A MATURITY MODEL FOR CARE PATHWAYS

Over the last recent decades, increasing the quality of healthcare services while reducing costs has been among the top concerns in the healthcare landscape. Several healthcare institutions have initiated improvement programs and invested considerably in process orientation and management. Care pathways are receiving increasing attention from clinicians, healthcare managers, and academics, as a way to standardize healthcare processes to improve the safety, quality, and efficiency of healthcare services. Despite considerable literature on the definition of care pathways, to date there is no agreement on their key process characteristics and the way they traverse from an immature to a mature state. Such a model would guide healthcare institutions to assess pathways’ level of maturity and generate a roadmap for improving towards higher levels. In this paper, we propose a maturity model for care pathways that is constructed taking a generic business process maturity model as a basis. The model was refined through a Delphi study with nine domain experts to address healthcare domain specific concerns. To evaluate its validity, we applied it in assessing the maturity of a particular care pathway taking place in 11 healthcare institutions. The results indicate the usefulness of the proposed model in assessing pathway’s maturity and its potential to provide guidance for its improvement

A Patient-Centered Framework for Evaluating Digital Maturity of Health Services: A Systematic Review

© Kelsey Flott, Ryan Callahan, Ara Darzi, Erik Mayer.Background: Digital maturity is the extent to which digital technologies are used as enablers to deliver a high-quality health service. Extensive literature exists about how to assess the components of digital maturity, but it has not been used to design a comprehensive framework for evaluation. Consequently, the measurement systems that do exist are limited to evaluating digital programs within one service or care setting, meaning that digital maturity evaluation is not accounting for the needs of patients across their care pathways. Objective: The objective of our study was to identify the best methods and metrics for evaluating digital maturity and to create a novel, evidence-based tool for evaluating digital maturity across patient care pathways. Methods: We systematically reviewed the literature to find the best methods and metrics for evaluating digital maturity. We searched the PubMed database for all papers relevant to digital maturity evaluation. Papers were selected if they provided insight into how to appraise digital systems within the health service and if they indicated the factors that constitute or facilitate digital maturity. Papers were analyzed to identify methodology for evaluating digital maturity and indicators of digitally mature systems. We then used the resulting information about methodology to design an evaluation framework. Following that, the indicators of digital maturity were extracted and grouped into increasing levels of maturity and operationalized as metrics within the evaluation framework. Results: We identified 28 papers as relevant to evaluating digital maturity, from which we derived 5 themes. The first theme concerned general evaluation methodology for constructing the framework (7 papers). The following 4 themes were the increasing levels of digital maturity: resources and ability (6 papers), usage (7 papers), interoperability (3 papers), and impact (5 papers). The framework includes metrics for each of these levels at each stage of the typical patient care pathway. Conclusions: The framework uses a patient-centric model that departs from traditional service-specific measurements and allows for novel insights into how digital programs benefit patients across the health system

Evaluating telemedicine: A focus on patient pathways

Evaluations of telemedicine have sought to assess various measures of effectiveness (e.g., diagnostic accuracy), efficiency (e.g., cost), and engagement (e.g., patient satisfaction) to determine its success. Few studies, however, have looked at evaluating the organizational impact of telemedicine, which involves technology and process changes that affect the way that it is used and accepted by patients and clinicians alike. This study reviews and discusses the conceptual issues in telemedicine research and proposes a fresh approach for evaluating telemedicine. First, we advance a patient pathway perspective, as most of the existing studies view telemedicine as a support to a singular rather than multiple aspects of a health care process. Second, to conceptualize patient pathways and understand how telemedicine impacts upon them, we propose simulation as a tool to enhance understanding of the traditional and telemedicine patient pathway

Alaska career pathways: A baseline analysis

This report details the findings from a 2013 statewide study of career pathways (CP) and programs of study (PoS) in secondary districts in Alaska. Twenty-seven of Alaska’s 54 districts provided data around the maturity of their CP/PoS, the availability of different CP/PoS, how career planning is addressed, and the availability of courses and PoS in the Health Sciences cluster. The differences between urban and rural communities are often noted in conversations around education, programming and policy in Alaska, and the data in this report reflect this established phenomenon. The contribution of this report is in helping to demystify and contextualize some of these known differences, and to make differentiated recommendations for moving forward.Acknowledgements / Executive summary / Introduction / Context for study / Method / Participation / Part I - Maturity of career pathway components / Part II - Available PoS within the career clusters / Part III Career planning / Part IV Health / Implications / Limitations / Recommendations / Conclusions / Reference

Effective models of employment-based training

Evolving models of employment-based training (EBT) are responding to skill shortages and the need to develop technical skills at a level higher than a certificate III—the benchmark qualification level considered by many as the minimum for ensuring sustainable job outcomes (Stanwick 2004). This research explored a variety of current employment-based training models and proposed five enhancements for higher-level qualifications. These changes concentrate on maintaining a balance of learning experiences between educational institutions and the workplace. The project was based around case studies in process manufacturing and child care. Thirty-three individuals, representing employers, employees/apprentices, vocational education and training (VET) providers, industry bodies and training package developers were interviewed. The issues and views expressed by those interviewed from both industries were consistent with what was found in the literature review. Current models of employment-based training can usefully be grouped as: two forms of 'fast-tracking' options in a formal apprenticeship model, especially at certificate III level, to address immediate skills shortages. These are accelerated progression models (shorter durations linked to a truly competency-based approach) and intensive up-front training, followed by work-based learning to ensure immediate productivity of the learner in the workplace higher-level VET qualifications gained either through an apprenticeship or by undertaking a vocational course the design of new skill sets/qualifications at various levels of the Australian Qualifications Framework (AQF) alternative provisions for young people. Although these models continue to make a significant contribution to the skilling of the Australian workforce, their full potential is limited by certain persistent issues. These include inconsistent regulatory arrangements, non-compliance by employers and registered training organisations, poor audit processes, variations in the interpretation and practice of competency-based training, and wages and awards. These various factors mean poor completion rates and losses for individuals, employers, governments and other stakeholders. Recent changes in policy direction are attempting to address some of these issues and simultaneously increase interest and growth in the uptake of employment-based training. Any new models of employment-based training should address existing problems, as well as take into account the emerging needs of industry for skilled labour. The design of the models must also address an ageing workforce and allow flexible entry points for all age groups. Furthermore, future employment-based training models also need to keep pace with how work is organised in an environment characterised by increased competition, outsourcing, casualisation and an emphasis on specialisation and innovation. What is becoming apparent is the need for a compendium of models, rather than a 'one size fits all' approach

Disrupted Maturation of the Microbiota and Metabolome among Extremely Preterm Infants with Postnatal Growth Failure

Growth failure during infancy is a major global problem that has adverse effects on long-term health and neurodevelopment. Preterm infants are disproportionately affected by growth failure and its effects. Herein we found that extremely preterm infants with postnatal growth failure have disrupted maturation of the intestinal microbiota, characterized by persistently low diversity, dominance of pathogenic bacteria within the Enterobacteriaceae family, and a paucity of strictly anaerobic taxa including Veillonella relative to infants with appropriate postnatal growth. Metabolomic profiling of infants with growth failure demonstrated elevated serum acylcarnitines, fatty acids, and other byproducts of lipolysis and fatty acid oxidation. Machine learning algorithms for normal maturation of the microbiota and metabolome among infants with appropriate growth revealed a pattern of delayed maturation of the microbiota and metabolome among infants with growth failure. Collectively, we identified novel microbial and metabolic features of growth failure in preterm infants and potentially modifiable targets for intervention

Glucose inhibits cardiac muscle maturation through nucleotide biosynthesis.

The heart switches its energy substrate from glucose to fatty acids at birth, and maternal hyperglycemia is associated with congenital heart disease. However, little is known about how blood glucose impacts heart formation. Using a chemically defined human pluripotent stem-cell-derived cardiomyocyte differentiation system, we found that high glucose inhibits the maturation of cardiomyocytes at genetic, structural, metabolic, electrophysiological, and biomechanical levels by promoting nucleotide biosynthesis through the pentose phosphate pathway. Blood glucose level in embryos is stable in utero during normal pregnancy, but glucose uptake by fetal cardiac tissue is drastically reduced in late gestational stages. In a murine model of diabetic pregnancy, fetal hearts showed cardiomyopathy with increased mitotic activity and decreased maturity. These data suggest that high glucose suppresses cardiac maturation, providing a possible mechanistic basis for congenital heart disease in diabetic pregnancy

Business process management: a bird's-eye view and research agenda.

Processes; Management; Research;

Metabolic profiling reveals coordinated switches in primary carbohydrate metabolism in grape berry (Vitis vinifera L.), a non-climacteric fleshy fruit

Changes in carbohydrate metabolism during grape berry development play a central role in shaping the final composition of the fruit. The present work aimed to identify metabolic switches during grape development and to provide insights into the timing of developmental regulation of carbohydrate metabolism. Metabolites from central carbon metabolism were measured using high-pressure anion-exchange chromatography coupled to tandem mass spectrometry and enzymatic assays during the development of grape berries from either field-grown vines or fruiting cuttings grown in the greenhouse. Principal component analysis readily discriminated the various stages of berry development, with similar trajectories for field-grown and greenhouse samples. This showed that each stage of fruit development had a characteristic metabolic profile and provided compelling evidence that the fruit-bearing cuttings are a useful model system to investigate regulation of central carbon metabolism in grape berry. The metabolites measured showed tight coordination within their respective pathways, clustering into sugars and sugar-phosphate metabolism, glycolysis, and the tricarboxylic acid cycle. In addition, there was a pronounced shift in metabolism around veraison, characterized by rapidly increasing sugar levels and decreasing organic acids. In contrast, glycolytic intermediates and sugar phosphates declined before veraison but remained fairly stable post-veraison. In summary, these detailed and comprehensive metabolite analyses revealed the timing of important switches in primary carbohydrate metabolism, which could be related to transcriptional and developmental changes within the berry to achieve an integrated understanding of grape berry development. The results are discussed in a meta-analysis comparing metabolic changes in climacteric versus non-climacteric fleshy fruits