scholarly journals Developing a Plan for the Sustainable Implementation of an Electronic Health Intervention (Partner in Balance) to Support Caregivers of People With Dementia: Case Study

JMIR Aging ◽  
10.2196/18624 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e18624
Author(s):  
Hannah Liane Christie ◽  
Lizzy Mitzy Maria Boots ◽  
Kirsten Peetoom ◽  
Huibert Johannes Tange ◽  
Frans Rochus Josef Verhey ◽  
...  
Keyword(s):  
Health Care ◽  
Business Model ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Implementation Plan ◽  
Dementia Case ◽  
People With Dementia ◽  
Electronic Health ◽  
Ehealth Intervention

Background Given the increasing use of digital interventions in health care, understanding how best to implement them is crucial. However, evidence on how to implement new academically developed interventions in complex health care environments is lacking. This case study offers an example of how to develop a theory-based implementation plan for Partner in Balance, an electronic health (eHealth) intervention to support the caregivers of people with dementia. Objective The specific objectives of this study were to (1) formulate evidence-based implementation strategies, (2) develop a sustainable business model, and (3) integrate these elements into an implementation plan. Methods This case study concerns Partner in Balance, a blended care intervention to support the caregivers of people with dementia, which is effective in improving caregiver self-efficacy, quality of life, and experienced control. The large-scale implementation of Partner in Balance took place in local dementia case-management services, local care homes, dementia support groups, and municipalities. Experiences from real-life pilots (n=22) and qualitative interviews with national stakeholders (n=14) were used to establish an implementation plan consisting of implementation strategies and a business model. Results The main finding was the need for a business model to facilitate decision-making from potential client organizations, who need reliable pricing information before they can commit to training coaches and implementing the intervention. Additionally, knowledge of the organizational context and a wider health care system are essential to ensure that the intervention meets the needs of its target users. Based on these findings, the research team formulated implementation strategies targeted at the engagement of organizations and staff, dissemination of the intervention, and facilitation of long-term project management in the future. Conclusions This study offers a theory-based example of implementing an evidence-based eHealth intervention in dementia health care. The findings help fill the knowledge gap on the eHealth implementation context for evidence-based eHealth interventions after the trial phase, and they can be used to inform individuals working to develop and sustainably implement eHealth.

scholarly journals Developing a Plan for the Sustainable Implementation of an Electronic Health Intervention (Partner in Balance) to Support Caregivers of People With Dementia: Case Study (Preprint)

2020 ◽  
Author(s):  
Hannah Liane Christie ◽  
Lizzy Mitzy Maria Boots ◽  
Kirsten Peetoom ◽  
Huibert Johannes Tange ◽  
Frans Rochus Josef Verhey ◽  
...  
Keyword(s):  
Health Care ◽  
Business Model ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Implementation Plan ◽  
Dementia Case ◽  
People With Dementia ◽  
Electronic Health ◽  
Ehealth Intervention

BACKGROUND Given the increasing use of digital interventions in health care, understanding how best to implement them is crucial. However, evidence on how to implement new academically developed interventions in complex health care environments is lacking. This case study offers an example of how to develop a theory-based implementation plan for Partner in Balance, an electronic health (eHealth) intervention to support the caregivers of people with dementia. OBJECTIVE The specific objectives of this study were to (1) formulate evidence-based implementation strategies, (2) develop a sustainable business model, and (3) integrate these elements into an implementation plan. METHODS This case study concerns Partner in Balance, a blended care intervention to support the caregivers of people with dementia, which is effective in improving caregiver self-efficacy, quality of life, and experienced control. The large-scale implementation of Partner in Balance took place in local dementia case-management services, local care homes, dementia support groups, and municipalities. Experiences from real-life pilots (n=22) and qualitative interviews with national stakeholders (n=14) were used to establish an implementation plan consisting of implementation strategies and a business model. RESULTS The main finding was the need for a business model to facilitate decision-making from potential client organizations, who need reliable pricing information before they can commit to training coaches and implementing the intervention. Additionally, knowledge of the organizational context and a wider health care system are essential to ensure that the intervention meets the needs of its target users. Based on these findings, the research team formulated implementation strategies targeted at the engagement of organizations and staff, dissemination of the intervention, and facilitation of long-term project management in the future. CONCLUSIONS This study offers a theory-based example of implementing an evidence-based eHealth intervention in dementia health care. The findings help fill the knowledge gap on the eHealth implementation context for evidence-based eHealth interventions after the trial phase, and they can be used to inform individuals working to develop and sustainably implement eHealth.

Sham Surgery

2020 ◽  
pp. 37-59
Author(s):  
Eric M. Patashnik ◽  
Alan S. Gerber ◽  
Conor M. Dowling
Keyword(s):  
Health Care ◽  
Arthroscopic Surgery ◽  
Evidence Based ◽  
Policy Makers ◽  
Knee Oa ◽  
Medical Societies ◽  
Systemic Problems ◽  
Based Medicine ◽  
Evidence Based Care

This chapter presents a detailed case study of a sham knee surgery case. The knee case is illustrative of systemic problems in the promotion of evidence-based medicine. Clearly, many medical societies are failing to take seriously their professional responsibility to deliver evidence-based care to patients and ensure that the nation does not squander scarce health care dollars on treatments of dubious worth. The chapter describes how the orthopedic community mostly ignored clear warnings that the arthroscopic surgery for osteoarthritis (OA) of the knee might not be effective. It also reviews the Moseley-Wray study's findings and looks at the less than optimal responses they prompted from medical societies and policy makers. The chapter then considers the debate surrounding another procedure for knee OA (arthroscopic partial meniscectomy) that has grown in popularity despite a lack of evidence, and identifies signs of the same performance pathologies.

Developing an innovative business model for hospital services in Iran: a case study of Moheb Hospitals

2019 ◽  
Vol 32 (1) ◽  
pp. 129-147 ◽  
Author(s):  
Marjan Miremadi ◽  
Kamyar Goudarzi
Keyword(s):  
Health Care ◽  
Business Model ◽  
Health Care Services ◽  
Business Models ◽  
Single Case ◽  
Quality Health Care ◽  
Content Type ◽  
Study Results ◽  
Quality Health

PurposeThis paper aims to focus on the role of hospital business models by examining the innovative business model of Moheb Hospitals, which have successfully achieved the goal of reducing costs and delivering high-quality health-care services in Iran by encouraging public–private partnership.Design/methodology/approachThis paper is a single case study.FindingsThe study results illustrate the hospital’s current business model and its underlying elements. After presenting the findings, this paper is concluded by presenting the standing issues that should also be addressed and how improvements and adjustments can be made.Originality/valueThis study offers new insight to identify and analyze the shortcomings of health-care sector in Iran and introduces new methods to efficiently use current competencies.

scholarly journals Call for information, call for quality in mental health care

2012 ◽  
Vol 22 (1) ◽  
pp. 9-13 ◽  
Author(s):  
A. Lora
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Systems ◽  
National Level ◽  
Quality Measurement ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Clinical Indicators

The quality of routine mental health care is not optimal, it can vary greatly from region to region and among providers; in many occasions, it does not correspond to the standards of evidence-based mental health. To bridge this gap, the promotion of a systematic use of the information available for quality assurance would be most helpful, but measuring the quality of mental health care is particularly challenging. Quality measurement can play a key role in transforming health care systems, and the routine measurement of quality, using clinical indicators derived from evidence-based practice guidelines, is an important step to this end. In Italy, the use of clinical indicators is still sporadic: over the last 5 years only three projects have been aimed at analysing, in a structured way, the quality of care in severe mental illness, and two of these were led by the Italian Society of Psychiatric Epidemiology. Not only in Italy but also at global level there is an urgent need for the implementation of mental health information systems that could lead to a substantial improvement in information technology. Once this has been achieved, a common set of clinical indicators, agreed upon at the regional and national level and useful for benchmarking and for comparing mental health services, could be defined. Finally, using the implementation strategies, a system of quality improvement at both regional and local levels will be built.

Methodological challenges when evaluating potential off-label prescribing of drugs using electronic health care databases: A case study of dabigatran etexilate in Europe

2018 ◽  
Vol 27 (7) ◽  
pp. 713-723 ◽  
Author(s):  
Miguel Cainzos-Achirica ◽  
Cristina Varas-Lorenzo ◽  
Anton Pottegård ◽  
Joelle Asmar ◽  
Estel Plana ◽  
...  
Keyword(s):  
Health Care ◽  
Dabigatran Etexilate ◽  
Off Label ◽  
Methodological Challenges ◽  
Electronic Health

scholarly journals Predicting Dropouts From an Electronic Health Platform for Lifestyle Interventions: Analysis of Methods and Predictors (Preprint)

2019 ◽  
Author(s):  
Daniel Hansen Pedersen ◽  
Marjan Mansourvar ◽  
Camilla Sortsø ◽  
Thomas Schmidt
Keyword(s):  
Health Care ◽  
Random Forest ◽  
Health Care Systems ◽  
Activity Patterns ◽  
Predictor Variables ◽  
Lifestyle Interventions ◽  
Health Coaches ◽  
Care Systems ◽  
Electronic Health ◽  
Ehealth Intervention

BACKGROUND The increasing prevalence and economic impact of chronic diseases challenge health care systems globally. Digital solutions can potentially improve efficiency and quality of care, but these initiatives struggle with nonusage attrition. Machine learning methods have been proven to predict dropouts in other settings but lack implementation in health care. OBJECTIVE This study aimed to gain insight into the causes of attrition for patients in an electronic health (eHealth) intervention for chronic lifestyle diseases and evaluate if attrition can be predicted and consequently prevented. We aimed to build predictive models that can identify patients in a digital lifestyle intervention at high risk of dropout by analyzing several predictor variables applied in different models and to further assess the possibilities and impact of implementing such models into an eHealth platform. METHODS Data from 2684 patients using an eHealth platform were iteratively analyzed using logistic regression, decision trees, and random forest models. The dataset was split into a 79.99% (2147/2684) training and cross-validation set and a 20.0% (537/2684) holdout test set. Trends in activity patterns were analyzed to assess engagement over time. Development and implementation were performed iteratively with health coaches. RESULTS Patients in the test dataset were classified as dropouts with an 89% precision using a random forest model and 11 predictor variables. The most significant predictors were the provider of the intervention, 2 weeks inactivity, and the number of advices received from the health coach. Engagement in the platform dropped significantly leading up to the time of dropout. CONCLUSIONS Dropouts from eHealth lifestyle interventions can be predicted using various data mining methods. This can support health coaches in preventing attrition by receiving proactive warnings. The best performing predictive model was found to be the random forest.

scholarly journals Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study (Preprint)

2017 ◽  
Author(s):  
Naomi Muinga ◽  
Steve Magare ◽  
Jonathan Monda ◽  
Onesmus Kamau ◽  
Stuart Houston ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Open Source ◽  
Health Information ◽  
Health Care Facilities ◽  
Health Record ◽  
Record System ◽  
Care Facilities ◽  
Electronic Health

BACKGROUND The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. OBJECTIVE We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. METHODS We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. RESULTS This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. CONCLUSIONS Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa.

scholarly journals Protocol for conducting scoping reviews to map implementation strategies in different care settings: focusing on evidence-based interventions for preselected phenomena in people with dementia

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e051611
Author(s):  
Christina Manietta ◽  
Tina Quasdorf ◽  
Mike Rommerskirch-Manietta ◽  
Jana Isabelle Braunwarth ◽  
Daniel Purwins ◽  
...  
Keyword(s):  
Complex Interventions ◽  
Implementation Strategies ◽  
Routine Care ◽  
Dementia Care ◽  
Evidence Based ◽  
Care Needs ◽  
Term Care ◽  
People With Dementia ◽  
Scoping Reviews ◽  
Analytical Approaches

IntroductionVarious evidence-based interventions are available to improve the care of people with dementia in different care settings, many of which are not or are only partially implemented in routine care. Different implementation strategies have been developed to support the implementation of interventions in routine care; however, the implementation of complex interventions remains challenging. The aim of our reviews is to identify promising strategies for, significant facilitators of and barriers to the implementation of evidence-based interventions for very common dementia care phenomena: (A) behaviour that challenges supporting a person with dementia in long-term care, (B) delirium in acute care and (C) the postacute care needs of people with dementia.Methods and analysisWe will conduct one scoping review for each preselected dementia care phenomenon (A, B and C). For this, three literature searches will be carried out in the following electronic databases: MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycINFO (via EBSCO). Additionally, we will perform backward and forward citation tracking via reference lists and Google Scholar. Identified records will be independently screened by two reviewers (title/abstract and full text) using the defined inclusion criteria. We will include all study designs and publications in the German or English language. For the data analyses, we will conduct a deductive content analysis using two different analytical approaches: Expert Recommendations for Implementation Change and the Consolidated Framework for Implementation Research.Ethics and disseminationDue to the nature of a review, ethical clearing is not required. We will disseminate our results in peer-reviewed journals, workshops with stakeholders, and (inter)national conferences.

scholarly journals How to Develop and Implement Recommended Guidance for European Psychiatry?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
W. Gaebel
Keyword(s):  
Health Care ◽  
Good Practice ◽  
Implementation Strategies ◽  
Steering Committee ◽  
Evidence Based ◽  
Pilot Work ◽  
Care Gaps ◽  
Clinical Questions ◽  
Methodological Aspects

One of the concrete projects resolved at the 2nd EPA European Platform of Psychiatrists meeting in Nice 2008 concerns the development and implementation of evidence-based treatment recommendations in psychiatry with an European dimension named "Recommended Guidance". The major objective is to improve quality of mental health care in Europe by providing evidence-based information and advice regarding core clinical questions and to identify and minimize health care gaps. As following steps it was targeted to establish a steering committee, to obtain clinical core priorities by contacting national psychiatric societies, to provide examples of good practice based on existing information, and to develop (first) "recommended guidance" for selected topics as pilot work. To promote this process, information regarding existing guidelines in psychiatry, methodological aspects of their development and evaluation as well as implementation strategies will be provided.

Sign in / Sign up

Export Citation Format

Share Document