A clinical support system based on quality of life estimation

Quality of life is a concept influenced by social, economic, psychological, spiritual or medical state factors. More specifically, the perceived quality of an individual's daily life is an assessment of their well-being or lack of it. In this context, information technologies may help on the management of services for healthcare of chronic patients such as estimating the patient quality of life and helping the medical staff to take appropriate measures to increase each patient quality of life. This paper describes a Quality of Life estimation system developed using information technologies and the application of data mining algorithms to access the information of clinical data of patients with cancer from Otorhinolaryngology and Head and Neck services of an oncology institution. The system was evaluated with a sample composed of 3013 patients. The results achieved show that there are variables that may be significant predictors for the Quality of Life of the patient: years of smoking (p value 0.049) and size of the tumor (p value < 0.001). In order to assign the variables to the classification of the quality of life the best accuracy was obtained by applying the John Platt's sequential minimal optimization algorithm for training a support vector classifier. In conclusion data mining techniques allow having access to patients additional information helping the physicians to be able to know the quality of life and produce a well-informed clinical decision

Final report on the evaluation of the RAC input data elements.

The Resource Allocation Criteria (RAC) began to develop in 1972, responding to management requirements of the Indian Health Service (IHS). The RAC is now the principal management tool of the IHS Manpower Management Program, which justifies all manpower-related budgetary requests to the Department of Health and Human Services (DHHS). RAC fulfills its obligations by identifying necessary tasks to provide quality resources for each segment of the health care system. The purpose of this study was to determine the reliability of the data inputs to RAC, the degree to which the quality of the input affects the reliability of the output. and Identification of means to improve the quality of input data. The study first identified input data elements through the use of archival (RAC) records and interviews with IHS personnel. From this data, flow charts and profile sheets were compiled. IHS Program/Area Offices site visits were then initiated. Here, patient records were sampled, meetings with site personnel to review methods in use were held, and local finance and contract personnel were interviewed to determine volume of and tracking method for services. Using these data, flow charts were developed and data estimates were constructed using all previously gathered material. From these data estimates, the accuracy of RAC input data was compared with the actual data collected and the constructed data estimates. The findings of the study included: 1) as a result of perceived undercounting, population data from IHS suffers from a lack of confidence at the Area Offices; 2) both inpatient and outpatient data are suspect because of the practice of issuing one patient more than one patient number and, conversely issuing the same patient number to more than one patient; 3) illegible record entries hinder accurate patient data gathering; 4) a high turnover in record keeping personnel; 5) a significantly lower error rate in inpatient data than in outpatient data; 6) a number of inpatient and outpatient records never enter the IHS data system; 7) alcoholism is not always reported as the cause of medical attention in projecting demand for contract health services; 8) RAC does not adequately project the additional need for P.L. 638 contracting; 9) data is often lacking from HSA-43 and HSA-64 reporting forms; 10) contract health service providers are not always audited; 11) many contract service bills are submitted after the close of the fiscal year; 12) RAC staffing tables are relatively insensitive from a statistical perspective; and 13) Service Units and Area Offices are more accurate predictors of direct service needs than are contract providers. Numerous recommendations are made concerning: 1) the national decennial census; 2) population migration and projections; 3) a unique patient identification numbering system; 4) inpatient and outpatient data verification procedures; 5) feasibility of developing the HSA-44-1 and the HSA-406 as clinical management tools; 6) an inventory of the patient record system; 7) Area Offices review systems checks; 8) the accuracy of patient data; 9) use of HSA-406 forms during itinerant visits; 10) a training program for Community Health Aides (CHAs); 11) reporting alcoholism as a primary diagnosis; 12) projected utilization of contract services to actual contract services needs; 13) a method of identifying and projecting P.L. 638 costs; 14) efforts to obtain all contractor invoices before the end of the fiscal year; 15) algorithms that support staffing tables and then perform another sensitivity analysis; and 21) standardization of collection, reporting, and recording parameters of projected and actual data and ensure a consistent application in developing RAC input data

Communication in sudden-onset major incidents. Patterns and challenges. A scoping review.

Major incidents and disasters are rare occurrences that challenge society and health care systems substantially. The mobilization of extraordinary resources calls for robust preparedness plans, regular training and funding. Command & control is essential in major incident management. To achieve, maintain and execute command & control, communication within emergency medical services and between authorities involved in major incident and disaster management is paramount. The main aim of the master thesis is to explore communication between emergency medical services professionals in sudden-onset major incidents in a broader perspective. The thesis focuses on previous patterns and challenges in communication to provide policymakers with data for the improvement of future major incident preparedness. A scoping review of existing scientific and non-indexed literature describing communication in sudden-onset major incidents provides the sources of information in the thesis. Based on the included literature, this scoping review has found that the patterns in major incident communication are frequent breakdown with potential and actual consequences for patient survival, outcome and management and for the expedited return to a normal state. The challenges in major incident communication are predominantly inter-authority communication difficulties, system overload and lack of introduction and training in the use of communication devices. Cross-border incidents challenge communication substantively. The scoping review has shown that focus has been on describing the operational and tactical approach in sudden-onset major incidents and that communication challenges have not been assessed systematically. A general agreement that communication has been challenging exists; however, it remains mainly unquantified and improvised means of communication have been used extensively

Advanced EMS Treatment and Survival After Cardiac Arrest

Successful cardiac arrest management requires the simultaneous coordination of a number of advanced treatments. In order to improve this process and related patient outcomes, Greenville County Emergency Medical Services (GCEMS) implemented multiple protocol and training changes between 2011 and May 2012. Changes included the introduction of streamlined guidelines and treatment processes, increased scope of care for paramedics, shift to an evidence-based training program, and introduction of an annual survivor ceremony. These modifications simultaneously targeted both the professionalism of paramedics and EMS system culture. Impact of the new cardiac arrest management program was assessed at both the individual and population health levels. The purpose of this retrospective study was to examine the efficacy of the systematic and cultural changes put into place by GCEMS. With the cooperation of Greenville Health System, we examined patient outcomes and records to analyze and assess the effectiveness of the new practices and guidelines. Key outcome measures such as patient neurological status, hospital readmission frequency, and cost measures were used to evaluate the impact of these changes. Adult, non-traumatic out of hospital cardiac arrest victims terminated in the field or transported to a Greenville Health System hospitalbetween January 1, 2010 to December 31, 2010 (per-intervention period) or June 1, 2012 to May 31, 2013 (post-intervention period) were included in the study. No data from 2011 was analyzed; this period was the transitional phase during which the treatment protocol changes were being implemented

The nursing contribution to chronic disease management: a whole systems approach: Report for the National Institute for Health Research Service Delivery and Organisation programme

Background Transforming the delivery of care for people with Long Term Conditions (LTCs) requires understanding about how health care policies in England and historical patterns of service delivery have led to different models of chronic disease management (CDM). It is also essential in this transformation to analyse and critique the models that have emerged to provide a more detailed evidence base for future decision making and better patient care. Nurses have made, and continue to make, a particular contribution to the management of chronic diseases. In the context of this study, there is a particular focus on the origins of each CDM model examined, the processes by which nursing care is developed, sustained and mainstreamed, and the outcomes of each case study as experienced by service users and carers. Aims To explore, identify and characterise the origins, processes and outcomes of effective CDM models and the nursing contribution to such models using a whole systems approach Methods The study was divided into three phases: Phase 1: Systematic mapping of published and web-based literature. Phase 2: A consensus conference of nurses working within CDM. Sampling criteria were derived from the conference and selected nurses attended a follow up workshop where case study sites were identified. Phase 3: Multiple case study evaluation Sample: 7 case studies representing 4 CDM models. These were: i) public health nursing model; ii) primary care nursing model; iii) condition specific nurse specialist model; iv) community matron model. Methods: Evaluative case study design with the unit of analysis the CDM model (Yin, 2003): • semi-structured interviews with practitioners, patients, their carers, managers and commissioners • documentary analysis • psycho-social and clinical outcome data from specific conditions • children and young people: focus groups, age-specific survey tools. Benchmarking outcomes: Adults benchmarked against the Health Outcomes Data Repository (HODaR) dataset (Currie et al, 2005). Young people were benchmarked against the Health Behaviour of School aged Children Survey (Currie et al, 2008). Cost analysis: Due to limitations in the available data, a simple costing exercise was undertaken to ascertain the per patient cost of the nurse contribution to CDM in each of the models, and to explore patterns of health and social care utilisation. Analysis: A whole system methodology was used to establish the principles of CDM. i) The causal system is a “network of causal relationships” and focuses on long term trends and processes. ii) The data system recognises that for many important areas there is very little data. Where a particular explanatory factor is important but precise data are lacking, a range of methods should be employed to illuminate each factor as much as possible. iii) The organisational whole system emphasises how various parts of the health and social care system function together as a single system rather than as parallel systems. iv) The patient experience recognises that the whole system comes together and is embodied in the experience of each patient. Key findings While all the models strove to be patient centred in their implementation, all were linked at a causal level to disease centric principles of care which dominated the patient experience. Public Health Model • The users (both parents and children) experienced a well organised and coordinated service that is crossing health and education sectors. • The lead school nurse has provided a vision for asthma management in school-aged children. This has led to the implementation of the school asthma strategy, and the ensuing impacts including growing awareness, prevention of hospital admissions, confidence in schools about asthma management and healthier children. Primary Care Model • GP practices are providing planned and routine management of chronic disease, tending to focus on single diseases treated in isolation. Care is geared to the needs of the uncomplicated stable patient. • More complex cases tend to be escalated to secondary care where they may remain even after the patient has stabilised. • Patients with multiple diagnoses continue to experience difficulty in accessing services or practice that is designed to provide a coherent response to the idiosyncratic range of diseases with which they present. This is as true for secondary care as for primary care. • While the QOF system has clearly been instrumental in developing and sustaining a primary care nursing model of CDM, it has also limited the scope of the model to single diseases recordable on a register, rather than focus on patient centred care needs. Nurse Specialist Model • The model works under a disease focused system underpinned by evidence based medicine exemplified by NICE guidelines and NSF’s. • The model follows a template drawn from medicine and sustainability is significantly dependent on the championship and protectionism offered by senior medical clinicians. • A focus on self-management in LTCs gives particular impetus to nurse-led enablement of self-management. • The shift of LTC services from secondary care to primary care has often not been accompanied by a shift in expertise. Community Matron Model • The community matron model was distinctive in that it had been implemented as a top down initiative. • The model has been championed by the community matrons themselves, and the pressure to deliver observable results such as hospital admission reductions has been significant. • This model was the only one that consistently resulted in open access (albeit not 24 hours) and first point of contact for patients for the management of their ongoing condition. Survey Findings Compared to patients from our case studies those within HODaR visited the GP, practice nurse or NHS walk-in centres more, but had less home visits from nurses or social services within the six weeks prior to survey. HODaR patients also took significantly more time off work and away from normal activities, and needed more care from friends/ relatives than patients from our study within the last six weeks. The differences between the HODaR and case study patients in service use cannot easily be explained but it could be speculated when referring to the qualitative data that the case study patients are benefiting from nurse-led care. Cost analysis – The nurse costs per patient are at least ten times higher for community matrons conducting CDM than for nurses working in other CDM models. The pattern of service utilisation is consistent with the focus of the community matron role to provide intensive input to vulnerable patients. Conclusions Nurses are spearheading the kind of approaches at the heart of current health policies (Department of Health, 2008a). However, tensions in health policy and inherent contradictions in the context of health care delivery are hampering the implementation of CDM models and limiting the contribution nurses are able to make to CDM. These include: ? data systems that were incompatible and recorded patients as a disease entity ? QOF reinforced a disease centric approach ? practice based commissioning was resulting in increasing difficulties in cross health sector working in some sites ? the value of the public health model may not be captured in evaluation tools which focus on the individual patient experience. Recommendations Commissioners and providers 1. Disseminate new roles and innovations and articulate how the role or service fits and enhances existing provision. 2. Promote the role of the nurses in LTC management to patients and the wider community. 3. Actively engage with service users in shaping LTC services to meet patients’ needs. 4. Improve the support and supervision for nurses working within new roles. 5. Develop training and skills of nurses working in the community to enable them to take a more central role in LTC management. 6. Develop organisations that are enabling of innovation and actively seek funding for initiatives that provide an environment where nurses can reach their potential in improving LTC services. 7. Work towards data systems that are compatible between sectors and groups of professionals. Explore ways of enabling patients to access data and information systems for test results and latest information. 8. Promote horizontal as well as vertical integration of LTC services. Practitioners 1. Increase awareness of patient identified needs through active engagement with the service user. 2. Work to develop appropriate measures of nursing outcomes in LTC management including not only bureaucratic and physiological outcomes, but patient-identified outcomes. Implications of research findings 1. Investment should be made into changing patient perceptions about the traditional division of labour, the nurses’ role and skills, and the expertise available in primary care for CDM. 2. Development and evaluation of patient accessible websites where patients can access a range of information, their latest test results and ways of interpreting these. 3. Long-term funding of prospective evaluations to enable identification of CDM outcomes. 4. Mapping of patient experience and patient satisfaction so that the conceptual differences between these two related ideas can be demonstrated. 5. Development of appropriate measures of patient experience that can be used as part of the quality outcome measures. 6. Cost evaluation/effectiveness studies carried out over time that includes national quality outcome indicators and valid measures of patient experience. 7. The importance of whole system working needs to be identified in the planning of services. 8. Research into the role of the health visitor in chronic disease management within a public health model

Assessment of innovative technologies application in medical imaging in Portugal

Dissertation presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Information Systems and Technologies ManagementFor the past few years, despite the Portuguese government announcing the upgrade of the Portuguese healthcare system, it is possible to verify the missing investment in that infrastructure, equipment and services. The lack of quality and the unavailability of modern equipments and infrastructures are some of the usual complaints of the healthcare providers and patients. This study aims to analyze and explain, the gaps between innovative technologies available in the market and the present implemented technologies in the Medical Imaging area in Portugal and, with the collected data, build an explanatory model of the motivations for the lack of investment. For the collection data purposes, 102 subjects were inquired, from multiple Portuguese hospitals and healthcare clinics related to medical imaging, with physicians, suppliers, service providers, and Senior Diagnostic and Therapeutic Technicians roles. After analyzing the data, it is possible to conclude that Portuguese medical imaging services need updated equipment and improved technology, more human resources, and training. Managers of healthcare organizations, mainly from the public sector, are motivated primarily to save costs due to the increasing healthcare organizations' expenditures. These facts are incurring in wrong diagnoses, patient dissatisfaction, and lack of confidence in Portuguese healthcare providers

Provision of medical abortion by midlevel healthcare providers in Kyrgyzstan : testing an intervention to expand safe abortion services to underserved rural and periurban areas

Publisher Copyright: © 2017 World Health OrganizationObjective: To demonstrate the feasibility and safety of training midlevel healthcare providers (midwives and family nurses) to provide medical abortion and postabortion contraception in underserved areas in Kyrgyzstan. Study design: This was an implementation study at four referral facilities and 28 Felsher Obstetric Points in two districts to train their midwives and family nurses to deliver safe and effective abortion care with co-packaged mifepristone–misoprostol and provide contraceptives postabortion. The outcome of abortion — complete abortion, incomplete abortion or o-going pregnancy — was the primary end point measured. An international consultant trained 18 midwives and 14 family nurses (with midwifery diplomas) to provide medical abortion care. Supervising gynecologists based in the referral centers and study investigators based in Bishkek provided monthly monitoring of services and collection of patient management forms. A voluntary self-administered questionnaire at the follow-up visit documented women's acceptability of medical abortion services. All study data were cross-checked and entered into an online data management system for descriptive analysis. Results: Between August 2014 and September 2015, midwives provided medical abortion to 554 women with a complete abortion rate of 97.8%, of whom 62% chose to use misoprostol at home. No women were lost to follow-up. Nearly all women (99.5%) chose a contraceptive method postabortion; 61% of women receiving services completed the acceptability form, of whom more than 99% indicated a high level of satisfaction with the service and would recommend it to a friend. Conclusion: This study demonstrates that trained Kyrgyz midwives and nurses can provide medical abortion safely and effectively. This locally generated evidence can be used by the Kyrgyz Ministry of Health to reduce unintended pregnancy and expand safe abortion care to women in underserved periurban and rural settings. Implications: Success in scaling up midwife/nurse provision of medical abortion in Kyrgyzstan will require registration of mifepristone–misoprostol, regulations permanently allowing midwife/nurse provision, strengthened procurement and distribution systems to prevent stockouts of supplies, preservice training of midwives/nurses and their involvement in district level supervision, monitoring and reporting, and support from supervisors.publishersversionPeer reviewe

Information Seeking Behaviour of Physicians for Patient Care in University Teaching Hospitals in North-Central, Nigeria

The study investigated information seeking behaviour of physicians for improved patient care in University Teaching Hospitals in North Central Nigeria. To achieve the research objectives, the study sets to find out: information seeking behaviour of physicians for improved patient care in University Teaching Hospitals, in North-Central, Nigeria; determine the extent to which the medical library provides the needed information for physicians in University Teaching Hospitals, in North-Central, Nigeria; determine the extent to which physicians use the medical library in University Teaching Hospitals, in North-Central, Nigeria. Three research questions were formulated to serve as a guide to the study. A descriptive survey research design was used for the research. The population of the study consisted of eight hundred and fifty (850) physicians who work in the teaching hospitals were used for the study. Census sampling technique was employed. Data was collected through electronic questionnaire which was face validated by two experts in the Department of Library and Information Science and one from test and measurement unit of Science Education, University of Nigeria Nsukka. The data collected was analysed using percentages, mean scores, and standard deviation. The findings of the study revealed that physicians prefer seeking information on the internet as compared with other sources. Also, it was revealed that physicians do not get information literacy skills training from the medical library. In addition, physicians do not use reference services in the medical library. Furthermore, it was revealed that physicians visit the medical library once in a while. Thus, the study recommended that library management should consider physicians behaviour in designing a good information system in the medical library

Evaluation of the Pascua Yaqui Health Care Plan as an Analytical Model and its Merits as an Effective Alternative to the Traditional IHS Delivery Models

This study is an evaluation of the Pascua Yaqui Health Care Plan (PYHCP) established in 1980. This is a pre-paid health service program that contracts the services of Health Maintenance Organizations (HMO\u27s). This pre-paid contract service differs from the public health care model used by the Indian Health Service (IHS) that emphasizes health promotion and wellness. The prepaid model focuses on cost containment, and was devised as an intermediary step between full IHS responsibility and direct provision of health care, and full tribal responsibility for the provision and management of health care services. This evaluation was intended to answer the following questions: 1) How well is the PYHCP contractor meeting the needs of the Pascua Yaqui tribal members in Pima county? 2) What are the strengths and problems of this pre-paid arrangement as the primary source of health service for this population? 3) What are the recommendations for solving these problems? 4) What positive aspects of PYHCP are potentially transferable to other sites? 5) How does the health status of the Pascua Yaqui Tribe compare with other Indian populations receiving most of their health care from IHS facilities? 6) What other kinds of comparisons can be made with other Indian communities?This evaluation required a narrative and statistical description of the FYHCP. Statistical data was received from PYHCP and the IHS Office of Program Development, and was then compared to state and national figures. The statistical description was restricted to information regarding those enrolled over the years of the plan. The narrative came from interviews conducted with health care personnel and tribal administrators at PYHCP sites and at two comparison sites. The two comparison sites were the Albuquerque Area and Oklahoma City Area IHS offices. A Patient Satisfaction Survey was conducted at the PYHCP site only. The survey was administered to 196 tribal members. The purpose of the survey was to elicit the patients\u27 perceptions of the HCP arrangement and to allow them to express any unmet needs. The survey instrument was tested for validity by the IHS Office of Planning and Development and reviewed by the evaluation project staff and by PYHCP administrators and staff. The instrument was also approved in its Spanish language version. Difficulties did emerge in the form of a shortage of statistical data. Maternal and child care data was particularly difficult to trace. Many death records were lost or the individual\u27s tribal affiliation was not recorded.There is an extensive description of the contractual agreement between IHS and PYHCP that covers the rights and obligations of the providing agencies involved, the type, quantity, and location of facilities, the definition of eligible beneficiaries, the types of services and the rates of compensation, emergency service availability, coordination services, training and outreach programs, statistical reporting, medical record maintenance, patient advocacy, etc. A second finding determined that the structure of PYHCP is similar to the HMO network model in terms of structure, processes and outcomes. The cost of the PYHCP program compared as nearly equivalent to IHS costs per capita, and were definitely reduced in terms of successful cost containment when compared to other HMO programs. Quantity of care is slightly higher than HMO rates which, when compared with costs, is quite favorable, and helps to dispel the notion that cost containment equals poor care. In addition, the majority of patients expressed comfort with the PYHCP. A third finding is that additional medical services and outreach efforts are provided by IHS and the Pascua Yaqui tribal government. They include home health services, education and patient advocacy, environmental health, behavioral health services, eyeglass and hearing aid services, and transportation. On the whole, the evaluation concluded positively for the PYHCP. The PYHCP compares quite favorably with IHS services in terms of negotiating for discounted services, making second and third medical opinions, patient follow-up, and social work services available.Most of the recommendations were most closely related to administration and inter-agency cooperation. They include: 1) lengthening the terms of the contract, 2) formalizing the administrative meetings, 3) requiring PYHCP contractors to pay rent for tribal clinic space in order to raise funds for expansion, 4) clarifying tribal participation provision in the contract, 5) clarify the provision regarding the hiring of social workers, 6) establishing a management information system and computerizing record keeping and the transfer of data, 7) providing management training for the tribal health department, 8) including the tribe in the planning of the contract, 9) clarifying indirect cost accounting used by the tribe as part of the planning process to avoid subsequent hidden costs to the tribal government. Recommendations relating to care include: 1) educating enrollees to avoid overuse of emergency facilities, 2) increasing cultural sensitivity, 3) resolving the issue of medical record ownership, 4) improving tracking and reporting procedures for patients, and 5) decreasing procedural paperwork for referral services, particularly those related to specialized medical equipment

Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes

Describes in detail eight change concepts as a guide to transforming a practice into a patient-centered medical home, including engaged leadership, quality improvement strategy, continuous and team-based healing relationships, and enhanced access