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Stefanini, Alessandro, Davide Aloini, Elisabetta Benevento, Riccardo Dulmin und Valeria Mininno. „A data-driven methodology for supporting resource planning of health services“. Socio-Economic Planning Sciences 70 (Juni 2020): 100744. http://dx.doi.org/10.1016/j.seps.2019.100744.
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IACOB, Nadina, und Felice SIMONELLI. „Towards a European Health Data Ecosystem“. European Journal of Risk Regulation 11, Nr. 4 (09.10.2020): 884–93. http://dx.doi.org/10.1017/err.2020.88.
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The digital health ecosystem is rife with opportunities to improve healthcare through data-driven services in the European Union (EU). The value of health data, in the multiple forms in which they come (from health records to lifestyle data collected by smartphones or wearables), can truly emerge when they are allowed to flow in the ecosystem within a governance framework supported by all relevant stakeholders, with trust as the common and clear thread underpinning it. The coronavirus pandemic has provided an additional impetus for change, showing the importance of coordination and adequate communication between Member States and quality data to inform decision-making. Significant challenges remain, however, in order to achieve a fully integrated European digital health ecosystem, including: (1) the potentially diverging rules set by Member States at the national level and the need for an EU framework for the secondary use of health data; (2) the need for transparency and accountability for sustaining a data-sharing framework involving public authorities, research organisations, industry and citizens; and (3) the need for interoperable data and processes. Taking stock of these challenges, this article puts forward policy recommendations to enable the provision of pan-European data-driven healthcare services and to build a transparent and trustworthy framework for citizens.
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Satinsky, Emily, Corine Driessens, David Crepaz-Keay und Antonis A. Kousoulis. „Mental health service users’ perceptions of data sharing and data protection: a short qualitative report“. BMJ Health & Care Informatics 25, Nr. 4 (Oktober 2018): 239–42. http://dx.doi.org/10.14236/jhi.v25i4.1033.
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BackgroundTo improve health services, social, economic and health data should be shared and linked to create a full narrative of lived experience. Mental health data sharing is often considered a particularly sensitive area.ObjectiveTo assess mental health service users’ perceptions regarding the current practice of administrative data-driven research.MethodWe conducted a focus group using case study scenarios. Themes and subthemes were analysed using qualitative methods.ResultsParticipants were generally happy for data owners to share their health, social and economic data if the purpose was transparent and if the information would inform and improve health policy and practice. Participants were less keen on sharing data through digital applications.ConclusionThis case study informs a data linkage study protocol. Research teams and database owners should strive to educate service users on data protection and create dissent opportunities.
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Birdthistle, Isolde J., Justin Fenty, Martine Collumbien, Charlotte Warren, James Kimani, Charity Ndwiga und Susannah Mayhew. „Integration of HIV and reproductive health services in public sector facilities: analysis of client flow data over time in Kenya“. BMJ Global Health 3, Nr. 5 (September 2018): e000867. http://dx.doi.org/10.1136/bmjgh-2018-000867.
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IntroductionIntegration of HIV/AIDS with reproductive health (RH) services can increase the uptake and efficiency of services, but gaps in knowledge remain about the practice of integration, particularly how provision can be expanded and performance enhanced. We assessed the extent and nature of service integration in public sector facilities in four districts in Kenya.MethodsBetween 2009 and 2012, client flow assessments were conducted at six time points in 24 government facilities, purposively selected as intervention or comparison sites. A total of 25 539 visits were tracked: 15 270 in districts where 6 of 12 facilities received an intervention to strengthen HIV service integration with family planning (FP); and 10 266 visits in districts where half the facilities received an HIV-postnatal care intervention in 2009–2010. We tracked the proportion of all visits in which: (1) an HIV service (testing, counselling or treatment) was received together with an RH service (FP counselling or provision, antenatal care, or postnatal care); (2) the client received HIV counselling.ResultsLevels of integrated HIV-RH services and HIV counselling were generally low across facilities and time points. An initial boost in integration was observed in most intervention sites, driven by integration of HIV services with FP counselling and provision, and declined after the first follow-up. Integration at most sites was driven by temporary rises in HIV counselling. The most consistent combination of HIV services was with antenatal care; the least common was with postnatal care.ConclusionsThese client flow data demonstrated a short-term boost in integration, after an initial intervention with FP services providing an opportunity to expand integration. Integration was not sustained over time highlighting the need for ongoing support. There are multiple opportunities for integrating service delivery, particularly within antenatal, FP and HIV counselling services, but a need for sustained systems and health worker support over time.Trial registration numberNCT01694862
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Walter, Angela Wangari, Randall P. Ellis und Yiyang Yuan. „Health care utilization and spending among privately insured children with medical complexity“. Journal of Child Health Care 23, Nr. 2 (19.07.2018): 213–31. http://dx.doi.org/10.1177/1367493518785778.
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Children with medical complexity have high health service utilization and health expenditures that can impose significant financial burdens. This study examined these issues for families with children enrolled in US private health plans. Using IBM Watson/Truven Analytics℠ MarketScan® commercial claims and encounters data (2012–2014), we analyzed through regression models, the differences in health care utilization and spending of disaggregated health care services by health plan types and children’s medical complexity levels. Children in consumer-driven and high-deductible plans had much higher out-of-pocket spending and cost shares than those in health maintenance organizations and preferred provider organizations (PPOs). Children with complex chronic conditions had higher service utilization and out-of-pocket expenditures while having lower cost shares on various categories of services than those without any chronic condition. Compared to families covered by PPOs, those with high-deductible or consumer-driven plans were 2.7 and 1.7 times more likely to spend over US$1000 out of pocket on their children’s medical care, respectively. Families with higher complexity levels were more likely to experience financial burdens from expenditures on children’s medical services. In conclusion, policymakers and families with children need to be cognizant of the significant financial burdens that can arise from children’s complex medical needs and health plan demand-side cost sharing.
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Stadnick, Nicole A., Anna S. Lau, Kelsey S. Dickson, Keri Pesanti, Debbie Innes-Gomberg und Lauren Brookman-Frazee. „Service use by youth with autism within a system-driven implementation of evidence-based practices in children’s mental health services“. Autism 24, Nr. 8 (18.07.2020): 2094–103. http://dx.doi.org/10.1177/1362361320934230.
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Public mental health systems play an important role in caring for youth with autism spectrum disorder. Like other dually diagnosed populations, youth with autism spectrum disorder may receive services in the context of evidence-based practice implementation efforts within public mental health systems. Little is known about service use patterns within the context of system-driven implementations efforts for this population. This case–control study examined mental health service patterns of 2537 youth with autism spectrum disorder compared to 2537 matched peers receiving care in the Los Angeles County Department of Mental Health, the largest public mental health department in the United States, within the context of a system-driven implementation of multiple evidence-based practices. Although not the primary target of this implementation effort, youth with autism spectrum disorder were served when they met criteria for the services based on their presenting mental health symptoms. Comparative analyses using administrative claims data were conducted to examine differences in mental health utilization patterns and clinical characteristics. Findings revealed significant differences in the volume and duration of mental health services as well as differences in the service type and evidence-based practice delivered between youth with and without autism spectrum disorder. Results provide direction targeting implementation efforts for youth with autism spectrum disorder within a public mental health system care reform.
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Simbolon, Pomarida, und Nagoklan Simbolon. „Association between Social-Cultural and the Utilization of Elderly Integrated Health Services (Posyandu Lansia) in Hamparan Perak Health Center“. Unnes Journal of Public Health 7, Nr. 1 (31.01.2018): 50–54. http://dx.doi.org/10.15294/ujph.v7i1.18201.
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Abstract
Elderly Integrated Health Service (Posyandu Lansia) is an integrated service post for elderly in certain areas that have been agreed upon, which are community driven. A significant elderly population will be accompanied by various problems and will affect various aspects of life especially health. Based on preliminary data, the number of elderly population of 930 people, but only about 230 people or about 24.7% who came to Elderly Integrated Health Services. The purpose of this research was to analyze the association between socio-cultural and the utilization of Elderly Integrated Health Services. The type of this research is the explanatory survey with research population of 160 people and research sample of 60 respondents. Data collection used questionnaire. The results of this study were there was a correlation between tradition (p = 0.000), belief (0.001) with the utilization of Elderly Integrated Health Services.
Abstrak
Posyandu Lansia adalah pos pelayanan terpadu untuk orang tua di daerah tertentu yang telah disepakati, yang digerakkan oleh masyarakat. Populasi lansia yang signifikan akan disertai dengan berbagai masalah dan akan mempengaruhi berbagai aspek kehidupan khususnya kesehatan. Berdasarkan data awal jumlah populasi lansia sebanyak 930 orang tetapi yang datang ke posyandu lansia hanya berkisar 230 orang atau sekitar 24,7%. Tujuan dari penelitian ini adalah untuk menganalisis hubungan social budaya dengan pemanfaatan posyandu. Jenis penelitian ini adalah survey explanatory dengan populasi penelitian 160 orang dan sampel penelitian 60 responden. Pengumpulan data dengan menggunakan kuesioner. Hasil penelitian ini menunjukkan ada hubungan antara tradisi (p=0,000), kepercayaan (0,001) dengan dengan pemanfaatan Posyandu.
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Ozumba, Benjamin C., Nkechi G. Onyeneho, Malgorzata Chalupowski und S. V. Subramanian. „Inequities in Access to Maternal Health Care in Enugu State: Implications for Universal Health Coverage to Meet Vision 2030 in Nigeria“. International Quarterly of Community Health Education 39, Nr. 3 (24.12.2018): 163–73. http://dx.doi.org/10.1177/0272684x18819977.
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We explored the equity issues in access to maternal health services in Enugu State, Nigeria. We conducted a cross-sectional survey of 1,600 women who had babies within 6 months prior to the survey, drawn from four urban and rural local government areas in Enugu State of Nigeria, using structured questionnaire. Focus group discussions were held with grandmothers and fathers of the new babies. In-depth interviews were held with health workers. Results showed that inequities exist in access to quality health service when the mothers needed health care. The inequities in access to quality antenatal care (ANC) services were driven mainly by the type of localities of the mothers. Mothers who lived in the urban areas had better access ( p = .013). Other factors that facilitated access to better ANC services included being educated ( p = .049), being older ( p = .009), and belonging to the richer wealth quintile ( p < .001). With respect to access to health service when in need of health, differentials were seen with respect to living in urban residence ( p < .001), distance to the health facilities ( p < .001), and being rich ( p < .001). Access to health services was associated with odds ratio of 3.6 (95% CI [2.9, 4.4]) and 1.54 (95% CI [1.3, 2.0]) for living in urban residence and existence of good ANC service points, respectively. Similarly, living in urban areas was associated with an odds ratio of 1.3 (95% CI [1.1, 1.6]) of having access to good ANC services. These inequities in access to health service were also captured in the qualitative data. Suboptimal access to quality health care by segments of the populations poses challenge to universal health coverage in Enugu State. Action is needed to promote coordinated delivery of health services to ensure no one is left behind, irrespective of where they live or the socioeconomic strata they are born into.
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Korhonen, Olli, Karin Väyrynen, Tino Krautwald, Glenn Bilby, Hedwig Anna Theresia Broers, Guido Giunti und Minna Isomursu. „Data-Driven Personalization of a Physiotherapy Care Pathway: Case Study of Posture Scanning“. JMIR Rehabilitation and Assistive Technologies 7, Nr. 2 (15.09.2020): e18508. http://dx.doi.org/10.2196/18508.
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Background Advanced sensor, measurement, and analytics technologies are enabling entirely new ways to deliver health care. The increased availability of digital data can be used for data-driven personalization of care. Data-driven personalization can complement expert-driven personalization by providing support for decision making or even by automating some parts of decision making in relation to the care process. Objective The aim of this study was to analyze how digital data acquired from posture scanning can enhance physiotherapy services and enable more personalized delivery of physiotherapy. Methods A case study was conducted with a company that designed a posture scan recording system (PSRS), which is an information system that can digitally record, measure, and report human movement for use in physiotherapy. Data were collected through interviews with different stakeholders, such as health care professionals, health care users, and the information system provider, and were analyzed thematically. Results Based on the results of our thematic analysis, we propose three different types of support that posture scanning data can provide to enhance and enable more personalized delivery of physiotherapy: 1) modeling the condition, in which the posture scanning data are used to detect and understand the health care user’s condition and the root cause of the possible pain; 2) visualization for shared understanding, in which the posture scanning data are used to provide information to the health care user and involve them in more collaborative decision-making regarding their care; and 3) evaluating the impact of the intervention, in which the posture scanning data are used to evaluate the care progress and impact of the intervention. Conclusions The adoption of digital tools in physiotherapy has remained low. Physiotherapy has also lacked digital tools and means to inform and involve the health care user in their care in a person-centered manner. In this study, we gathered insights from different stakeholders to provide understanding of how the availability of digital posture scanning data can enhance and enable personalized physiotherapy services.
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Lanzoni, Gabriela Marcellino de Melo, Betina Hörner Schlindwein Meirelles, Alacoque Lorenzini Erdmann, Maira Buss Thofehrn und Clarice Maria Dall'Agnol. „ACTIONS/INTERACTIONS MOTIVATING NURSING LEADERSHIP IN THE CONTEXT OF PRIMARY HEALTH CARE“. Texto & Contexto - Enfermagem 24, Nr. 4 (24.11.2015): 1121–29. http://dx.doi.org/10.1590/0104-0707201500003740013.
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The aim of this qualitative study is to understand the actions/interactions identified as motivating leadership for nurses working at Primary Health Care services in a city in the South of Brazil. The Grounded Theory was used as the methodological framework. Data collection occurred through semi-structured interviews with twenty-three nurses working in the municipal health network and seven Nursing professors with expertise on the theme, distributed in four sample groups. The analysis revealed the category Composing the profile of nurses for leadership and its importance in health organizations, supported by three subcategories. The nurse exercises leadership driven by personality, vocational training stimulus, characteristics of the profession and influence of the environment. Nurses are influenced and influence the health service, acting in compliance with health policies, helping to foster the participation and integration of other workers in the health services.
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Regmi, Krishna. „Methodological and practical viewpoints of qualitative-driven mixed method design: the case of decentralisation of primary healthcare services in Nepal“. Primary Health Care Research & Development 19, Nr. 01 (11.09.2017): 64–76. http://dx.doi.org/10.1017/s1463423617000597.
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BackgroundAlthough considerable attention has been paid to the use of quantitative methods in health research, there has been limited focus on decentralisation research using a qualitative-driven mixed method design. Decentralisation presents both a problematic concept and methodological challenges, and is morecontext-specificand is oftenmulti-dimensional. Researchers often consider using more than one method design when researching phenomena is complex in nature.AimTo explore the effects of decentralisation on the provision of primary healthcare services.MethodsQualitative-driven mixed method design, employing three methods of data collections: focus group discussions (FGDs), semi-structured interviews (SSIs) and participant observations under two components, that is, core component and supplementary components were used. Four FGDs with health service practitioners, three FGDs with district stakeholders, 20 SSIs with health service users and 20 SSIs with national stakeholders were carried out. These were conducted sequentially. NVivo10, a data management program, was utilised to code the field data, employing a content analysis method for searching the underlying themes or concepts in the text material.FindingsBoth positive and negative experiences related to access, quality, planning, supplies, coordination and supervision were identified.ConclusionThis study suggests some evidence of the effects of decentralisation on health outcomes in general, as well as filling a gap of understanding and examining healthcare through a qualitative-driven mixed methods approach, in particular. Future research in the area of qualitative in-depth understanding of the problems (why decentralisation, why now and what for) would provoke an important data set that benefits the researchers and policy-makers for planning and implementing effective health services.
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Pratt, Nicole L., Andre Andrade, Lisa M. Kalisch, Vanessa T. Le Blanc, John Barratt und Elizabeth E. Roughead. „Responding to the Under-Utilisation of Necessary Health Care in the Time of COVID-19: A Precision Public Health intervention“. Senior Care Pharmacist 36, Nr. 1 (01.01.2021): 6–10. http://dx.doi.org/10.4140/tcp.n.2021.6.
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The Veterans' Medicines Advice and Therapeutics Education Services (MATES) program is a national data driven, behaviorally informed, health intervention to improve the use of medicines among Australian veterans. The program, which has been operating since 2004, has led the way in the use of government held data assets to generate evidenced-based health information, which, when provided to clinicians alongside educational materials, can make demonstrable improvements in health and promote practice change.
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Segal, Leonie, Sophie Guy und Gareth Furber. „What is the current level of mental health service delivery and expenditure on infants, children, adolescents, and young people in Australia?“ Australian & New Zealand Journal of Psychiatry 52, Nr. 2 (14.07.2017): 163–72. http://dx.doi.org/10.1177/0004867417717796.
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Objectives: The study aim was to estimate the current level of ambulatory mental health service delivery to young people aged 0–24 years in Australia and associated government expenditure. Recognising the importance of the early years for the development of mental illness and socioeconomic outcomes, we were particularly interested in service access by infants and young children. Methods: We extracted information from government administrative datasets on the number of people who received mental health services, number of services and expenditure through the health sector for 2014–2015. Results are primarily reported by age groups 0–4, 5–11, 12–17 and 18–24 years. Results: Less than 1% of 0- to 4-year-olds received a mental health service in any one service setting, whereas nearly 11% of 18- to 24-year-olds received a mental health service through the Medicare Benefits Schedule Better Access programme alone. Many more services were delivered to 12- to 24-year-olds (>4 million) than to 0- to 11-year-olds (552,000). Medicare Benefits Schedule Better Access delivers services to more children and youth than do state/territory community mental health services, although the latter provide more services per client. In 2013–2014, Australian Government expenditure on ambulatory mental health services for 0- to 24-year-olds was AUD428 million, similar to the AUD491 million spent by state/territory governments. Conclusion: The study provides a benchmark for data-driven service planning to ensure that the mental health needs of infants, children and young people are met. Our results indicate that the youngest age group are underserviced relative to need, even noting infants and children may receive services for behavioural/mental health issues from providers not captured in our study (such as paediatricians). The developmental origins of mental illness underlies the urgency of adequate provision by governments of perinatal, infant and child mental health services to avoid loss of life potential and reduce the pressures on the justice, child protection and welfare systems.
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Wang, Xueqin, Yiik Diew Wong und Kum Fai Yuen. „Does COVID-19 Promote Self-Service Usage among Modern Shoppers? An Exploration of Pandemic-Driven Behavioural Changes in Self-Collection Users“. International Journal of Environmental Research and Public Health 18, Nr. 16 (13.08.2021): 8574. http://dx.doi.org/10.3390/ijerph18168574.
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Due to health concerns related to COVID-19, shoppers have learned to minimise social contact by adopting various contactless self-service technologies to fulfil their consumption needs. This study explores shoppers’ behavioural changes in relation to self-service, using the special research context of e-commerce self-collection services. By synthesising insights from the health psychology literature, this study proposes an affective-cognitive-social perspective to explain the pandemic-driven behavioural changes of self-collection users. The survey instrument is used for online data collection (n = 500), and a combined (descriptive and quantitative) method is adopted for data analysis. Our results suggest that, although with a relatively weak predictive power, the affective and cognitive appraisals of health risks lead to the reinforced usage of self-collection service. This also applies to the factors of action/coping planning and subjective norm. This study theoretically contributes to the self-service literature and creates managerial implications for retailers and logistics operators.
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Giovanis, Apostolos, George Pierrakos, Ioannis Rizomyliotis und Spyridon Binioris. „Assessing service quality and customer behavioral responses in hospital outpatient services“. International Journal of Quality and Service Sciences 10, Nr. 2 (18.06.2018): 98–116. http://dx.doi.org/10.1108/ijqss-03-2017-0023.
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Purpose In contrast to the reflective approach of service quality measurement, this paper aims to propose and validate a parsimonious multidimensional second-order formatively measured model of service quality for primary health-care services provided by hospital outpatient departments. The index’s empirical validity is examined by investigating the strength of its relationship with certain behavioral responses such as patient satisfaction and behavioral intentions. Design/methodology/approach Data were collected through a stratified random sampling from eight hospital outpatient departments in Greece. Covariance-based structural equation modeling techniques were used to validate the proposed service quality index and further investigate its effect on patient satisfaction and behavioral intention. Findings The data analysis indicated that the proposed formative index is fully functional with medical care being the factor and mostly contributes to service quality perception, followed by administrative service and staff performance, and facilities condition and nursing care. It, further, confirmed the partial mediating role of satisfaction, as it enhances the high impact of service quality on behavioral intentions. Research limitations/implications The relationships among hospital outpatient departments service quality, patient satisfaction and behavioral intentions were validated with data from one country and a health-care system which is state driven and funded. Practical implications An understanding of hospital primary health-care service quality formation is important to health-care decision makers because it offers them the opportunity to consider patients’ needs and wants, and takes the appropriate actions for improving the relevant underling procedures in a more efficient manner to achieve favorable behavioral responses. Originality/value The paper manages to propose and empirically evaluate a formatively measured approach of service quality and investigate the effects of the proposed index on patient satisfaction and behavioral intention, especially in the hospital outpatient services context in Greece.
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Sukeri, Kiran, Orlando A. Betancourt, Robin Emsley, Mohammed Nagdee und Helmut Erlacher. „Forensic mental health services: Current service provision and planning for a prison mental health service in the Eastern Cape“. South African Journal of Psychiatry 22, Nr. 1 (06.05.2016): 5. http://dx.doi.org/10.4102/sajpsychiatry.v22i1.787.
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<strong>Objectives:</strong> No research data exists on forensic psychiatric service provision in the Eastern Cape, Republic of South Africa. The objective of this research was to assess current forensic psychiatric service provision and utilisation rates at Fort England Hospital. This is important in improving and strengthening the service. A related objective was to develop a model for a provincial prison mental health service. <strong></strong><p><strong>Methodology:</strong> This study is a situational analysis of an existing forensic psychiatric service in the Eastern Cape. The design of the study was cross sectional. An audit questionnaire was utilised to collate quantitative data, which was submitted to Fort England Hospital, Grahamstown. A proposed prison mental health service was developed utilising prevalence rates of mental illness among prisoners to calculate bed and staff requirements for an ambulatory and in-patient service. <strong></strong></p><p><strong>Results:</strong> During the study period a total of 403 remand detainees were admitted to the forensic psychiatry division of Fort England Hospital. The average length of stay was 494 days and the bed utilisation rate was determined at 203.54%. We estimate that to provide a provincial prison mental health service to treat psychotic illnesses and major depression the province requires a 52 bedded facility and a total staff complement of approximately 31. <strong></strong></p><p><strong>Conclusions:</strong> Forensic psychiatric services include the assessment, management and treatment of mentally disordered persons in conflict with the law and prisoners requiring psychiatric assessments. The Eastern Cape Province does not have plans or policies to assess and manage mentally ill offenders, resulting in an increased load on available services. We recommend that an inter-departmental task team, which includes Health, Justice and Constitutional Development and Correctional Services, should be established in the province, to develop a strategy to assist in the development of an effective and efficient forensic psychiatric service. This should be driven by the provincial Department of Health.</p>
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Vezyridis, Paraskevas, und Stephen Timmons. „E-Infrastructures and the divergent assetization of public health data: Expectations, uncertainties, and asymmetries“. Social Studies of Science 51, Nr. 4 (27.01.2021): 606–27. http://dx.doi.org/10.1177/0306312721989818.
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In this article, we examine some of the expectations, frictions and uncertainties involved with the assetization of de-identified NHS patient data by (primary care) research services in UK. Pledges to Electronic Health Record (EHR) data-driven research attempt to reconfigure public health data as an asset for realizing multiple values across healthcare, research and finance. We introduce the concept of ‘asymmetrical divergence’ in public health data assetization to study the various practices of configuring and using this data, both as a continuously generated resource to be extracted and as an asset to be circulated in the knowledge economy. As data assetization and exploitations grow bigger and more diverse, the capitalization of these datasets may constitute EHR data-driven research in healthcare as an attractive technoscientific activity, but one limited to those actors with specific sociotechnical resources in place to fully exploit them at the required scale.
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Hoeyer, Klaus. „Data as promise: Reconfiguring Danish public health through personalized medicine“. Social Studies of Science 49, Nr. 4 (04.07.2019): 531–55. http://dx.doi.org/10.1177/0306312719858697.
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‘Personalized medicine’ might sound like the very antithesis of population science and public health, with the individual taking the place of the population. However, in practice, personalized medicine generates heavy investments in the population sciences – particularly in data-sourcing initiatives. Intensified data sourcing implies new roles and responsibilities for patients and health professionals, who become responsible not only for data contributions, but also for responding to new uses of data in personalized prevention, drawing upon detailed mapping of risk distribution in the population. Although this population-based ‘personalization’ of prevention and treatment is said to be about making the health services ‘data-driven’, the policies and plans themselves use existing data and evidence in a very selective manner. It is as if data-driven decision-making is a promise for an unspecified future, not a demand on its planning in the present. I therefore suggest interrogating how ‘promissory data’ interact with ideas about accountability in public health policies, and also with the data initiatives that the promises bring about. Intensified data collection might not just be interesting for what it allows authorities to do and know, but also for how its promises of future evidence can be used to postpone action and sidestep uncomfortable knowledge in the present.
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Warshaw, Hope, Diana Isaacs und Janice MacLeod. „The Reference Guide to Integrate Smart Insulin Pens Into Data-Driven Diabetes Care and Education Services“. Diabetes Educator 46, Nr. 4_suppl (August 2020): 3S—20S. http://dx.doi.org/10.1177/0145721720930183.
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Purpose More than 7 million Americans who have diabetes use insulin therapy. The majority continue to use syringes and vials or traditional insulin pens to deliver their insulin doses. Using these tools to deliver insulin presents numerous challenges for both the person with diabetes and their clinicians. This article provides an in-depth introduction to a new category of insulin delivery devices and integrated management systems, referred to as smart insulin pens. The article includes information about how these integrated insulin delivery systems can reduce many of the challenges of rapid-acting insulin dosing via injection by enabling easier and more accurate dose recording, dose calculations, and sharing of diabetes management data with clinicians. This article also discusses new roles for diabetes care and education specialists in diabetes data-driven care and practice and addresses how smart insulin pens represent one of many newer digital diabetes management tools that can assist people with diabetes and their clinicians to optimally achieve and deliver quality, data-driven diabetes care. Conclusions Newer and simplified insulin delivery devices with their integrated management systems, such as smart insulin pens, have the potential to minimize the challenges and complexities associated with insulin injection therapy while also providing people with diabetes and their clinicians more complete and integrated data in easily transmitted reports that support more efficient data analysis.
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Halliwell-Ewen, M., B. Atkin, C. T. Huins und C. L. Dalton. „Restructuring ENT out-patient services during the coronavirus disease 2019 pandemic – an iterative approach“. Journal of Laryngology & Otology 134, Nr. 8 (14.07.2020): 670–79. http://dx.doi.org/10.1017/s0022215120001450.
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AbstractBackgroundCoronavirus disease 2019 has demanded enormous adjustments to National Health Service provisions. Non-urgent out-patient work was initially postponed or performed virtually, but is now being re-established. In ENT surgery, aerosol-generating procedures pose a particular challenge in out-patient settings.ObjectiveA rapid restructuring of ENT out-patient services is required, to safely accommodate aerosol-generating procedures and increase in-person attendances, whilst coronavirus disease 2019 persists.MethodsData were collected prospectively over four consecutive cycles. Two surveys were conducted. Results were analysed and disseminated, with recommendations for service restructuring implemented at cycle end-points.ResultsOut-patient activity increased four-fold, associated with a significant rise in aerosol-generating procedures during the study period. Mean aerosol-generating procedure duration dropped weekly, implying a learning curve. Service restructuring occurred at cycle end-points.ConclusionIterative data gathering, results analysis and outcome dissemination enabled a swift, data-driven approach to the restructuring of ENT out-patient services. Patient and staff safety was ensured, whilst out-patient capacity was optimised.
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Dahm, Maria R., Anthony Brown, Dean Martin, Maureen Williams, Brian Osborne, Jocelyne Basseal, Mary Potter et al. „Interaction and innovation: practical strategies for inclusive consumer-driven research in health services“. BMJ Open 9, Nr. 12 (Dezember 2019): e031555. http://dx.doi.org/10.1136/bmjopen-2019-031555.
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IntroductionDespite advances in the co-creation of clinical research involving consumers in the last few decades, consumer engagement in health services research generally remains inconsistent and is too often treated as a perfunctory exercise.ObjectiveDrawing on a health services study on diagnostic test result management, communication and follow-up, we: (1) outline practical strategies used to enhance the contribution of health consumer representatives across all stages of health services research, including active involvement in prioritising objectives for data analysis and participating in data analysis and the dissemination of findings; and (2) describe the impact of continued engagement of consumers on the programme of research, the interpretation of findings and their translational potential.Key innovationsKey enabling innovations for engagement included: (1) planned opportunities for long-term consumer involvement across all stages of the research process from conception to dissemination; (2) enhanced consumer engagement capacity; (3) purposeful recruitment of appropriately trained consumers; (4) provision of support structures for active consumer involvement in research design, analysis and write-up; and (5) financial support for consumer involvement.Impact/ConclusionEnhancing consumer contribution and establishing inclusive research design requires a negotiated, interactive, meaningful and transparent process. As a collaborative approach, consumer-driven research involvement offers opportunities for new, often unexpected or unexplored perspectives to feature across the whole research process. In a move away from tokenistic consumer involvement, consumers and researchers who participated in this novel and immersive research project identified inclusive research as a powerful tool to enhance health services research and its translation into effective policy.
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Gordon, Neil F., Richard D. Salmon, Brenda S. Wright, George C. Faircloth, Kevin S. Reid und Terri L. Gordon. „Clinical Effectiveness of Lifestyle Health Coaching“. American Journal of Lifestyle Medicine 11, Nr. 2 (07.07.2016): 153–66. http://dx.doi.org/10.1177/1559827615592351.
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We have developed, tested, and successfully implemented an affordable, evidence-based, technology-enabled, data-driven, outcomes-oriented, comprehensive lifestyle health coaching (LHC) program. The LHC program has been used primarily to provide services to employees of larger employers (ie, with at least 3000 employees) but has also been implemented in a variety of other settings, including hospitals, cardiac rehabilitation centers, physician practices, and as part of multicenter clinical trials. The program is delivered mainly using the telephone and Internet. Health coaches are guided by a Web-based participant management and tracking system. Lifestyle management interventions are based on several behavior change models and strategies, especially adult learning theory, social learning theory, the stages of change model, single concept learning theory, and motivational interviewing. The program is administered by nonphysician health professionals whose services are integrated with the care provided by participants’ physicians. Outcomes data from published studies, including randomized clinical trials and independent third-party conducted research, have documented the clinical effectiveness of this evidence-based approach in terms of modification of multiple risk factors in healthy persons as well as those with certain common chronic diseases.
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Lee, Bonnie, Peter Kellett, Kamal Seghal und Corina Van den Berg. „Breaking the silence of racism injuries: a community-driven study“. International Journal of Migration, Health and Social Care 14, Nr. 1 (05.03.2018): 1–14. http://dx.doi.org/10.1108/ijmhsc-01-2016-0003.
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Purpose Injuries resulting from racism are largely hidden by silence. Community services to provide healing from racism are missing in at least one Canadian city. The purpose of this paper is to identify the injuries suffered by immigrants who experienced racism and discuss the development of culturally appropriate programs and tools to address injuries from racism. Design/methodology/approach Participants representing visible minorities service providers from non-profit, public-funded organizations in a major Canadian city took part in two focus groups. Data from focus groups were thematically analyzed. Findings Racism produces traumatic and persistent psychological, social and intergenerational injuries. An ostensible gap exists in services, professional education and skills to address the psycho-social effects of this complex problem. The complicity of silence in both dominant and subordinated groups contributes to its perpetuation. A dearth of screening and assessment instruments is a barrier in identifying individuals whose mental health and addiction problems may have underlying racism-related etiology. Creation of community healing circles is recommended as a preferred method over individual “treatment” to expose and deconstruct racism, strengthen ethnic identity and intergenerational healing. Research limitations/implications These qualitative findings were generated based on the perspectives of a small purposive sample (n=8) of immigrant service providers and immigrants from one Canadian city. Many of these findings are consistent with the existing literature on internalized racism and racism injuries. Generalizability to the wider population of the province and of Canada requires further research. Practical implications Practitioners in health and social care as well as educators need to understand the injuries and internalized effects of racism to provide appropriate services and leadership. Development of anti-racism professional knowledge and skills, healing circles, and assessment instruments will contribute to deconstructing racism and mitigating its injuries. Originality/value Community-driven studies exploring racism and the lack of services to address the issue are scarce. This study pulls together the experience of service providers and their insights on ways to break the detrimental silence surrounding racism.
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Puszka, Stefanie, Kylie M. Dingwall, Michelle Sweet und Tricia Nagel. „E-Mental Health Innovations for Aboriginal and Torres Strait Islander Australians: A Qualitative Study of Implementation Needs in Health Services“. JMIR Mental Health 3, Nr. 3 (19.09.2016): e43. http://dx.doi.org/10.2196/mental.5837.
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Background Electronic mental health (e-mental health) interventions offer effective, easily accessible, and cost effective treatment and support for mental illness and well-being concerns. However, e-mental health approaches have not been well utilized by health services to date and little is known about their implementation in practice, particularly in diverse contexts and communities. Objective This study aims to understand stakeholder perspectives on the requirements for implementing e-mental health approaches in regional and remote health services for Indigenous Australians. Methods Qualitative interviews were conducted with 32 managers, directors, chief executive officers (CEOs), and senior practitioners of mental health, well-being, alcohol and other drug and chronic disease services. Results The implementation of e-mental health approaches in this context is likely to be influenced by characteristics related to the adopter (practitioner skill and knowledge, client characteristics, communication barriers), the innovation (engaging and supportive approach, culturally appropriate design, evidence base, data capture, professional development opportunities), and organizational systems (innovation-systems fit, implementation planning, investment). Conclusions There is potential for e-mental health approaches to address mental illness and poor social and emotional well-being amongst Indigenous people and to advance their quality of care. Health service stakeholders reported that e-mental health interventions are likely to be most effective when used to support or extend existing health services, including elements of client-driven and practitioner-supported use. Potential solutions to obstacles for integration of e-mental health approaches into practice were proposed including practitioner training, appropriate tool design using a consultative approach, internal organizational directives and support structures, adaptations to existing systems and policies, implementation planning and organizational and government investment.
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Cochran, Ferdouz, Laura Jackson, Anne Neale, John Lovette und Liem Tran. „A Community EcoHealth Index from EnviroAtlas Ecosystem Services Metrics“. International Journal of Environmental Research and Public Health 16, Nr. 15 (02.08.2019): 2760. http://dx.doi.org/10.3390/ijerph16152760.
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Human health is inextricably tied to ecosystem services (ES), including those associated with greenspace in urban communities. EnviroAtlas provides close to 100 maps of ES metrics based on high-resolution land cover data in featured communities across the contiguous United States. Using selected EnviroAtlas ES metrics, a Community EcoHealth Index (CEHI) was created based on an ecohealth framework including health promotion and hazard buffering domains. Aggregation of eight selected ES metrics in these domains entailed a weighted distance measure, where objective, data-driven weights were generated. CEHI was calculated by Census Block Group (CBG) at both the local level and the national level for 22 EnviroAtlas communities. Results were mapped to show one- to five-star CBGs or neighborhoods within and across all 22 featured communities. At the national level, CEHI favors communities in forested ecoregions. The local version of CEHI is more appropriate to inform social, economic, and environmental decision-making for improving community ES associated with human health.
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Hayward, Kate, Bilal A. Mateen, E. Diane Playford und Gail Eva. „Developing vocational rehabilitation services for people with long-term neurological conditions: Identifying facilitators and barriers to service provision“. British Journal of Occupational Therapy 82, Nr. 6 (09.03.2019): 337–47. http://dx.doi.org/10.1177/0308022619830294.
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Introduction This study aimed to understand existing vocational rehabilitation service provision in one locality in London (population 3.74 million), identify any gaps and explore reasons for this, to support service development. Method Using soft systems methodology to guide the research process, semi-structured interviews were completed with nine participants, who were clinicians and managers providing vocational rehabilitation within a National Health Service context. Data were analysed thematically to build a ‘rich picture’ and develop a conceptual model of vocational rehabilitation service delivery. Findings were then ratified with participants at an engagement event. Results The findings indicate a spectrum of vocational rehabilitation service provision for long-term neurological conditions with differing levels of funding in place. Vocational rehabilitation often takes place ‘under the radar’ and therefore the true vocational rehabilitation needs of this population, and the extent of service provision, is not known. There is inconsistency of understanding across the services as to what constitutes vocational rehabilitation and outcomes are not routinely measured. Conclusion For vocational rehabilitation services to develop they require appropriate funding, driven by government policy to commissioners. Clear definitions of vocational rehabilitation, collecting and sharing outcome data and effective communication across services are needed at a local level. This is expressed in a conceptual model of vocational rehabilitation service delivery.
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Saxena, Nakul, Alex Xiaobin You, Zhecheng Zhu, Yan Sun, Pradeep Paul George, Kiok Liang Teow, Phui-Nah Chong et al. „Singapore's regional health systems-a data-driven perspective on frequent admitters and cross utilization of healthcare services in three systems“. International Journal of Health Planning and Management 32, Nr. 1 (29.06.2015): 36–49. http://dx.doi.org/10.1002/hpm.2300.
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Adueni, Isaac Akuamoah-Boateng, James Ben Hayfron-Acquah und Joseph Kobina Panford. „Developing a common cloud platform to manage Ghana’s healthcare system. Case study: Ghana Health Service (GHS)“. Journal of Communications Technology, Electronics and Computer Science 4 (16.02.2016): 6. http://dx.doi.org/10.22385/jctecs.v4i0.25.
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Cloud computing integration into healthcare services can bring about significant benefits economically, and increase the formation and effective organization of integrated healthcare delivery systems. The second section contains data from different sources, takes a gander at cloud applications in healthcare from the perspective of governmental offices, researchers and computer specialists. This work sorts to create a common cloud platform that can be used to manage Ghana’s healthcare delivery system. The application of innovative information technology driven services in healthcare systems has the potential to enhance operational efficiency, provide collaboration and improve patient outcomes. Available information indicates that healthcare services are in dire need of attention with respect to providing efficient, cost effective and timely delivery of healthcare services. It details different shades of opinion, experience, applicability the development, use and integration of cloud technology into healthcare systems.
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Masluroh, Masluroh, und Lili Farlikhatun. „Efektivitas Pemanfaatan Posyandu Lanjut Usia“. Jurnal Kebidanan dan Kesehatan Tradisional 5, Nr. 1 (09.03.2020): 36–40. http://dx.doi.org/10.37341/jkkt.v5i1.129.
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Background: The elderly Posyandu is an integrated service post for the elderly that is driven by the community to be able to get health services. The coverage of elderly health services in Bekasi City in 2013 has generally reached the target. The RPJMD and SPM targets are 70%, the health service achievement of the elderly reaches 84.2%, but there are still Puskesmas that have not yet reached the target of one, Jati Bening Health Center. The purpose of this study was to determine the factors related to the use of elderly Posyandu.Methods: The place of research is in the working area of the Jatibening Health Center and was carried out in 2019. This study used an analytical survey method with a cross sectional approach. The population in this study are the elderly who are registered in the Posyandu of the elderly in the working area of the Jatibening Health Center totaling 100 people, a sample of 80 respondents using the Simple Random Sampling technique. Data collection by check list and questionnaire, the data is analyzed using univariate and bivariate analysis with Chi-square.Results: The results showed there was a relationship between the knowledge of the elderly (P 0.037), family support (0.0001), and the role of cadres (P 0.01) with the use of the elderly posyandu.Conclusion: From the results of the study it can be concluded that the factors of elderly knowledge, family support and the role of cadres in the use of elderly Posyandu greatly affect how the elderly Posyandu can be utilized properly, therefore researchers suggest for health workers to be able to improve health services by providing better health services and counseling the elderly about the benefits of posyandu for the elderly.
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Grow, Melissa, und Stephanie Culotta. „A-64 Neuropsychological Assessment in Bilateral Perisylvian Polymicrogyria: A Tool for Data-Driven Intervention“. Archives of Clinical Neuropsychology 36, Nr. 6 (30.08.2021): 1106. http://dx.doi.org/10.1093/arclin/acab062.82.
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Abstract Objective This case study examined neurocognitive features associated with a rare genetic/neurological disorder impacting the cerebral cortex. Bilateral perisylvian polymicrogyria (BPP) is characterized by abnormal embryonic growth affecting both sides of the brain near the Sylvian fissure. BPP occurs randomly though researchers suspect an underlying genetic abnormality that may have autosomal recessive inheritance. Neurodevelopmental manifestations include neurocognition marked by EEG abnormalities, impaired motor function, and deficits in speech articulation, language development, learning and memory, and adaptive skills. Method A 13-year 7-month-old male with BPP, detected at 24 months by MRI, was seen for neuropsychological assessment to guide habilitative, academic and adaptive interventions. Relevant medical history includes stimulant medication and pharyngeal flap surgery. Parental concerns include the provision of appropriate special education services and withdrawal behaviors. Results Assessment revealed a complex neuropsychological profile characterized by nonverbal versus verbal intellectual strengths, receptive-expressive language impairment, underlying deficits in phonemic awareness, diminished fine motor speed, and diminished verbal fluency. Verbal list learning, semantic memory, and attention were intact. Mild elevations were evident for anxiety symptoms. Conclusion BPP, a rare genetic disorder, represents significant challenges for affected children. In this case study, a 13-year 7-month-old youngster’s assessment revealed underlying neurocognitive and neuromotor deficits most pronounced in aspects of language, speech articulation, select domains of executive functioning and academic skills. Areas of strength, including verbal memory and semantic recall, were indicated and merit consideration in developing appropriate interventions. This case study illustrates the value of neuropsychological assessment in guiding therapeutic interventions, pharmacotherapy, and appropriate educational services in this rare neurological disorder.
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Thomas, Sherin, Abhishek Dubey, Daniel E. Viassolo und Magson Zanette. „Digital Fleet Management: A Scalable Cloud Framework based on Data-driven Prediction Models“. Annual Conference of the PHM Society 12, Nr. 1 (03.11.2020): 8. http://dx.doi.org/10.36001/phmconf.2020.v12i1.1273.
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A scalable Digital Fleet Management system can be leveraged by most organizations with high-volume high-value assets. In such scenarios, predictive analytics for tool health becomes central, as it enables decision-making in terms of planning, maintenance, end-of-life replacement, tool selection, etc. End-to-end solutions, spanning all the way from gathering live tool data to the visual representation of tool health, are certainly of major interest.
Long-term fleet management can be accomplished through a consistent evaluation of the fleet performance profile. Predictive analysis can anticipate maintenance needs and resultant downtimes, and in turn it helps improve scheduling of procurement and distribution of the fleet.
This paper focuses on managing a fleet of thousands of downhole tools based on tool health condition and other variables – a very common use case in Oil & Gas Services. An end-to-end automated scalable cloud framework is described in detail. This framework integrates failure prediction models for each single asset in the fleet of tools. Based on historical tool data, the models generate tool risk indices (one index per asset) which correlate to the probability of tool failure during near-future field jobs. These risk indices can be used for optimal asset-to-job mapping. They also help in de-risking field operations by identifying tools for overhaul or retirement. The proposed method integrates the tasks of: fetching data from 200,000+ tools, performing feature engineering, modeling via Machine Learning (ML) , and visualizing into a cloud pipeline. Framework scalability becomes a key requirement as fleet size increases or decreases over time to match market demands. The framework also allows for the addition of new ML models to the platform by citizen data scientists, who are not cloud experts. Finally, it is shown who this framework provides systematic steps for sustenance of such large cloud platform.
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Kyriazis, Dimosthenis. „Protection of Service-Oriented Environments Serving Critical Infrastructures“. Inventions 3, Nr. 3 (30.08.2018): 62. http://dx.doi.org/10.3390/inventions3030062.
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The emergence of service-oriented architectures has driven the shift towards a service-oriented paradigm, which has been adopted in several application domains. The advent of cloud computing facilities and recently of edge computing environments has increased the aforementioned paradigm shift towards service provisioning. In this context, various “traditional” critical infrastructure components have turned to services, being deployed and managed on top of cloud and edge computing infrastructures. However, the latter poses a specific challenge: the services of the critical infrastructures within and across application verticals/domains (e.g., transportation, health, industrial venues, etc.) need to be continuously available with near-zero downtime. In this context, this paper presents an approach for high-performance monitoring and failure detection of critical infrastructure services that are deployed in virtualized environments. The failure detection framework consists of distributed agents (i.e., monitoring services) to ensure timely collection of monitoring data, while it is enhanced with a voting algorithm to minimize the case of false positives. The goal of the proposed approach is to detect failures in datacenters that support critical infrastructures by targeting both the acquisition of monitoring data in a performant way and the minimization of false positives in terms of potential failure detection. The specific approach is the baseline towards decision making and triggering of actions in runtime to ensure service high availability, given that it provides the required data for decision making on time with high accuracy.
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Maritim, Patricia, Adam Silumbwe, Joseph Mumba Zulu, George Sichone und Charles Michelo. „Health beliefs and health seeking behavior towards lymphatic filariasis morbidity management and disability prevention services in Luangwa District, Zambia: Community and provider perspectives“. PLOS Neglected Tropical Diseases 15, Nr. 2 (22.02.2021): e0009075. http://dx.doi.org/10.1371/journal.pntd.0009075.
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Background Morbidity management and disability prevention (MMDP) services are essential for the management of chronic stages of lymphatic filariasis (LF) infection. However, there is limited information on health beliefs and health seeking behavior towards MMDP services for LF in endemic regions of Zambia. This study sought to document health beliefs and health seeking behavior towards MMDP services for LF in Luangwa District, Zambia. Methods This was an exploratory qualitative study conducted with community members including LF patients, community health workers and healthcare providers. Data was collected through a series of four focus group discussions stratified by sex and 26 in-depth interviews. Data was analyzed by thematic analysis using NVivo software. Results The perceived causes of the chronic manifestations of LF included; contact with animal faeces, use of traditional herbal aphrodisiacs (mutoto), witchcraft and sexual contact with women who were menstruating or had miscarried. LF patients opted to visit traditional healers before going to health facilities. Hydrocele patients were afraid of hydrocelectomies as they were thought to cause infertility or death. Very few community members were able to identify any home and facility-based care strategies for lymphoedema. Health system and cultural barriers to seeking healthcare included; long distances to the health facilities, lack of awareness of existing MMDP services, perceived costs of accessing MMDP services, gender and social norms, and fear of stigmatization. Conclusion Health seeking behavior for LF in the district is mainly driven by negative beliefs about the causes of the disease and lack of awareness of available MMDP services and homecare strategies. Lymphatic filariasis programs should promote strategies that seek to empower patients and community members with the required information to access and use the MMDP services at the health facilities, as well as adhere to self-care practices in their households.
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Fraser, Jennifer Anne, Marie Hutchinson und Jessica Appleton. „Nurses’ experiences of home visiting new parents in rural and regional communities in Australia: a descriptive qualitative study“. Journal of Children's Services 11, Nr. 3 (19.09.2016): 204–16. http://dx.doi.org/10.1108/jcs-07-2015-0023.
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Purpose Child and family health (CAFH) services in Australia initially provide at least one nurse-home-visit following the birth of a child. Planning and referral then commences for the on-going provision of appropriate services to families. Unfortunately, services in rural and regional communities in Australia can be fragmented and poorly resourced. Little is known about CAFH nurses’ experiences of working with families in these communities. The purpose of this paper is to examine the way CAFH nurses work within a universal health service model that may be compromised by isolation, discontinuity and fragmentation. Design/methodology/approach Focus groups with 26 CAFH nurses from five rural, two regional and one urban community in New South Wales (NSW), Australia were conducted. A secondary, thematic analysis of the qualitative data were undertaken to reflect on change and continuity in the field of universal CAFH services. Analysis was driven by two key research questions: How do CAFH nurses experience their role in universal home-based CAFH services within rural and regional areas of Australia and, what unique factors are present in rural and regional areas that impact on their CAFH nursing role? Findings The experience of the CAFH nurses as presented by these data revealed a role that was family centred and concerned for the welfare of the family, yet compromised by the need to meet the disproportionately complex needs of families in the absence of a strong network of services. The opportunity to present the findings provides insight into the way in which families engage with available services in isolated communities. CAFH nurses in the study attempted to maintain service integrity by adapting to the unique context of their work. Originality/value It is important to understand the mechanisms through which CAFH nurses operate to work effectively with families referred to their service. This paper describes the way in which CAFH nurses work with families not meeting the threshold for more intensive and targeted home-visiting service delivery in rural and regional communities of NSW, Australia.
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Steyn, Petrus S., Victoria Boydell, Joanna Paula Cordero, Heather McMullen, Ndema Habib, Thi My Huong Nguyen, Dela Nai, Donat Shamba und James Kiarie. „Rationale and design of a complex intervention measuring the impact and processes of social accountability applied to contraceptive programming: CaPSAI Project“. Gates Open Research 4 (05.03.2020): 26. http://dx.doi.org/10.12688/gatesopenres.13075.1.
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Background: There are numerous barriers leading to a high unmet need for family planning and contraceptives (FP/C). These include limited knowledge and information, poor access to quality services, structural inefficiencies in service provision and inadequately trained and supervised health professionals. Recently, social accountability programs have shown promising results in addressing barriers to accessing sexual and reproductive health services. As a highly complex participatory process with multiple and interrelated components, steps and actors, studying social accountability poses methodological challenges. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project study protocol was developed to measure the impact of a social accountability process on contraceptive uptake and use and to understand the mechanisms and contextual factors that influence and generate these effects (with emphasis on health services actors and community members). Methods: CaPSAI Project is implementing a social accountability intervention where service users and providers assess the quality of local FP/C services and jointly identify ways to improve the delivery and quality of such services. In the project, a quasi-experimental study utilizing an interrupted time series design with a control group is conducted in eight intervention and eight control facilities in each study country, which are Ghana and Tanzania. A cross-sectional survey of service users and health care providers is used to measure social accountability outcomes, and a cohort of women who are new users of FP/C is followed up after the completion of the intervention to measure contraceptive use and continuation. The process evaluation utilizes a range of methods and data sources to enable a fuller description of how the findings were produced. Conclusion: This complex study design could provide researchers and implementers with the means to better measure and understand the mechanisms and contextual factors that influence social accountability processes in reproductive health, adding important findings to the evidence base.
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Steyn, Petrus S., Victoria Boydell, Joanna Paula Cordero, Heather McMullen, Ndema Habib, Thi My Huong Nguyen, Dela Nai, Donat Shamba und James Kiarie. „Rationale and design of a complex intervention measuring the impact and processes of social accountability applied to contraceptive programming: CaPSAI Project“. Gates Open Research 4 (10.12.2020): 26. http://dx.doi.org/10.12688/gatesopenres.13075.2.
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Background: There are numerous barriers leading to a high unmet need for family planning and contraceptives (FP/C). These include limited knowledge and information, poor access to quality services, structural inefficiencies in service provision and inadequately trained and supervised health professionals. Recently, social accountability programs have shown promising results in addressing barriers to accessing sexual and reproductive health services. As a highly complex participatory process with multiple and interrelated components, steps and actors, studying social accountability poses methodological challenges. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project study protocol was developed to measure the impact of a social accountability intervention on contraceptive uptake and use and to understand the mechanisms and contextual factors that influence and generate these effects (with emphasis on health services actors and community members). Methods: CaPSAI Project is implementing a social accountability intervention where service users and providers assess the quality of local FP/C services and jointly identify ways to improve the delivery and quality of such services. In the project, a quasi-experimental study utilizing an interrupted time series design with a control group is conducted in eight intervention and eight control facilities in each study country, which are Ghana and Tanzania. A cross-sectional survey of service users and health care providers is used to measure social accountability outcomes, and a cohort of women who are new users of FP/C is followed up after the completion of the intervention to measure contraceptive use and continuation. The process evaluation utilizes a range of methods and data sources to enable a fuller description of how the findings were produced. Conclusion: This complex study design could provide researchers and implementers with the means to better measure and understand the mechanisms and contextual factors that influence social accountability processes in reproductive health, adding important findings to the evidence base.
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Fulton, Emily A., Katie Newby, Kayleigh Kwah, Lauren Schumacher, Kajal Gokal, Louise J. Jackson, Felix Naughton, Tim Coleman, Alun Owen und Katherine E. Brown. „A digital behaviour change intervention to increase booking and attendance at Stop Smoking Services: the MyWay feasibility RCT“. Public Health Research 9, Nr. 5 (April 2021): 1–62. http://dx.doi.org/10.3310/phr09050.
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Background Smoking remains a leading cause of illness and preventable death. NHS Stop Smoking Services increase quitting, but, as access is in decline, cost-effective interventions are needed that promote these services. StopApp™ (Coventry University, Coventry, UK) is designed to increase booking and attendance at Stop Smoking Services. Design A two-arm feasibility randomised controlled trial of StopApp (intervention) compared with standard promotion and referral to Stop Smoking Services (control) was conducted to assess recruitment, attrition and health equity of the design, alongside health economic and qualitative process evaluations. Setting Smokers recruited via general practitioners, community settings and social media. Participants Smokers aged ≥ 16 years were recruited in one local authority. Participants had to live or work within the local authority area, and there was a recruitment target of 120 participants. Interventions StopApp to increase booking and attendance at Stop Smoking Services. Main outcome measures Participants completed baseline measures and follow-up at 2 months post randomisation entirely online. Objective data on the use of Stop Smoking Services were collected from participating Stop Smoking Services, and age groups, sex, ethnicity and socioeconomic status in baseline recruits and follow-up completers/non-completers were assessed for equity. Results Eligible participants (n = 123) were recruited over 116 days, with good representation of lower socioeconomic status groups; black, Asian and minority ethnic groups; and all age groups. Demographic profiles of follow-up completers and non-completers were broadly similar. The attrition rate was 51.2%, with loss to follow-up lowest in the social media setting (n = 24/61; 39.3%) and highest in the general practitioner setting (n = 21/26; 80.8%). Most measures had < 5% missing data. Social media represented the most effective and cost-efficient recruitment method. In a future, definitive, multisite trial with recruitment driven by social media, our data suggest that recruiting ≥ 1500 smokers over 12 months is feasible. Service data showed that five bookings for the Stop Smoking Services were scheduled using StopApp, of which two did not attend. Challenges with data access were identified. A further five participants in the intervention arm self-reported booking and accessing Stop Smoking Services outside StopApp compared with two control arm participants. Event rate calculations for the intervention were 8% (Stop Smoking Services data), 17% (including self-reports) and 3.5% from control arm self-reports. A conservative effect size of 6% is estimated for a definitive full trial. A sample size of 840 participants would be required to detect an effect for the primary outcome measure of booking a Stop Smoking Services appointment in a full randomised controlled trial. The process evaluation found that participants were satisfied with the research team contact, study methods and provision of e-vouchers. Staff interviews revealed positive and negative experiences of the trial and suggestions for improvements, including encouraging smokers to take part. Conclusion This feasibility randomised controlled trial found that, with recruitment driven wholly or mainly by social media, it is possible to recruit and retain sufficient smokers to assess the effectiveness and cost-effectiveness of StopApp. The study methods and measures were found to be acceptable and equitable, but accessing Stop Smoking Services data about booking, attendance and quit dates was a challenge. A full trial may be feasible if service data are accessible. This will require careful planning with data controllers and a targeted social media campaign for recruitment. Changes to some study measures are needed to avoid missing data, including implementation of a more intensive follow-up data collection process. Future work We plan a full, definitive randomised controlled trial if the concerns around data access can be resolved, with adaptations to the recruitment and retention strategy. Limitations Our trial had high attrition and problems with collecting Stop Smoking Services data, which resulted in a reliance on self-reporting. Trial registration Research Registry: 3995. The trial was registered on 18 April 2018. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
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Horn, Ruth, und Angeliki Kerasidou. „Sharing Whilst Caring: Solidarity and Public Trust in a Data-Driven Healthcare System“. Studia Universitatis Babeş-Bolyai Bioethica 66, Special Issue (09.09.2021): 91. http://dx.doi.org/10.24193/subbbioethica.2021.spiss.56.
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"In the UK, the solidaristic character of the NHS makes it one of the most trusted public institutions. In recent years, the introduction of data-driven technologies in healthcare has opened up the space for collaborations with private digital companies seeking access to patient data. However, these collaborations appear to challenge the public’s trust in the healthcare system. In this paper we explore how the opening of the healthcare sector to private digital companies challenges the existing social contract and the NHS’s solidaristic character, and impacts on public trust. We start by critically discussing different examples of partnerships between the NHS and private companies that collect and use data. We then analyse the relationship between trust and solidarity, and investigate how this relationship changes in the context of digital companies entering the healthcare system. Finally, we show ways for the NHS to maintain public trust by putting in place a solidarity grounded partnership model with companies seeking to access patient data. Such a model would need to serve collective interests through, for example, securing preferential access to goods and services, providing health benefits, and monitoring data access. A solidarity grounded partnership model will help establish a social contract or licence that responds to the public’s expectations and to principles of a solidaristic healthcare system. "
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Williams, David M., Jibby Medina, Desmond Wright, Kate Jones und Jennifer E. Gallagher. „A Review of Effective Methods of Delivery of Care: Skill-Mix and Service Transfer to Primary Care Settings“. Primary Dental Care os17, Nr. 2 (April 2010): 53–60. http://dx.doi.org/10.1308/135576110791013884.
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Aims Health policy in England is seeking to minimise hospital use and provide access to services in a primary healthcare setting and maximise skill-mix, driven by issues such as cost and access. The aim of this review was to determine the effectiveness of increased use of skill-mix and service transfer within general and oral healthcare. Secondary outcome measures were related to cost, quality, access, health outcomes and satisfaction. Methods Data sources were the Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination DARE, British Nursing Index, CINAHL, EMBASE, MEDLINE, and PsycINFO from 1996 to August 2008. The reference lists of relevant papers were scanned to identify additional studies. Data selection A rapid appraisal of systematic reviews, randomised controlled trials, controlled trials and service evaluations in relation to specialist services, practitioners with a special interest, medical and dental, nursing and dental care professionals, together with evidence of service shifts from secondary to primary care was undertaken. Results A total of 206 papers were reviewed. All titles and abstracts of articles and papers found were extracted and validated according to predefined criteria. They were screened for relevance by two researchers, who assessed trial quality and extracted data. Twenty-six papers met the inclusion criteria. The literature demonstrated limited evidence of the cost-effectiveness and health outcomes associated with changes in setting and skill-mix. However, there was evidence of improved access, patient and professional satisfaction. Conclusions There is an overwhelming need for well-designed interventions with robust evaluation to examine cost-effectiveness and benefits to patients and the health workforce.
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Douglas, Elaine, und David Bell. „SOCIAL ISOLATION AND LONELINESS: A LATENT CLASS APPROACH TO COSTING HEALTH SERVICE ENGAGEMENT IN AGING POPULATIONS“. Innovation in Aging 3, Supplement_1 (November 2019): S535. http://dx.doi.org/10.1093/geroni/igz038.1967.
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Abstract Social isolation and loneliness are associated with poorer health status and poorer health outcomes. Little is known the impact on health service usage, and its inherent cost, although it is considered to be higher. Latent class analysis (LCA) was used to determine profiles (population groups) of loneliness and social isolation in older people (aged 50+, n=1,057) using model-fit criteria. Loneliness was measured using the UCLA Loneliness Scale and social isolation used a measure of social networks and social contact. We then analysed the socio-demographic, perceived health, and health behaviour of these profiles using descriptive statistics and logistic regression. The survey data (HAGIS, 2016/17) were linked to retrospective administrative health data to investigate patterns of repeat prescription use (from 2009) and health service usage (from 2005) and their associated costs. Our results highlight the distinction and inter-relation between social isolation and loneliness (including associations with socio-demographic and health characteristics), and the variation in health service usage and costs between the population groups. LCA profiles may help focussed targeting of these groups for health interventions. Further, the data-driven approach of LCA may overcome some of the limitations of indices of social isolation and loneliness. As such, this will extend the existing methodological approaches to quantitative analyses of social isolation and loneliness and demonstrate the benefits of using linked administrative health data. Significantly, this study incorporates the social and financial cost of social isolation and loneliness on health and its implications for health services.
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Nissinen, S., T. Leino, K. Tarvainen und S. Soini. „Occupational health physicians as users of electronic health records“. Occupational Medicine 70, Nr. 9 (05.08.2020): 628–32. http://dx.doi.org/10.1093/occmed/kqaa138.
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Abstract Background Electronic health records (EHRs)’ purpose is to facilitate the documentation of patient data and to improve the exchange of information between the professionals involved in a patient’s care. Aims To investigate occupational health (OH) physicians’ experiences of EHRs and the factors hampering work. Methods An electronic questionnaire was sent to physicians working in OH services in April 2017 and a total of 342 OH physicians participated in the study. The results were reported as quantities and percentages. The survey text was analysed using data-driven content analysis. Results The respondents considered their EHR stable in terms of technical features but the routine tasks with EHR were not straightforward. Also, the documentation of patient data for statistical purposes took an unreasonable amount of time and the access to patient data from other organizations was poor. Instead, a well-functioning feature of EHRs were electronic prescriptions. The factors, which hampered respondents’ work, were constant or frequent time pressure, too little time to do their job properly and a stress caused by uncompleted tasks. Conclusions This study showed that the usability problems of EHRs were the slowness, unexpected downtimes and difficulties in obtaining patient data. Also, respondents felt very often a lack of time in their work. OH physicians’ work is best supported by EHRs that consider their specific role in healthcare, i.e. the assessment of work ability, the co-ordination of care and rehabilitation and support for return to work.
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Hajek, André, Benedikt Kretzler und Hans-Helmut König. „Factors Associated with Dental Service Use Based on the Andersen Model: A Systematic Review“. International Journal of Environmental Research and Public Health 18, Nr. 5 (03.03.2021): 2491. http://dx.doi.org/10.3390/ijerph18052491.
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Background: A systematic review synthesizing studies examining the determinants of dental service use drawing on the (extended) Andersen model is lacking. Hence, our purpose was to fill this knowledge gap; Methods: Three established electronic databases (PubMed, PsycInfo, as well as CINAHL) were searched. Observational studies focusing on the determinants of dental service use drawing on the Andersen model were included; Results: In sum, 41 studies have been included (ten studies investigating children/adolescents and 31 studies investigating adults). Among children, particularly higher age (predisposing characteristic), higher income (enabling resource) and more oral health problems (need factor) were associated with increased dental service use. Among adults, findings are, in general, less consistent. However, it should be noted that one half of the studies found an association between increased education (predisposing characteristic) and increased dental service. In general, study quality was rather high. However, it should be noted that most studies did not report how they dealt with missing data; Conclusions: Our systematic review revealed that all components (i.e., predisposing characteristics, enabling resources and need factors) of the Andersen model tend to be associated with dental service use among children, whereas the findings are more mixed among adults. In conclusion, beyond need factors, dental service use also tend to be driven by other factors. This may indicate over—or, more likely—underuse of dental services and could enrich the inequality discussion in dental services research.
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Dollard, M. F., und W. McTernan. „Psychosocial safety climate: a multilevel theory of work stress in the health and community service sector“. Epidemiology and Psychiatric Sciences 20, Nr. 4 (05.09.2011): 287–93. http://dx.doi.org/10.1017/s2045796011000588.
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Work stress is widely thought to be a significant problem in the health and community services sector. We reviewed evidence from a range of different data sources that confirms this belief. High levels of psychosocial risk factors, psychological health problems and workers compensation claims for stress are found in the sector. We propose a multilevel theoretical model of work stress to account for the results. Psychosocial safety climate (PSC) refers to a climate for psychological health and safety. It reflects the balance of concern by management about psychological healthv.productivity. By extending the health erosion and motivational paths of the Job Demands-Resources model, we propose that PSC within work organisations predicts work conditions and in turn psychological health and engagement. Over and above this, however, we expect that the external environment of the sector particularly government policies, driven by economic rationalist ideology, is increasing work pressure and exhaustion. These conditions are likely to lead to a reduced quality of service, errors and mistakes.
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Li, Jiang, Annette E. Maxwell, Beth A. Glenn, Alison K. Herrmann, L. Cindy Chang, Catherine M. Crespi und Roshan Bastani. „Healthcare Access and Utilization among Korean Americans: The Mediating Role of English Use and Proficiency“. International Journal of Social Science Research 4, Nr. 1 (21.01.2016): 83. http://dx.doi.org/10.5296/ijssr.v4i1.8678.
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The literature suggests that Korean Americans underutilize health services. Cultural factors and language barriers appear to influence this pattern of low utilization but studies on the relationships among length of stay in the US, English use and proficiency, and utilization of health services among Korean Americans have yielded inconsistent results. This study examines whether English language use and proficiency plays a mediating role in the relationships between length of stay in the US and health insurance coverage, access to and use of care. Structural equation modeling was used for mediation analysis with multiple dependent variables among Korean Americans (N= 555) using baseline data from a large trial designed to increase Hepatitis B testing. The results show 36% of the total effect of proportion of lifetime in the US on having health insurance was significantly mediated by English use and proficiency (indirect effect =0.166, SE= 0.07, p<.05; direct effect=0.296, SE= 0.13, p<.05). Proportion of lifetime in the US was not associated with usual source of care and health service utilization. Instead, health care utilization was primarily driven by having health insurance and a usual source of care, further underscoring the importance of these factors. A focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans has the potential to mitigate health disparities associated with reduced access to health services in this population.
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Garcia, Paulo, Francine Darroch, Leah West und Lauren BrooksCleator. „Ethical Applications of Big Data-Driven AI on Social Systems: Literature Analysis and Example Deployment Use Case“. Information 11, Nr. 5 (26.04.2020): 235. http://dx.doi.org/10.3390/info11050235.
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The use of technological solutions to address the production of goods and offering of services is ubiquitous. Health and social issues, however, have only slowly been permeated by technological solutions. Whilst several advances have been made in health in recent years, the adoption of technology to combat social problems has lagged behind. In this paper, we explore Big Data-driven Artificial Intelligence (AI) applied to social systems; i.e., social computing, the concept of artificial intelligence as an enabler of novel social solutions. Through a critical analysis of the literature, we elaborate on the social and human interaction aspects of technology that must be in place to achieve such enabling and address the limitations of the current state of the art in this regard. We review cultural, political, and other societal impacts of social computing, impact on vulnerable groups, and ethically-aligned design of social computing systems. We show that this is not merely an engineering problem, but rather the intersection of engineering with health sciences, social sciences, psychology, policy, and law. We then illustrate the concept of ethically-designed social computing with a use case of our ongoing research, where social computing is used to support safety and security in home-sharing settings, in an attempt to simultaneously combat youth homelessness and address loneliness in seniors, identifying the risks and potential rewards of such a social computing application.
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Prasanti, Ditha, Ikhsan Fuady und Sri Seti Indriani. „Membangun Komunikasi dalam Sinergi Pelayanan Kesehatan di Kabupaten Bandung“. KOMUNIKA: Jurnal Dakwah dan Komunikasi 14, Nr. 1 (25.04.2020): 17–28. http://dx.doi.org/10.24090/komunika.v14i1.3033.
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The "one data" policy driven by the government through the Ministry of Health is believed to be able to innovate and give a new face to health services. Of course, the improvement of health services starts from the smallest and lowest layers, namely Polindes. Starting from this policy and the finding of relatively low public health service problems, the authors see a health service in Polindes, which contributes positively to improving the quality of public health services. The health service is the author's view of the communication perspective through the study of Communication in the Synergy of Public Health Services Polindes (Village Maternity Post) in Tarumajaya Village, Kertasari District, Bandung Regency. The method used in this research is a case study. The results of the study revealed that public health services in Polindes are inseparable from the communication process that exists in the village. The verbal communication process includes positive synergy between the communicator and the communicant. In this case, the communicators are village midwives, village officials, namely the village head and his staff, the sub-district health center, and the active role of the village cadres involved. In contrast, the communicant that was targeted was the community in the village of Tarumajaya. This positive synergy results in a marked increase in public services, namely by providing new facilities in the village, RTK (Birth Waiting Home).
Kebijakan “one data” yang dimotori oleh pemerintah melalui Kementerian kesehatan diyakini mampu membuat inovasi dan memberikan wajah baru terhadap layanan kesehatan. Tentunya, perbaikan layanan kesehatan tersebut dimulai dari lapisan terkecil dan terbawah yakni Polindes. Berawal dari kebijakan tersebut dan masih ditemukannya masalah pelayanan kesehatan publik yang relatif rendah, penulis melihat sebuah layanan kesehatan di Polindes, yang memberikan kontribusi positif dalam peningkatan kualitas layanan kesehatan masyarakat. Pelayanan kesahatan tersebut penulis lihat dari perpektif komunikasi melaui penelitian Komunikasi dalam Sinergi Pelayanan Kesehatan Publik Polindes (Pos Bersalin Desa) di Desa Tarumajaya, Kecamatan Kertasari, Kabupaten Bandung ini dilakukan. Metode yang digunakan dalam penelitian ini adalah studi kasus. Hasil penelitian mengungkapkan bahwa pelayanan kesehatan publik di Polindes, tidak terlepas dari adanya proses komunikasi yang terjalin di desa tersebut. Proses komunikasi verbal tersebut meliputi sinergitas positif antara pihak komunikator dan komunikan. Dalam hal ini, komunikator tersebut adalah Bidan Desa, Aparat Desa yakni Kepala Desa beserta staffnya, Puskesmas tingkat kecamatan, serta peran aktif dari para kader desa yang terlibat. Sedangkan komunikan yang menjadi target adalah masyarakat di desa Tarumajaya. Sinergitas positif tersebut menghasilkan peningkatan pelayanan publik yang nyata, yaitu dengan adanya penyediaan fasilitas baru di desa, RTK (Rumah Tunggu Kelahiran).
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Dudko, Yevgeni, Estie Kruger und Marc Tennant. „Is mix of care influenced by the provider environment? A comparison of four care pathways in oral health“. Australian Health Review 39, Nr. 1 (2015): 51. http://dx.doi.org/10.1071/ah14064.
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Objective In Australia, access to dental care has been available through several different pathways: (1) private practice; (2) public clinics; (3) Aboriginal Medical Services (AMS)-based clinics; and (4) until recently, the Chronic Disease Dental Scheme (CDDS). The aim of the present study was to compare the types of dental services most commonly delivered in the various clinical pathways based on the hypothesis that disease-driven care should lead to similar mixes of dental care provided. Methods Data from a series of previously published sources was used to identify and compare the most commonly performed dental procedures in the different pathways. A comparison was also made with the available international data (US). Results There was a marked difference between service mixes provided through the four pathways. Patients obtaining dental care through AMS-based and public pathways had more extractions and less restorative and preventive care compared with private and CDDS pathways. Compared with the international data, dental service mixes in Australia were found to be not as evenly distributed. Value of care provided through private and CDDS pathways were two- to threefold higher than that of AMS-based and public pathways. Conclusion The data indicate that the original hypothesis that the disease-driven care should lead to similar mixes of provided dental care, is not supported. What is known about the topic? The pricing of dental care is a topic that gets substantial discussion in the private sector. However, its effect in the government sector is very limited in its consideration. This research is a bold first step in Australia to look at the influence of different modes of care delivery on the mix of care provided. What does this paper add? This research is a unique first effort to examine the influence of different modes of care delivery on the type of care provided. It clearly highlights that the pathway for care in the government sector do have very different care outcomes. What are the implications for practitioners? The implications are clear; practitioners need to be aware that care is provided in the context of the pathway in which the care is offered and this will influence the type of care provided. Care is not a single outcome and multiple factors influence the outcome for patients.
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Krausz, Michael, Jean Nicolas Westenberg, Daniel Vigo, Richard Trafford Spence und Damon Ramsey. „Emergency Response to COVID-19 in Canada: Platform Development and Implementation for eHealth in Crisis Management“. JMIR Public Health and Surveillance 6, Nr. 2 (15.05.2020): e18995. http://dx.doi.org/10.2196/18995.
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Background Public health emergencies like epidemics put enormous pressure on health care systems while revealing deep structural and functional problems in the organization of care. The current coronavirus disease (COVID-19) pandemic illustrates this at a global level. The sudden increased demand on delivery systems puts unique pressures on pre-established care pathways. These extraordinary times require efficient tools for smart governance and resource allocation. Objective The aim of this study is to develop an innovative web-based solution addressing the seemingly insurmountable challenges of triaging, monitoring, and delivering nonhospital services unleashed by the COVID-19 pandemic. Methods An adaptable crisis management digital platform was envisioned and designed with the goal of improving the system’s response on the basis of the literature; an existing shared health record platform; and discussions between health care providers, decision makers, academia, and the private sector in response to the COVID 19 epidemic. Results The Crisis Management Platform was developed and offered to health authorities in Ontario on a nonprofit basis. It has the capability to dramatically streamline patient intake, triage, monitoring, referral, and delivery of nonhospital services. It decentralizes the provision of services (by moving them online) and centralizes data gathering and analysis, maximizing the use of existing human resources, facilitating evidence-based decision making, and minimizing the risk to both users and providers. It has unlimited scale-up possibilities (only constrained by human health risk resource availability) with minimal marginal cost. Similar web-based solutions have the potential to fill an urgent gap in resource allocation, becoming a unique asset for health systems governance and management during critical times. They highlight the potential effectiveness of web-based solutions if built on an outcome-driven architecture. Conclusions Data and web-based approaches in response to a public health crisis are key to evidence-driven oversight and management of public health emergencies.
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Peng, Li-Ning, Fei-Yuan Hsiao, Wei-Ju Lee, Shih-Tsung Huang und Liang-Kung Chen. „Comparisons Between Hypothesis- and Data-Driven Approaches for Multimorbidity Frailty Index: A Machine Learning Approach“. Journal of Medical Internet Research 22, Nr. 6 (11.06.2020): e16213. http://dx.doi.org/10.2196/16213.
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Background Using big data and the theory of cumulative deficits to develop the multimorbidity frailty index (mFI) has become a widely accepted approach in public health and health care services. However, constructing the mFI using the most critical determinants and stratifying different risk groups with dose-response relationships remain major challenges in clinical practice. Objective This study aimed to develop the mFI by using machine learning methods that select variables based on the optimal fitness of the model. In addition, we aimed to further establish 4 entities of risk using a machine learning approach that would achieve the best distinction between groups and demonstrate the dose-response relationship. Methods In this study, we used Taiwan’s National Health Insurance Research Database to develop a machine learning multimorbidity frailty index (ML-mFI) using the theory of cumulative diseases/deficits of an individual older person. Compared to the conventional mFI, in which the selection of diseases/deficits is based on expert opinion, we adopted the random forest method to select the most influential diseases/deficits that predict adverse outcomes for older people. To ensure that the survival curves showed a dose-response relationship with overlap during the follow-up, we developed the distance index and coverage index, which can be used at any time point to classify the ML-mFI of all subjects into the categories of fit, mild frailty, moderate frailty, and severe frailty. Survival analysis was conducted to evaluate the ability of the ML-mFI to predict adverse outcomes, such as unplanned hospitalizations, intensive care unit (ICU) admissions, and mortality. Results The final ML-mFI model contained 38 diseases/deficits. Compared with conventional mFI, both indices had similar distribution patterns by age and sex; however, among people aged 65 to 69 years, the mean mFI and ML-mFI were 0.037 (SD 0.048) and 0.0070 (SD 0.0254), respectively. The difference may result from discrepancies in the diseases/deficits selected in the mFI and the ML-mFI. A total of 86,133 subjects aged 65 to 100 years were included in this study and were categorized into 4 groups according to the ML-mFI. Both the Kaplan-Meier survival curves and Cox models showed that the ML-mFI significantly predicted all outcomes of interest, including all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions at 1, 5, and 8 years of follow-up (P<.01). In particular, a dose-response relationship was revealed between the 4 ML-mFI groups and adverse outcomes. Conclusions The ML-mFI consists of 38 diseases/deficits that can successfully stratify risk groups associated with all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions in older people, which indicates that precise, patient-centered medical care can be a reality in an aging society.
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Akanbang, Bernard Afiik Akanpabadai. „Monitoring of water and sanitation services within an integrated decentralised monitoring system: experiences from Ghana“. Journal of Water, Sanitation and Hygiene for Development 11, Nr. 3 (16.03.2021): 461–73. http://dx.doi.org/10.2166/washdev.2021.261.
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Abstract Monitoring of water and sanitation services has for a long time been project driven in the developing world. The need for data to inform subnational planning and delivery of quality services has led to the adoption of decentralised integrated monitoring. However, little is known about the strengths and weaknesses of this approach in the monitoring of water and sanitation services. A case study design in which document reviews were combined with 22 key informant interviews held between March and July 2019 in the Upper West Region of Ghana were used to investigate the research problem. Findings show that integration enhanced the processes for validating and using monitoring data and ensuring downward accountability. However, logistical and financial support and inadequate critical reflection is a major challenge under the integration. The paper calls for special attention to be paid to funding and logistics for monitoring water and sanitation services.