Using Task Models to Understand the Intersection of Numeracy Skills and Technical Competence With Medical Device Design

Task models are used in many different ways throughout the design and development of interactive systems. When the interactive systems are safety critical, task models can play an important role in ensuring system behaviours are consistent with user requirements, which may help to prevent errors. While task models can be used to describe a user’s goals and the steps required to achieve that goal, to understand where user errors may occur we also need to consider the users’ understanding of how to perform a task and how this relates to the system they are using. Our focus is on the use of medical devices such as syringe drivers and infusion pumps for intravenous medication, which forms a major part of hospital inpatient care throughout the world. While we might rely on software engineering and human factors techniques to ensure correctness of such devices, their use by medical personnel in practice includes other factors that are equally important. These include training medical personnel in the use of medical devices. Also numeracy education for medical staff to ensure that they are able to set up and perform the necessary calculations to convert prescribed medication into the appropriate values and measures for their delivery mechanisms. We have developed an approach that aims to bring together concepts of technology design (both functional correctness and usability concerns), numeracy and medication delivery competency. In order to do so we use task models as a common language that enables us to consider these different domains in a single way. We find that the ability to describe the two domains within a single process allows us to compare models of knowledge, tasks and use of devices, which can elicit potential mismatches and problems.

Healthcare Utilization of Below Poverty Line Population under Government-Funded Health Protection Scheme in One Sub-district in Bangladesh: A Cross-Sectional Study

Background The below poverty line (BPL) population in rural Bangladesh have low access to hospital inpatient-care (IPC) services. The Government of Bangladesh (GoB) launched pilot Shasthyo Suroksha Karmasuchi (SSK) at Kalihati Upazila of Tangail district in 2016 aiming to improve IPC access of the BPL population and financial protection for healthcare. The GoB funded scheme provides IPC for 78 diseases and outpatient consultation through an existing health facility. In this study, we aimed to assess the level of healthcare utilization among the scheme beneficiaries and identify the associated factors with utilization. MethodsThis was an exploratory study with a cross-sectional household survey conducted from July to September 2018 among 806 sampled households using a structured questionnaire. Data on illness and healthcare utilization was collected from the selected households for the last 90 days of the interview date. A logistic regression model was applied to determine the factors associated with healthcare utilization from SSK facility. ResultsOverall, 8% of the ill patients in the last 90 days prior to survey sought healthcare from SSK facilities (n=639; total patients who sought care), 28% from medically trained providers (MTPs), and 64% from non-MTPs. Of the 23 (3.6%) patients who sought inpatient care (IPC), less than half (10 patients) of them utilized IPC under SSK. Individuals with accident/injury, unemployed, having knowledge about SSK, non-BPL status, were more likely to utilize healthcare from SSK facility. Individuals reside more than 15 km away from facility, had 4-5 family members, and above secondary level education were less likely to utilize care from SSK facility. Conclusions It is evident that healthcare utilization of beneficiaries from the SSK scheme was very low. Effective strategies for enhancing knowledge on SSK benefits and precise BPL households targeting can be instrumental in increasing utilization of the scheme. The scheme also has a potential to bring the individuals under its coverage who utilize healthcare from other MTP and non-MTP.

Healthcare Utilization of Below Poverty Line Population under Government-Funded Health Protection Scheme in one sub-district in Bangladesh: A Cross-Sectional Study

BackgroundThe below poverty line (BPL) population in rural Bangladesh have low access to hospital inpatient-care (IPC) services. The Government of Bangladesh (GoB) launched pilot Shasthyo Suroksha Karmasuchi (SSK) at Kalihati Upazila of Tangail district in 2016 aiming to improve IPC access of the BPL population and financial protection for healthcare. The GoB funded scheme provides IPC for 78 diseases and outpatient consultation through an existing health facility. In this study, we aimed to assess the level of healthcare utilization among the scheme beneficiaries and identify the associated factors with utilization.MethodsThis was an exploratory study with a cross-sectional household survey conducted from July to September 2018 among 806 sampled households using a structured questionnaire. Data on illness and healthcare utilization was collected from the selected households for the last 90 days of the interview date. A logistic regression model was applied to determine the factors associated with healthcare utilization from SSK facility.ResultsOverall, 8% of the ill patients in the last 90 days prior to survey sought healthcare from SSK facilities (n=639; total patients who sought care), 28% from medically trained providers (MTPs), and 64% from non-MTPs. Of the 23 (3.6%) patients who sought inpatient care (IPC), less than half (10 patients) of them utilized IPC under SSK. Individuals with accident/injury, unemployed, having knowledge about SSK, non-BPL status, were more likely to utilize healthcare from SSK facility. Individuals reside more than 15 km away from facility, had 4-5 family members, and above secondary level education were less likely to utilize care from SSK facility.Conclusions It is evident that healthcare utilization of beneficiaries from the SSK scheme was very low. Effective strategies for enhancing knowledge on SSK benefits and precise BPL households targeting can be instrumental in increasing utilization of the scheme. The scheme also has a potential to bring the individuals under its coverage who utilize healthcare from other MTP and non-MTP.

Translation, adaptation and validation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) for use in Japan: a multicentre cross-sectional study

ObjectivesThe Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a well-established and internationally recognised scale for measuring patients’ experience with hospital inpatient care. This study aimed to develop a Japanese version of the HCAHPS and to examine its structural validity, criterion-related validity and internal consistency reliability.DesignMulticentere cross-sectional study.SettingA total of 48 hospitals in Japan.Participants6522 patients aged ≥16 years who were discharged from the participating hospitals.ResultsConfirmatory factor analysis showed excellent goodness of fit of the same factor structure as that of the original HCAHPS, with the following composites: communication with nurses, communication with doctors, responsiveness of hospital staff, hospital environment, communication about medicines and discharge information. All hospital-level Pearson correlation coefficients between the Japanese HCAHPS composites and overall hospital rating exceeded the criteria. Results of inter-item correlations indicated adequate internal consistency reliability.ConclusionsThe Japanese HCAHPS has acceptable psychometric properties for assessing patients’ experience with hospital inpatient care. This scale could be used for quality improvement based on the assessment of patients’ experience with hospital care and for health services research in Japan.

1664. The Utilization of Hospital Inpatient Care due to Tuberculosis, Republic of Ireland, 2015-2018

Background The Republic of Ireland (ROI) is a low incidence TB country. The last reform of TB services in the ROI in 2003 recommended that most TB management should be delivered on an outpatient basis with 3 hospitals being designated as TB centres. Our aim was to describe the utilization of hospital inpatient care by patients with TB in the Republic of Ireland. Methods Hospital coding data were searched to identify TB hospital discharges between 01/01/2015-31/12/18. The projected cost of TB episodes of care was calculated using payment rules for public hospitals in Ireland. Results 1185 admissions with TB as the principal diagnosis were identified. 801/1185 (68%) episodes of care were emergencies and 384/1185 (32%) were elective We estimate that 65.1% (818/1257) patients with TB notified in the Republic of Ireland from 2015-2018 had an episode of care in a public hospital and (50.8%) 639/818 had an emergency episode of care. We estimate that mean annual cost of TB inpatient care per year in the ROI from 2015-2018 was €2,638,828 - 2,955,047, with emergency episodes of care costing an average of €2,250,926 - 2,557,397 per year. Conclusion The burden of TB on hospital inpatient care in the Republic of Ireland is significant. The national TB policy should change in recognition of this. Disclosures All Authors: No reported disclosures

Step Towards Interoperability in Nursing Practice

Hospital inpatient care compromises one of the most demanding services in health institutions for providing a careful and continuous healthcare assistance. Such demands require a constant update of the patients' health record allied with support systems responsible for monitoring their clinical information. In this context, the problem in this study becomes a process of continuous improvement. To define the case study, it was necessary to use research tools such as questionnaires and interviews. With these techniques, it was possible to delineate the state and dimension of the problem. Subsequently, the approach and solution was established and a new web platform for the daily monitoring of patients was proposed focused on nurses. The tool incorporates a real-time data visualization, and a patient record during an inpatient care episode. Moreover, this article also highlights the required adaptability of this platform for each health unit according to needs. With this solution, it is expected to correct many of the problems detected through quantitative results.