, University of Copenhagen, Blegdansvej 3B, 2200, Copenhagen N, Denmark.,Department of Endocrinology, Copenhagen University Hospital Hvidovre, Kettegaards Alle 30, 2650, Hvidovre, Denmark
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Rossinot H, Marquestaut O, de Stampa M. The experience of patients and family caregivers during hospital-at-home in France. BMC Health Serv Res 2019; 19:470. [PMID: 31288804 DOI: 10.1186/s12913-019-4295-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 06/24/2019] [Indexed: 11/16/2022] Open
Abstract
Background Public health policies tend to generalize the use of Hospital-At-Home (HAH) to answer the growing will of patients to be treated or to die at home. HAH is a model of care that provides acute-level services in the patient’s home with the interventions of variety of health care professionals. Relatives participate also in the interventions by helping for sick patients at home, but we lack data on the care of patients and caregivers in HAH. The aim of this study was to make an inventory of the experiences of patients and family caregivers in HAH. Methods The research was qualitative using nineteen semi-directed interviews from nine patients and ten caregivers of one care unit of Greater Paris University Hospitals’ HAH, and the grounded theory was used to analyze the transcripts. Caregivers were also asked, after the interview, to fill in the Zarit Burden Inventory. Results HAH remained mostly unknown for patients and caregivers before the admission proposition and the outlook of being admitted in HAH was perceived as positive, for both of them. Caregivers had a versatile role throughout HAH, leading to situations of suffering, but also had sources of support. The return home was considered satisfactory by both caregivers and patients, related to the quality of care and increased morale despite HAH’s organizational constraints. We noted an impact of HAH on the relationship between the patient and the caregiver(s), but caused by multiple factors: the fact that the care takes places at home, its consequences but also the disease itself. Conclusion HAH strongly involved the patient’s caregiver(s) all along the process. HAH’s development necessitates to associate both patients and caregivers and to take into account their needs at every step. This study highlights the need to better assess the ability of the caregiver to cope with his or her relative in HAH with acute and subacute care at home. Electronic supplementary material The online version of this article (10.1186/s12913-019-4295-7) contains supplementary material, which is available to authorized users.
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Blomberg H, Welander J. A narrative study of newly graduated registered Swedish nurses' establishment in the profession and the portrayal of a healthcare organisation. J Health Organ Manag 2019; 33:413-425. [PMID: 31282811 DOI: 10.1108/jhom-09-2018-0251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to investigate how the participants talk about their experiences as newly graduated nurses, managers and nursing colleagues in the context of "newcomers' establishment in the profession" and to identify how they portray the healthcare organisation in their narratives. DESIGN/METHODOLOGY/APPROACH A narrative approach is used to reveal and illustrate three perspectives on the topic "new-comers' establishment". In total, 14 interviews are conducted with 4 managers, 4 nursing colleagues and 6 newly graduated registered nurses. The focus of this study is how a healthcare organisation embraces and retains newly graduated registered nurses and how this is perceived. FINDINGS The newcomers' establishment is facilitated by an orientation programme and an orientation period, individual support provided by managers and colleagues, and the creation of trust to boost confidence in nursing situations. The organisation is portrayed as struggling with high workloads, nursing shortages, high levels of responsibility and showing concern and an interest in the newcomer. The parties criticise the university for not teaching the most basic knowledge, thereby revealing the existence of a theory-practice gap. ORIGINALITY/VALUE The research shows how building trust amongst the organisation's members is essential for creating a satisfying workplace and the retention of newly graduated registered nurses. Empirical descriptions of newly graduated nurses, managers and nursing colleagues experiences of "newcomers establishment" are rare, which is why the description of such "establishment" in this research increases the value of the paper.
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Affiliation(s)
- Helena Blomberg
- School of Health, Care and Welfare, Mälardalen University , Eskilstuna, Sweden
| | - Jonas Welander
- School of Health, Care and Welfare, Mälardalen University , Eskilstuna, Sweden
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Abstract
Rising healthcare costs are major concerns in most high-income countries. Yet, political measures to reduce costs have so far remained futile and have damaged the best interests of patients and citizen. We therefore explored the possibilities to analyze healthcare systems as a socially constructed complex adaptive system (CAS) and found that by their very nature such CAS tend not to respond as expected to top-down interventions. As CAS have emergent behaviors, the focus on their drivers - purpose, economy and behavioral norms - requires particular attention. First, the importance of understanding the purpose of health care as improvement of health and its experience has been emphasized by two recent complementary re-definitions of health and disease. The economic models underpinning today's healthcare - profit maximization - have shifted the focus away from its main purpose. Second, although economic considerations are important, they must serve and not dominate the provision of healthcare delivery. Third, expected health professionals' behavioral norms - to first consider the health and wellbeing of patients - have been codified in the universally accepted Declaration of Geneva 2017. Considering these three aspects it becomes clear that complex adaptive healthcare systems need mindful top-down/bottom-up leadership that supports the nature of innovation for health care driven by local needs. The systemic focus on improving people's health will then result in significant cost reductions.
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Affiliation(s)
- Joachim P. Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Holgate, NSW, 2250, Australia
- International Society for Systems and Complexity Sciences for Health, Waitsfield, VT, USA
| | - Johannes Bircher
- Hepatology Department of Biomedical Research, University of Bern, Bern, Switzerland
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D'Alleva A, Leigheb F, Rinaldi C, Di Stanislao F, Vanhaecht K, De Ridder D, Bruyneel L, Cangelosi G, Panella M. Achieving quadruple aim goals through clinical networks: A systematic review. J Healthc Qual Res 2019; 34:29-39. [PMID: 30713135 DOI: 10.1016/j.jhqr.2018.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/09/2018] [Accepted: 10/22/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Clinical Networks are complex interventions that enable healthcare professionals from various disciplines to work in a coordinated manner in the context of multiple care settings, to provide a high quality response to a specific disease. The aim of this study was to evaluate if clinical networks are able to improve effectiveness, efficiency, patients' satisfaction and professionals' behavior in the health care settings, namely the "quadruple aim" quality goals. MATERIALS AND METHODS A systematic review of documents published until February 28, 2018, in Medline, Embase and CINAHL was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. A specific research strategy was created to identify studies evaluating effectiveness, efficiency, patient satisfaction and professionals well-being obtained through clinical networks implementation. RESULTS 14249 studies were identified; 12 of these were eligible to the evaluation of "Quadruple Aim" outcomes. 9 studies focused on patients' outcomes improvement and 4 on network efficiency. Professionals' and patients' experience were not considered in any study. CONCLUSIONS There are some evidences that clinical network can improve patients' outcomes and health funds allocation in a small number of moderate-low quality studies. Further rigorous studies are needed to confirm these findings and to evaluate patients' and professionals' experience, taking into account also networks' structural features that could influence outcomes achievement.
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Bush PL, Pluye P, Loignon C, Granikov V, Wright MT, Repchinsky C, Haggerty J, Bartlett G, Parry S, Pelletier JF, Macaulay AC. A systematic mixed studies review on Organizational Participatory Research: towards operational guidance. BMC Health Serv Res 2018; 18:992. [PMID: 30577859 PMCID: PMC6421946 DOI: 10.1186/s12913-018-3775-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/28/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Organizational Participatory Research (OPR) seeks organizational learning and/or practice improvement. Previous systematic literature reviews described some OPR processes and outcomes, but the link between these processes and outcomes is unknown. We sought to identify and sequence the key processes of OPR taking place with and within healthcare organizations and the main outcomes to which they contribute, and to define ideal-types of OPR. METHODS This article reports a participatory systematic mixed studies review with qualitative synthesis A specialized health librarian searched MEDLINE, CINAHL, Embase Classic + Embase, PsycINFO, the Cochrane Library, Social Work Abstracts and Business Source Complete, together with grey literature data bases were searched from inception to November 29, 2012. This search was updated using forward citation tracking up to June 2014. Reporting quality was appraised and unclear articles were excluded. Included studies clearly reported OPR where the main research related decisions were co-constructed among the academic and healthcare organization partners. Included studies were distilled into summaries of their OPR processes and outcomes, which were subsequently analysed using deductive and inductive thematic analysis. All summaries were analysed; that is, data analysis continued beyond saturation. RESULTS Eighty-three studies were included from the 8873 records retrieved. Eight key OPR processes were identified. Four follow the phases of research: 1) form a work group and hold meetings, 2) collectively determine research objectives, 3) collectively analyse data, and 4) collectively interpret results and decide how to use them. Four are present throughout OPR: 1) communication, 2) relationships; 3) commitment; 4) collective reflection. These processes contribute to extra benefits at the individual and organizational levels. Four ideal-types of OPR were defined. Basic OPR consists of OPR processes leading to achieving the study objectives. This ideal-type and may be combined with any of the following three ideal-types: OPR resulting in random additional benefits for the individuals or organization involved, OPR spreading to other sectors of the organization and beyond, or OPR leading to subsequent initiatives. These results are illustrated with a novel conceptual model. CONCLUSION The model provides operational guidance to help OPR stakeholders collaboratively address organizational issues and achieve desired outcomes and more. REVIEW REGISTRATION As per PROSPERO inclusion criteria, this review is not registered.
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Affiliation(s)
- Paula Louise Bush
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montréal, Quebec, H3S 1Z1 Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montréal, Quebec, H3S 1Z1 Canada
| | - Christine Loignon
- Department of Family Medicine, Sherbrooke University, 150 Place Charles Lemoyne suite 200, Longueuil, Quebec, J4K 0A8 Canada
| | - Vera Granikov
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montréal, Quebec, H3S 1Z1 Canada
| | - Michael T. Wright
- Institute for Social Health, Catholic University of Applied Sciences Berlin, Köpenicker Allee 39-57, 10318 Berlin, Germany
| | - Carol Repchinsky
- Special projects, Canadian Pharmacists Association, 1785 Alta Vista Drive, Ottawa, ON K1G 3Y6 Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montréal, Quebec, H3S 1Z1 Canada
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montréal, Quebec, H3S 1Z1 Canada
| | - Sharon Parry
- West Island YMCA, 230 Brunswick Blvd, Pointe-Claire, Quebec, H9R 5N5 Canada
| | | | - Ann C. Macaulay
- CIET/Participatory Research at McGill (PRAM), 5858 Cote de Neiges, 3rd floor, Montreal, Montreal, QC H3S 1Z1 Canada
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Abstract
Purpose The purpose of this paper is to describe the design and construction of a privilege mapping system (clinical and organizational competences) of the medical staff of the Niguarda Hospital in Milan, Italy. The second aim is to measure and assess the impact of implementing an evaluation process of clinical competences at the same hospital. Design/methodology/approach The paper retraces the development and implementation of the evaluation of the privilege system, highlighting the subjects involved, the phases and outputs. Moreover, a questionnaire was distributed to 50 heads of unit involved in the planning, building and implementation of competences mapping. Five areas were investigated: competences evaluation for professional development; the impact on work organization and professional roles; professional collaboration; its impact according to context (hospital or unit) and time scale (short or long term); and ability to evaluate clinical outcome. Findings Results reveal success factors for the development and implementation of a privilege mapping system. Furthermore, the survey revealed that clinical leaders are aware of the importance of competences evaluation. In particular, they consider it as a management tool useful for professional development, for identifying excellence and planning operational activities. Originality/value Literature and practical evidence recognize the need to assess the clinical and organizational competences in order to assign tasks and responsibilities. However, there are no studies that describe the construction of systems of evaluation of privileges, as it has never been investigated as professionals perceive these tools.
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Affiliation(s)
- Simone Fanelli
- Department of Public Management, University of Parma , Parma, Italy
| | - Gianluca Lanza
- Department of Public Management, University of Parma , Parma, Italy
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Fix GM, Hyde JK, Bolton RE, Parker VA, Dvorin K, Wu J, Skolnik AA, McInnes DK, Midboe AM, Asch SM, Gifford AL, Bokhour BG. The moral discourse of HIV providers within their organizational context: An ethnographic case study. Patient Educ Couns 2018; 101:2226-2232. [PMID: 30131263 PMCID: PMC7819576 DOI: 10.1016/j.pec.2018.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Providers make judgments to inform treatment planning, especially when adherence is crucial, as in HIV. We examined the extent these judgments may become intertwined with moral ones, extraneous to patient care, and how these in turn are situated within specific organizational contexts. METHODS Our ethnographic case study included interviews and observations. Data were analyzed for linguistic markers indexing how providers conceptualized patients and clinic organizational structures and processes. RESULTS We interviewed 30 providers, observed 43 clinical encounters, and recorded fieldnotes of 30 clinic observations, across 8 geographically-diverse HIV clinics. We found variation, and identified two distinct judgment paradigms: 1) Behavior as individual responsibility: patients were characterized as "good," "behaving," or "socio-paths," and "flakes." Clinical encounters focused on medication reconciliation; 2) Behaviors as socio-culturally embedded: patients were characterized as struggling with housing, work, or relationships. Encounters broadened to problem-solving within patients' life-contexts. In sites with individualized conceptualizations, providers worked independently with limited support services. Sites with socio-culturally embedded conceptualizations had multidisciplinary teams with resources to address patients' life challenges. CONCLUSIONS AND PRACTICE IMPLICATIONS When self-management is viewed as an individual's responsibility, nonadherence may be seen as a moral failing. Multidisciplinary teams may foster perceptions of patients' behaviors as socially embedded.
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Affiliation(s)
- Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Justeen K Hyde
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Brandeis University, The Heller School for Social Policy and Management, Waltham, MA, USA
| | - Victoria A Parker
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Peter T. Paul College of Business & Economics, University of New Hampshire, Durham, NH, USA
| | - Kelly Dvorin
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA
| | - Juliet Wu
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA
| | - Avy A Skolnik
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Amanda M Midboe
- Center for Innovation to Implementation (ci2i), VA Palo Alto HCS, Palo Alto, CA, USA
| | - Steven M Asch
- Center for Innovation to Implementation (ci2i), VA Palo Alto HCS, Palo Alto, CA, USA; Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Charron J, Gouëzec H, Bajeux E. [Home blood transfusion in France: Benefits and development terms]. Transfus Clin Biol 2018; 26:304-308. [PMID: 30268597 DOI: 10.1016/j.tracli.2018.08.161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/29/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Patients with cancers or malignant homeopathies can suffer from chronic anemia and be regularly transfused in hospitals. Most of the time, their performance status is low. Few local structures currently provide blood transfusion services and patients have to go under difficult and costing transportation to the hospital. The objective of this work is to evaluate benefits and development terms of home blood transfusion for patients with chronic anemia and having to get transfused regularly. METHODS A field investigation-mixing observations and interviews and a literature review were conducted. RESULTS Home blood transfusion represented a little part of home health care activity. When it was practiced, its organization was heterogeneous: it was sometimes performed by a doctor, sometimes by a nurse. Home blood transfusion was benefic for patients: it was more comfortable and it allowed them to avoid harmful transportation to the hospital. Few adverse events occurred during various experiments, all were mild. Before its revaluation in March 2018, home blood transfusion was not enough funded by National health insurance. Home blood transfusion also suffered from a lack of framework until the publication of recommendations in April 2018. CONCLUSIONS Lack of a framework and sufficient funding prevented home blood transfusion development until changes that occurred in 2018. Therefore, this activity should develop in years to come. Allowing reducing unnecessary hospitalizations, home blood transfusion fit into French health national strategy.
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Affiliation(s)
- J Charron
- Service d'épidémiologie et de Santé publique, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes, France.
| | - H Gouëzec
- Service d'épidémiologie et de Santé publique, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - E Bajeux
- Service d'épidémiologie et de Santé publique, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
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Ahlstedt C, Eriksson Lindvall C, Holmström IK, Muntlin Athlin Å. What makes registered nurses remain in work? An ethnographic study. Int J Nurs Stud 2018; 89:32-38. [PMID: 30339953 DOI: 10.1016/j.ijnurstu.2018.09.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Registered nurses' work-related stress, dissatisfaction and burnout are some of the problems in the healthcare and that negatively affect healthcare quality and patient care. A prerequisite for sustained high quality at work is that the registered nurses are motivated. High motivation has been proved to lead to better working results. The theory of inner work life describes the dynamic interplay between a person's perceptions, emotions and motivation and the three key factors for a good working life: nourishment, progress and catalysts. OBJECTIVES The aim of the study was to explore registered nurses' workday events in relation to inner work life theory, to better understand what influences registered nurses to remain in work. DESIGN A qualitative explorative study with an ethnographic approach. METHODS Participant observation over four months; in total 56 h with 479 events and 58 informal interviews during observation; all registered nurses employed at the unit (n = 10) were included. In addition, individual interviews were conducted after the observation period (n = 9). The dataset was analysed using thematic analysis and in the final step of the analysis the categories were reflected in relation to the three key factors in theory of inner work life. RESULTS Nourishment in a registered nurse context describes the work motivation created by the interpersonal support between colleagues. It was important to registered nurses that physicians and colleagues respected and trusted their knowledge in the daily work, and that they felt comfortable asking questions and supporting each other. Progress in the context of registered nurses' work motivation was the feeling of moving forward with a mix of small wins and the perception of solving more complex challenges in daily work. It was also fundamental to the registered nurses' development through new knowledge and learning during daily work. Catalysts, actions that directly facilitate the work, were highlighted as the possibility to work independently along with the opportunity to work together with other registered nurses. CONCLUSION This study has a number of implications for future work and research on creating an attractive workplace for registered nurses. Working independently, with colleagues from the same profession, integrated with learning, visible progress, and receiving feedback from the work itself, contribute to work motivation.
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Affiliation(s)
- Carina Ahlstedt
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
| | | | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | - Åsa Muntlin Athlin
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden; Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Adelaide Nursing School, University of Adelaide, Adelaide, Australia
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Willging CE, Sommerfeld DH, Jaramillo ET, Lujan E, Bly RS, Debenport EK, Verney SP, Lujan R. "Improving Native American elder access to and use of health care through effective health system navigation". BMC Health Serv Res 2018; 18:464. [PMID: 29914446 PMCID: PMC6006994 DOI: 10.1186/s12913-018-3182-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/03/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Public insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care. METHODS This community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders. DISCUSSION The information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities. TRIAL REGISTRATION This protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404 . Registered June 6, 2018.
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Affiliation(s)
- Cathleen E. Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque, NM 87106 USA
- Department of Anthropology, University of New Mexico, MSC01-1040, Anthropology 1, Albuquerque, NM 87131 USA
| | - David H. Sommerfeld
- Department of Psychiatry, University of California, 9500 Gilman Drive (8012) La Jolla, San Diego, CA 92093-0812 USA
| | - Elise Trott Jaramillo
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque, NM 87106 USA
- Department of Anthropology, University of New Mexico, MSC01-1040, Anthropology 1, Albuquerque, NM 87131 USA
| | - Erik Lujan
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque, NM 87106 USA
| | - Roxane Spruce Bly
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque, NM 87106 USA
| | - Erin K. Debenport
- Department of Anthropology, University of California, Los Angeles, 374 Portola Plaza, 341 Haines Hall, Box 951553, Los Angeles, CA 90095 USA
| | - Steven P. Verney
- Department of Psychology, University of New Mexico, MSC03-2220, 1, Albuquerque, NM 87131 USA
| | - Ron Lujan
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque, NM 87106 USA
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Beaussier M, Albaladejo P, Sciard D, Jouffroy L, Benhamou D, Ecoffey C, Aubrun F. Operation and organisation of ambulatory surgery in France. Results of a nationwide survey; The OPERA study. Anaesth Crit Care Pain Med 2017; 36:353-357. [PMID: 28826981 DOI: 10.1016/j.accpm.2017.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 11/28/2022]
Abstract
Operation and organisation of ambulatory surgical activity in France remains largely undocumented. This nationwide observational prospective survey, carried out between December 2013 and December 2014, was undertaken to characterise the organisational processes of ambulatory surgery in France. Three hundred centres were randomly chosen from a list of 891 hospitals practicing ambulatory surgery, with stratification according to the type of facility (public general hospital, university hospital, private hospital) and region. An email was sent to the board of the randomly chosen facilities with an attached information letter explaining how the survey worked. Hospitals who did not reply to this email were contacted by phone. Among the 206 hospitals that answered the survey, 92 were private, 78 were public and 36 were university hospitals. Median accommodation capacities of ambulatory units were 8 beds, mostly distinct from conventional surgical ward. Patient pathways dedicated to ambulatory surgery appear as the current predominant practice. 77% of the French ambulatory units have a head nurse in charge of logistics and coordination. Several items still have to be improved, such as the adherence to modern fasting rules and the unnecessary use of stretcher to move the patient. Objective discharge score is used in 77% of ambulatory units. This survey highlights the implementation of some positive organisational parameters corresponding to common good practices recommendations. In contrast, several other recommendations are still insufficiently applied and may hamper the development of safe ambulatory surgery. This brings up new challenges for health regulatory boards, hospitals and ambulatory units managers.
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Affiliation(s)
- Marc Beaussier
- Department of anaesthesiology, institut mutualiste Montsouris, Paris, France.
| | - Pierre Albaladejo
- Department of anaesthesiology and intensive care medicine, Grenoble university hospital, Grenoble, France
| | - Didier Sciard
- Department of anaesthesiology, institut mutualiste Montsouris, Paris, France
| | | | - Dan Benhamou
- Department of anaesthesiology and intensive care medicine, groupe hospitalier et faculté de médecine Paris Sud, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Claude Ecoffey
- Department of anaesthesiology and intensive care medicine, Rennes university hospital, Rennes, France
| | - Frederic Aubrun
- Department of anaesthesiology and intensive care medicine, La Croix-Rousse university hospital, hospices civils de Lyon, Lyon, France
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Mira JJ, Lorenzo S, Navarro I, Pérez-Jover V, Vitaller J. [Design and validation of the CSR-Hospital-SP scale to measure corporate social responsibility]. Gac Sanit 2013; 27:529-32. [PMID: 23333031 DOI: 10.1016/j.gaceta.2012.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 10/18/2012] [Accepted: 11/20/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To design and validate a scale (CSR-Hospital-SP) to determine health professionals' views on the approach of management to corporate social responsibility (CSR) in their hospital. METHODS The literature was reviewed to identify the main CSR scales and select the dimensions to be evaluated. The initial version of the scale consisted of 25 items. A convenience sample of a minimum of 224 health professionals working in five public hospitals in five autonomous regions were invited to respond. Floor and ceiling effects, internal consistency, reliability, and construct validity were analyzed. RESULTS A total of 233 health professionals responded. The CSR-Hospital-SP scale had 20 items grouped into four factors. The item-total correlation was higher than 0.30; all factor loadings were greater than 0.50; 59.57% of the variance was explained; Cronbach's alpha was 0.90; Spearman-Brown's coefficient was 0.82. CONCLUSION The CSR-Hospital-SP scale is a tool designed for hospitals that implement accountability mechanisms and promote socially responsible management approaches.
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Affiliation(s)
- José Joaquín Mira
- Departamento de Psicología de la Salud, Universidad Miguel Hernández, Elche, Alicante, España; Departamento de Salud Sant Joan-Alacant, Alicante, España.
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Lancellotti P, Rosenhek R, Pibarot P, Iung B, Otto CM, Tornos P, Donal E, Prendergast B, Magne J, La Canna G, Piérard LA, Maurer G. ESC Working Group on Valvular Heart Disease position paper--heart valve clinics: organization, structure, and experiences. Eur Heart J 2013; 34:1597-606. [PMID: 23293304 DOI: 10.1093/eurheartj/ehs443] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND With an increasing prevalence of patients with valvular heart disease (VHD), a dedicated management approach is needed. The challenges encountered are manifold and include appropriate diagnosis and quantification of valve lesion, organization of adequate follow-up, and making the right management decisions, in particular with regard to the timing and choice of interventions. Data from the Euro Heart Survey have shown a substantial discrepancy between guidelines and clinical practice in the field of VHD and many patients are denied surgery despite having clear indications. The concept of heart valve clinics (HVCs) is increasingly recognized as the way to proceed. At the same time, very few centres have developed such expertise, indicating that specific recommendations for the initial development and subsequent operating requirements of an HVC are needed. AIMS The aim of this position paper is to provide insights into the rationale, organization, structure, and expertise needed to establish and operate an HVC. Although the main goal is to improve the clinical management of patients with VHD, the impact of HVCs on education is of particular importance: larger patient volumes foster the required expertise among more senior physicians but are also fundamental for training new cardiologists, medical students, and nurses. Additional benefits arise from research opportunities resulting from such an organized structure and the delivery of standardized care protocols. CONCLUSION The growing volume of patients with VHD, their changing characteristics, and the growing technological opportunities of refined diagnosis and treatment in addition to the potential dismal prognosis if overlooked mandate specialized evaluation and care by dedicated physicians working in a specialized environment that is called the HVC.
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Affiliation(s)
- Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, Liège, Belgium.
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