scholarly journals Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework

10.2196/23775 ◽  
2021 ◽  
Vol 23 (1) ◽  
pp. e23775
Author(s):  
Hannah M James ◽  
Chrysanthi Papoutsi ◽  
Joseph Wherton ◽  
Trisha Greenhalgh ◽  
Sara E Shaw
Keyword(s):  
Health Care ◽  
Large Scale ◽  
Resistance To Change ◽  
Scale Up ◽  
Organizational Factors ◽  
Lessons Learned ◽  
Service Development ◽  
Health Administration ◽  
Reimbursement Mechanisms ◽  
Over Time

Background COVID-19 has thrust video consulting into the limelight, as health care practitioners worldwide shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe, and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption, with limited consideration of how video consulting can be mainstreamed and sustained. Objective This study sought to do the following: (1) review and synthesize reported opportunities, challenges, and lessons learned in the scale-up, spread, and sustainability of video consultations, and (2) identify transferable insights that can inform policy and practice. Methods We identified papers through systematic searches in PubMed, CINAHL, and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesize findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organizational factors, wider macro-level considerations, and emergence over time. Results We identified 13 papers describing 10 different video consultation services in 6 regions, covering the following: (1) video-to-home services, connecting providers directly to the patient; (2) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural center; and (3) large-scale top-down evaluations scaled up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care. Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption. Conclusions There remains a significant lack of evidence that can support the spread and scale-up of video consulting. Given the recent pace of change due to COVID-19, a more definitive evidence base is urgently needed to support global efforts and match enthusiasm for extending use.

scholarly journals Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (Preprint)

2020 ◽  
Author(s):  
Hannah M James ◽  
Chrysanthi Papoutsi ◽  
Joseph Wherton ◽  
Trisha Greenhalgh ◽  
Sara E Shaw
Keyword(s):  
Health Care ◽  
Large Scale ◽  
Resistance To Change ◽  
Scale Up ◽  
Organizational Factors ◽  
Lessons Learned ◽  
Service Development ◽  
Health Administration ◽  
Reimbursement Mechanisms ◽  
Over Time

BACKGROUND COVID-19 has thrust video consulting into the limelight, as health care practitioners worldwide shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe, and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption, with limited consideration of how video consulting can be mainstreamed and sustained. OBJECTIVE This study sought to do the following: (1) review and synthesize reported opportunities, challenges, and lessons learned in the scale-up, spread, and sustainability of video consultations, and (2) identify transferable insights that can inform policy and practice. METHODS We identified papers through systematic searches in PubMed, CINAHL, and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesize findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organizational factors, wider macro-level considerations, and emergence over time. RESULTS We identified 13 papers describing 10 different video consultation services in 6 regions, covering the following: (1) video-to-home services, connecting providers directly to the patient; (2) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural center; and (3) large-scale top-down evaluations scaled up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care. Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption. CONCLUSIONS There remains a significant lack of evidence that can support the spread and scale-up of video consulting. Given the recent pace of change due to COVID-19, a more definitive evidence base is urgently needed to support global efforts and match enthusiasm for extending use.

scholarly journals Scaling Up Delivery of Biofortified Staple Food Crops Globally: Paths to Nourishing Millions

2021 ◽  
pp. 037957212098250
Author(s):  
Jennifer K. Foley ◽  
Kristina D. Michaux ◽  
Bho Mudyahoto ◽  
Laira Kyazike ◽  
Binu Cherian ◽  
...  
Keyword(s):  
Pearl Millet ◽  
Large Scale ◽  
Scale Up ◽  
Lessons Learned ◽  
Raw Material ◽  
Micronutrient Deficiencies ◽  
Seed Systems ◽  
Public And Private ◽  
Context Specific ◽  
Public And Private Sector

Background: Micronutrient deficiencies affect over one quarter of the world’s population. Biofortification is an evidence-based nutrition strategy that addresses some of the most common and preventable global micronutrient gaps and can help improve the health of millions of people. Since 2013, HarvestPlus and a consortium of collaborators have made impressive progress in the enrichment of staple crops with essential micronutrients through conventional plant breeding. Objective: To review and highlight lessons learned from multiple large-scale delivery strategies used by HarvestPlus to scale up biofortification across different country and crop contexts. Results: India has strong public and private sector pearl millet breeding programs and a robust commercial seed sector. To scale-up pearl millet, HarvestPlus established partnerships with public and private seed companies, which facilitated the rapid commercialization of products and engagement of farmers in delivery activities. In Nigeria, HarvestPlus stimulated the initial acceptance and popularization of vitamin A cassava using a host of creative approaches, including “crowding in” delivery partners, innovative promotional programs, and development of intermediate raw material for industry and novel food products. In Uganda, orange sweet potato (OSP) is a traditional subsistence crop. Due to this, and the lack of formal seed systems and markets, HarvestPlus established a network of partnerships with community-based nongovernmental organizations and vine multipliers to popularize and scale-up delivery of OSP. Conclusions: Impact of biofortification ultimately depends on the development of sustainable markets for biofortified seeds and products. Results illustrate the need for context-specific, innovative solutions to promote widespread adoption.

scholarly journals Exploring the feasibility of a network of organizations for pain rehabilitation: what are the lessons learned?

2020 ◽  
Author(s):  
Cynthia Lamper ◽  
Ivan PJ Huijnen ◽  
Mariëlle EAL Kroese ◽  
Albère J Köke ◽  
Gijs Brouwer ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Large Scale ◽  
Critical Mass ◽  
Implementation Strategies ◽  
Daily Practice ◽  
Lessons Learned ◽  
Integration Of Care ◽  
Treatment Protocols ◽  
Rehabilitation Care

Abstract Background and aims: Integration of care is lacking for chronic musculoskeletal pain (CMP) patients. Network Pain Rehabilitation Limburg (NPRL), a transmural health care network, has been designed to provide integrated rehabilitation care from a biopsychosocial perspective to improve patients’ levels of functioning. This feasibility study aims to provide insight into barriers and facilitators for the development, implementation, and transferability of NPRL.Methods: This study was conducted with a three-phase iterative and incremental design from October 2017 to October 2018. NPRL comprises two rehabilitation practices, and three local primary care networks, with a general practitioner together with, a mental health practice nurse, and a physiotherapist or exercise therapist. These stakeholders with a random sample of participating patients took part in evaluations, consisting of interviews, focus groups, and observations. Field notes and observations were recorded during meetings. The Consolidated Framework for Implementation Research guided data collection and analysis. Results were used to refine the next phase.Results: According to health care professionals (HCPs), guidelines and treatment protocols facilitate consistency and transparency in collaboration, biopsychosocial language, and treatment. One barrier is stigmatization of CMP in society. Non-participating HCPs’ treatment approaches are often more biomedical than biopsychosocial, causing patients to resist participating in NPRL. The current organization of health care, with cultural, structural, and financial aspects, acts as a barrier, complicating implementation between and within practices. HCPs preferred the iterative, bottom-up strategy. A critical mass of participating organizations is needed for proper implementation.Conclusion: NPRL is feasible in daily practice if barriers are overcome and facilitators of development, implementation, and transferability are promoted. These findings will be used to refine NPRL. A large-scale process and effect evaluation will be performed. Our implementation strategies and results may assist other health care organizations aspiring to implement a transmural network using a similar model.

scholarly journals Prospective predictors of sustainment of multiple EBPs in a system-driven implementation context: Examining sustained delivery based on administrative claims

2021 ◽  
Vol 2 ◽  
pp. 263348952110578
Author(s):  
Anna S. Lau ◽  
Teresa Lind ◽  
Mojdeh Motamedi ◽  
Joyce H. L. Lui ◽  
Mary Kuckertz ◽  
...  
Keyword(s):  
Large Scale ◽  
Organizational Context ◽  
Scale Up ◽  
Volume Ratio ◽  
Organizational Factors ◽  
Self Report ◽  
Administrative Claims ◽  
Sustained Delivery ◽  
Cross Sectional ◽  
Program Leaders

Background System-driven scale-up of multiple evidence-based practices (EBPs) is an increasingly common method used in public mental health to improve care. However, there are little data on the long-term sustained delivery of EBPs within these efforts, and previous studies have relied on retrospective self-report within cross-sectional studies. This study identified prospective predictors of sustained EBP delivery at the EBP-, therapist-, and organizational-levels using survey and administrative claims data within a large-scale system-driven implementation effort. Methods 777 therapists and 162 program leaders delivering at least one of six EBPs of interest completed surveys assessing perceptions of EBPs and organizational context. These surveys were linked to administrative data to examine prospective predictors of therapists’ EBP delivery over 33 months. Results Five of the six EBPs implemented showed sustained delivery in the system, with volume varying by EBP. Although total EBP claim volume per therapist decreased over time, the volume ratio (ratio of EBP-specific claims to total EBP and non-EBP claims) stayed relatively stable. Multilevel models revealed that EBPs that required consultation, had unstructured content, higher therapist self-efficacy with the EBP, and more positive program leader perceptions of the EBP were associated with greater sustained volume and volume ratio of the EBP. Therapists who were trained in fewer EBPs, who were unlicensed, and who worked in agencies rated by program leaders as lower on organizational staff autonomy and stress showed greater sustained EBP volume and volume ratio. Finally, more direct service hours per week provided by therapist predicted greater sustained EBP volume, but lower volume ratio. Conclusions The results point to the importance of EBP, therapist, and organizational factors that may be targeted in implementation strategies to promote the sustainment of EBPs.

scholarly journals Lessons Learned: Recommendations For Implementing a Longitudinal Study Using Wearable and Environmental Sensors in a Health Care Organization

10.2196/13305 ◽  
2019 ◽  
Vol 7 (12) ◽  
pp. e13305 ◽  
Author(s):  
Michelle L'Hommedieu ◽  
Justin L'Hommedieu ◽  
Cynthia Begay ◽  
Alison Schenone ◽  
Lida Dimitropoulou ◽  
...  
Keyword(s):  
Health Care ◽  
Data Collection ◽  
Large Scale ◽  
Care Setting ◽  
Lessons Learned ◽  
Health Care Setting ◽  
Sensor Data ◽  
Care Organization ◽  
Environmental Sensors ◽  
Comprehensive Understanding

Although traditional methods of data collection in naturalistic settings can shed light on constructs of interest to researchers, advances in sensor-based technology allow researchers to capture continuous physiological and behavioral data to provide a more comprehensive understanding of the constructs that are examined in a dynamic health care setting. This study gives examples for implementing technology-facilitated approaches and provides the following recommendations for conducting such longitudinal, sensor-based research, with both environmental and wearable sensors in a health care setting: pilot test sensors and software early and often; build trust with key stakeholders and with potential participants who may be wary of sensor-based data collection and concerned about privacy; generate excitement for novel, new technology during recruitment; monitor incoming sensor data to troubleshoot sensor issues; and consider the logistical constraints of sensor-based research. The study describes how these recommendations were successfully implemented by providing examples from a large-scale, longitudinal, sensor-based study of hospital employees at a large hospital in California. The knowledge gained from this study may be helpful to researchers interested in obtaining dynamic, longitudinal sensor data from both wearable and environmental sensors in a health care setting (eg, a hospital) to obtain a more comprehensive understanding of constructs of interest in an ecologically valid, secure, and efficient way.

scholarly journals Consolidation of Clinical Microbiology Laboratories and Introduction of Transformative Technologies

2020 ◽  
Vol 33 (2) ◽  
Author(s):  
Olivier Vandenberg ◽  
Géraldine Durand ◽  
Marie Hallin ◽  
Andreas Diefenbach ◽  
Vanya Gant ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Health Care ◽  
Translational Research ◽  
Clinical Microbiology ◽  
Large Scale ◽  
Clinical Laboratory ◽  
Cost Effective ◽  
Service Development ◽  
Positive Health ◽  
Geographical Regions

SUMMARY Clinical microbiology is experiencing revolutionary advances in the deployment of molecular, genome sequencing-based, and mass spectrometry-driven detection, identification, and characterization assays. Laboratory automation and the linkage of information systems for big(ger) data management, including artificial intelligence (AI) approaches, also are being introduced. The initial optimism associated with these developments has now entered a more reality-driven phase of reflection on the significant challenges, complexities, and health care benefits posed by these innovations. With this in mind, the ongoing process of clinical laboratory consolidation, covering large geographical regions, represents an opportunity for the efficient and cost-effective introduction of new laboratory technologies and improvements in translational research and development. This will further define and generate the mandatory infrastructure used in validation and implementation of newer high-throughput diagnostic approaches. Effective, structured access to large numbers of well-documented biobanked biological materials from networked laboratories will release countless opportunities for clinical and scientific infectious disease research and will generate positive health care impacts. We describe why consolidation of clinical microbiology laboratories will generate quality benefits for many, if not most, aspects of the services separate institutions already provided individually. We also define the important role of innovative and large-scale diagnostic platforms. Such platforms lend themselves particularly well to computational (AI)-driven genomics and bioinformatics applications. These and other diagnostic innovations will allow for better infectious disease detection, surveillance, and prevention with novel translational research and optimized (diagnostic) product and service development opportunities as key results.

The Effects of Survey Enhancements on the Quality of Reporting in the Medical Expenditure Panel Survey, 2008–2015

2019 ◽  
Vol 8 (3) ◽  
pp. 589-616 ◽  
Author(s):  
Samuel H Zuvekas ◽  
Adam I Biener ◽  
Wendy D Hicks
Keyword(s):  
Health Care ◽  
Data Quality ◽  
Large Scale ◽  
Medical Expenditure Panel Survey ◽  
Lessons Learned ◽  
Health Care Use ◽  
Medical Expenditure ◽  
Panel Survey ◽  
Quality Of Reporting

Abstract It is well established that survey respondents imperfectly recall health care use in surveys. However, careful attention to both survey design and fielding procedures can enhance recall. We examine the effects of a comprehensive, multi-pronged approach to changing field procedures in the Medical Expenditure Panel Survey (MEPS) to improve quality of health care use reporting. Conducted annually since 1996, the MEPS is the leading large-scale nationally representative health survey with detailed individual and household information on health care use and expenditures. These survey enhancements were undertaken in 2013–2014 because of concerns over a drop in the quality of reporting in 2010 that persisted into 2011–2012. The approach combined focused retraining of field supervisors and interviewers, developing quality metrics and reports for ongoing monitoring of interviewers, and revising advanced letters and materials sent to respondents. We seek to determine the extent to which changes in field procedures and trainings improved interviewer and respondent behaviors associated with better reporting, and more importantly, improved reporting accuracy. We use longitudinal MEPS data from 2008 through 2015, combining household reported use with sociodemographic and health status characteristics, and paradata on the characteristics of the interviews and interviewers. We exploit the longitudinal data and timings of major trainings and changes in field procedures in regression models, separating out the effects of the trainings and other fielding changes to the extent possible. We find that the 2013–2014 data quality improvement activities substantially improved reporting quality. Positive interviewer behaviors increased substantially to above pre-2010 levels, and utilization reporting has recovered to above pre-2010 levels, returning MEPS to trend. Importantly, these substantial gains occurred in 2013, prior to extensive in-person training for most of the field force. We examine the lessons learned from this data quality initiative both for the MEPS program and for other large household surveys.

scholarly journals Lessons Learned: Recommendations For Implementing a Longitudinal Study Using Wearable and Environmental Sensors in a Health Care Organization (Preprint)

2019 ◽  
Author(s):  
Michelle L'Hommedieu ◽  
Justin L'Hommedieu ◽  
Cynthia Begay ◽  
Alison Schenone ◽  
Lida Dimitropoulou ◽  
...  
Keyword(s):  
Health Care ◽  
Data Collection ◽  
Large Scale ◽  
Care Setting ◽  
Lessons Learned ◽  
Health Care Setting ◽  
Sensor Data ◽  
Care Organization ◽  
Environmental Sensors ◽  
Comprehensive Understanding

UNSTRUCTURED Although traditional methods of data collection in naturalistic settings can shed light on constructs of interest to researchers, advances in sensor-based technology allow researchers to capture continuous physiological and behavioral data to provide a more comprehensive understanding of the constructs that are examined in a dynamic health care setting. This study gives examples for implementing technology-facilitated approaches and provides the following recommendations for conducting such longitudinal, sensor-based research, with both environmental and wearable sensors in a health care setting: pilot test sensors and software early and often; build trust with key stakeholders and with potential participants who may be wary of sensor-based data collection and concerned about privacy; generate excitement for novel, new technology during recruitment; monitor incoming sensor data to troubleshoot sensor issues; and consider the logistical constraints of sensor-based research. The study describes how these recommendations were successfully implemented by providing examples from a large-scale, longitudinal, sensor-based study of hospital employees at a large hospital in California. The knowledge gained from this study may be helpful to researchers interested in obtaining dynamic, longitudinal sensor data from both wearable and environmental sensors in a health care setting (eg, a hospital) to obtain a more comprehensive understanding of constructs of interest in an ecologically valid, secure, and efficient way.

scholarly journals An innovation in primary mental health services: The MidValley Well-being Service

2017 ◽  
Vol 20 (3) ◽  
pp. 25-33
Author(s):  
Margaret Pack
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Community Mental Health Services ◽  
Well Being ◽  
Lessons Learned ◽  
Service Development ◽  
Local Resident ◽  
Ministry Of Health

In 2004-5 a new primary health organisation (PHO) project was established that aimed to improve access to equitable health care for the residents of three suburban areas of Lower Hutt, Wellington serviced by three medical practices. After an early successful funding tender in the Ministry of Health, PHO funding round, the MidValley PHO Charitable Trust was formed and from there the MidValley Well-being Service was established and developed in 2005-7. Through positive feedback from Ministry of Health at the two-year evaluation, the service was funded for a third year and at the time of writing continues to grow and expand. This article is a reflection of ‘lessons learned’ in establishing a new PHO initiative in the community mental health services which is seen as accurately attuning and responding to the needs of the local resident population. The author describes the ways in which social work’s traditional concerns of social justice, Treaty of Waitangi principles of partnership, protection, self determination and participation, and a holistic approach to health care can assist in the envisioning of new service development under PHO initiatives.

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