Introducing Economic Evaluation as a Decision Support Tool in Health Care: A Case Review of I.R. Iran

Health Scope ◽  
2012 ◽  
Vol 1 (3) ◽  
pp. 101-109
Author(s):  
Abdolvahab Baghbanian ◽  
Saeed Esmaeili
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Economic Evaluation ◽  
Decision Support Tool ◽  
Case Review ◽  
Support Tool

scholarly journals Optimization of Decision Support Tool using Medication Regimens to Assess Rehospitalization Risks

2014 ◽  
Vol 05 (03) ◽  
pp. 773-788 ◽  
Author(s):  
M. Dierich ◽  
T. Adam ◽  
B.L Westra ◽  
C.H. Olson
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Elderly Patients ◽  
Hospital Readmissions ◽  
Decision Support Tool ◽  
Potentially Inappropriate Medications ◽  
Support Tool ◽  
Cut Point ◽  
Medication Regimen Complexity ◽  
Automated Algorithm

Summary Background: Unnecessary hospital readmissions are costly for the U.S. health care system. An automated algorithm was developed to target this problem and proven to predict elderly patients at greater risk of rehospitalization based on their medication regimens. Objective: Improve the algorithm for predicting elderly patients’ risks for readmission by optimizing the sensitivity of its medication criteria. Methods: Outcome and Assessment Information Set (OASIS) and medication data were reused from a study that defined and tested an algorithm for assessing rehospitalization risks of 911 patients from 15 Medicare-certified home health care agencies. Odds Ratio analyses, literature reviews and clinical judgments were used to adjust the scoring of patients’ High Risk Medication Regimens (HRMRs). Receiver Operating Characteristic (ROC) analysis evaluated whether these adjustments improved the predictive strength of the algorithm’s components. Results: HRMR scores are composed of polypharmacy (number of drugs), potentially inappropriate medications (PIM) (drugs risky to the elderly), and Medication Regimen Complexity Index (MRCI) (complex dose forms, dose frequency, instructions or administration). Strongest ROC results for the HRMR components were Areas Under the Curve (AUC) of .68 for polypharmacy when excluding supplements; and .60 for PIM and .69 for MRCI using the original HRMR criteria. The “cut point” identifying MRCI scores as indicative of medication-related readmission risk was increased from 20 to 33. Conclusion: The automated algorithm can predict elderly patients at risk of hospital readmissions and its underlying criteria is improved by a modification to its polypharmacy definition and MRCI cut point. Citation: Olson CH, Dierich M, Adam T, Westra BL. Optimization of decision support tool using medication regimens to assess rehospitalization risks. Appl Clin Inf 2014; 5: 773–788http://dx.doi.org/10.4338/ACI-2014-04-RA-0040

scholarly journals Factors Affecting Health Care Engagement of Patients With End-Stage Heart Failure: An Exploratory Survey Study

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831986551
Author(s):  
Lisa Carey Lohmueller ◽  
Aakanksha Naik ◽  
Luke Breitfeller ◽  
Colleen K. McIlvennan ◽  
Manreet Kanwar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Decision Making ◽  
Decision Support ◽  
Information Seeking ◽  
Decision Support Tool ◽  
Treatment Decisions ◽  
Support Tool ◽  
End Stage Heart Failure ◽  
End Stage

Background. The decision to receive a permanent left ventricular assist device (LVAD) to treat end-stage heart failure (HF) involves understanding and weighing the risks and benefits of a highly invasive treatment. The goal of this study was to characterize end-stage HF patients across parameters that may affect their decision making and to inform the development of an LVAD decision support tool. Methods. A survey of 35 end-stage HF patients at an LVAD implant hospital was performed to characterize their information-seeking habits, interaction with physicians, technology use, numeracy, and concerns about their health. Survey responses were analyzed using descriptive statistics, grounded theory method, and Bayesian network learning. Results. Most patients indicated an interest in using some type of decision support tool (roadmap of health progression: 46%, n = 16; personal prognosis: 51%, n = 18; short videos of patients telling stories of their experiences with an LVAD: 57%, n = 20). Information patients desired in a hypothetical decision support tool fell into the following topics: prognoses for health outcomes, technical information seeking, expressing emotions, and treatment decisions. Desire for understanding their condition was closely related to whether they had difficult interpreting their electronic medical record in the past. Conclusions. Most patients reported interest in engaging in their health care decision making and seeing their prognosis and electronic health record information. Patients who were less interested in their own treatment decisions were characterized by having less success understanding their health information. Design of a decision support tool for potential LVAD patients should consider a spectrum of health literacy and include information beyond the technical specifications of LVAD support.

scholarly journals Development of a Digital Decision Support Tool to Aid Participation of Children With Disabilities in Pediatric Rehabilitation Services: Explorative Qualitative Study (Preprint)

2019 ◽  
Author(s):  
Elin Vinblad ◽  
Ingrid Larsson ◽  
Maria Lönn ◽  
Emma Olsson ◽  
Jens M Nygren ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Young People ◽  
Children With Disabilities ◽  
People With Disabilities ◽  
Decision Support Tool ◽  
Rehabilitation Services ◽  
Pediatric Rehabilitation ◽  
Children And Young People ◽  
Support Tool

BACKGROUND Building a health care system in accordance with the rule of law requires child-centered care, where children and young people, regardless of ability, are allowed to participate in visits with their health care professionals. As part of an overall project focusing on developing and implementing a digital decision support tool to increase the participation of children with disabilities in pediatric rehabilitation, this study brings new knowledge as to how this specific patient group views participation. OBJECTIVE The aim of this formative study was to explore the experiences of children and young people with disabilities concerning increasing their participation in the pediatric rehabilitation services. METHODS The formative study had an explorative design, based on a latent qualitative content analysis with an inductive approach. Interviews were conducted with 20 children (6-17 years) and 8 young people (19-30 years) with disabilities about their experiences of participation in pediatric rehabilitation services. RESULTS A total of 3 categories emerged reflecting the participants’ possibilities of participation in the pediatric rehabilitation services: to feel involved, to feel independent, and to work in partnership. To feel involved meant being listened to and being connected, to feel independent meant being admitted and being enabled, and to work in partnership meant being supported and being able to entrust others with the decision making. With the overall theme <italic>moving toward empowerment of children in pediatric rehabilitation</italic>, a true feeling of participation can be experienced. CONCLUSIONS The views of children and young people with disabilities are that children should be given the prerequisites for empowerment by being allowed to feel involved and independent as well as to work in partnership to experience true participation in the pediatric rehabilitation services. This finding is essential in the design of a digital decision support tool based on the children’s needs and perspectives.

scholarly journals Prevention of AcuTe admIssioN algorithm (PATINA): study protocol of a stepped wedge randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anders Fournaise ◽  
Jørgen T. Lauridsen ◽  
Mickael Bech ◽  
Uffe K. Wiil ◽  
Jesper B. Rasmussen ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Home Care ◽  
Controlled Trial ◽  
Decision Support Tool ◽  
Community Dwelling ◽  
Support Tool ◽  
Acute Admission ◽  
Increased Risk ◽  
Older Citizens

Abstract Background The challenges imposed by ageing populations will confront health care systems in the years to come. Hospital owners are concerned about the increasing number of acute admissions of older citizens and preventive measures such as integrated care models have been introduced in primary care. Yet, acute admission can be appropriate and lifesaving, but may also in itself lead to adverse health outcome, such as patient anxiety, functional loss and hospital-acquired infections. Timely identification of older citizens at increased risk of acute admission is therefore needed. We present the protocol for the PATINA study, which aims at assessing the effect of the ‘PATINA algorithm and decision support tool’, designed to alert community nurses of older citizens showing subtle signs of declining health and at increased risk of acute admission. This paper describes the methods, design and intervention of the study. Methods We use a stepped-wedge cluster randomized controlled trial (SW-RCT). The PATINA algorithm and decision support tool will be implemented in 20 individual area home care teams across three Danish municipalities (Kerteminde, Odense and Svendborg). The study population includes all home care receiving community-dwelling citizens aged 65 years and above (around 6500 citizens). An algorithm based on home care use triggers an alert based on relative increase in home care use. Community nurses will use the decision support tool to systematically assess health related changes for citizens with increased risk of acute hospital admission. The primary outcome is acute admission. Secondary outcomes are readmissions, preventable admissions, death, and costs of health care utilization. Barriers and facilitators for community nurse’s acceptance and use of the algorithm will be explored too. Discussion This ‘PATINA algorithm and decision support tool’ is expected to positively influence the care for older community-dwelling citizens, by improving nurses’ awareness of citizens at increased risk, and by supporting their clinical decision-making. This may increase preventive measures in primary care and reduce use of secondary health care. Further, the study will increase our knowledge of barriers and facilitators to implementing algorithms and decision support in a community care setup. Trial registration ClinicalTrials.gov, identifier: NCT04398797. Registered 13 May 2020.

scholarly journals A five-step approach for developing and implementing a Rural Primary Health Care Model for Dementia: a community–academic partnership

2019 ◽  
Vol 20 ◽  
Author(s):  
Debra Morgan ◽  
Julie Kosteniuk ◽  
Dallas Seitz ◽  
Megan E. O’Connell ◽  
Andrew Kirk ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Decision Support ◽  
Needs Assessment ◽  
Decision Support Tool ◽  
Evidence Based ◽  
Dementia Diagnosis ◽  
Support Tool ◽  
Primary Health ◽  
Team Based Care

AbstractAimThis study is aimed at developing a Rural Primary Health Care (PHC) Model for delivering comprehensive PHC for dementia in rural settings and addressing the gap in knowledge about disseminating and implementing evidence-based dementia care in a rural PHC context.BackgroundLimited access to specialists and services in rural areas leads to increased responsibility for dementia diagnosis and management in PHC, yet a gap exists in evidence-based best practices for rural dementia care.MethodsElements of the Rural PHC Model for Dementia were based on seven principles of effective PHC for dementia identified from published research and organized into three domains: team-based care, decision support, and specialist-to-provider support. Since 2013 the researchers have collaborated with a rural PHC team in a community of 1000 people in the Canadian province of Saskatchewan to operationalize these elements in ways that were feasible in the local context. The five-step approach included: building relationships; conducting a problem analysis/needs assessment; identifying core and adaptable elements of a decision support tool embedded in the model and resolving applicability issues; implementing and adapting the intervention with local stakeholders; and sustaining the model while incrementally scaling up.ResultsDeveloping and sustaining relationships at regional and PHC team levels was critical. A comprehensive needs assessment identified challenges related to all domains of the Rural PHC Model. An existing decision support tool for dementia diagnosis and management was adapted and embedded in the team’s electronic medical record. Strategies for operationalizing other model elements included integrating team-based care co-ordination into the decision support tool and family-centered case conferences. Research team specialists provided educational sessions on topics identified by the PHC team. This paper provides an example of a community-based process for adapting evidence-based practice principles to a real-world setting.

scholarly journals Application d’une méthode d’étude quantitative et qualitative des rejets liquides hospitaliers au niveau de la Région de Marrakech Tensift El Haouz, Maroc

2016 ◽  
Vol 12 (32) ◽  
pp. 110
Author(s):  
Qadouri Asmaa ◽  
Mouhir Latifa ◽  
Belkadi Mohammed Said
Keyword(s):  
Health Care ◽  
Drinking Water ◽  
Decision Support ◽  
Decision Support Tool ◽  
Private Health Care ◽  
Sewer System ◽  
Public And Private ◽  
Support Tool ◽  
Hospital Effluent ◽  
The City

This study led to the development of a decision support tool to quantify the hospital effluent generated by public and private health care establishments in the region of Marrakech-Tensift-El Haouz situated in Morocco. The estimation concerns the consumption in drinking water, the production in wastewater and on the most consummate products collectively in the whole of the establishments of care and which join the sewer system (cleaner, soap, washing, Glutaraldehyde) based on the capacity litter, the hospitable vocations and the production rate. By having the results of quantification of the deposit rejected in the municipal network, the present study estimates then for the case of the city of Marrakesh the part of contribution of the hospital effluent in the municipal pollution.

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