Designing Shared Decision-Making Interventions for Dissemination and Sustainment: Can Implementation Science Help Translate Shared Decision Making Into Routine Practice

Shared decision making (SDM) is not widely practiced in routine care due to a variety of organizational, provider, patient, and contextual factors. This article explores how implementation science-which encourages attention to the multilevel contextual factors that influence the adoption, implementation, and sustainment of health care practices-can provide useful insights for increasing SDM use in routine practice. We engaged with stakeholders representing different organizations and geographic locations over three phases: 1) multidisciplinary workgroup meeting comprising researchers and clinicians (n = 11); 2) survey among a purposive sample of 47 patient advocates, clinicians, health care system leaders, funders, policymakers, and researchers; and 3) working session among diverse stakeholders (n = 30). The workgroup meeting identified priorities for action and research, which included targeting multiple audiences and levels, shifting culture toward valuing and supporting SDM, and considering contextual factors influencing SDM implementation. Survey respondents provided recommendations for increasing adoption, implementation, and maintenance of SDM in practice including providing tools to support SDM, obtaining stakeholders\u27 involvement, and raising awareness of the importance of SDM. Stakeholders in the working session provided recommendations on the design of a guide for implementation of SDM in clinical settings, strategies to disseminate educational curricula on SDM, and strategies to influence policies to increase SDM use. These specific recommendations serve as a call to action to pursuing specific promising strategies aimed at increasing SDM use in practice and enhance understanding of the perspectives of diverse stakeholders at multiple levels from an implementation science perspective that appear fruitful for further study and application

Pathways to democratized healthcare: Envisioning human-centered AI-as-a-service for customized diagnosis and rehabilitation

The ongoing digital revolution in the healthcare sector, emphasized by bodies like the US Food and Drug Administration (FDA), is paving the way for a shift towards person-centric healthcare models. These models consider individual needs, turning patients from passive recipients to active participants. A key factor in this shift is Artificial Intelligence (AI), which has the capacity to revolutionize healthcare delivery due to its ability to personalize it. With the rise of software in healthcare and the proliferation of the Internet of Things (IoT), a surge of digital data is being produced. This data, alongside improvements in AI’s explainability, is facilitating the spread of person-centric healthcare models, aiming at improving health management and patient experience. This paper outlines a human-centered methodology for the development of an AI-as-a-service platform with the goal of broadening access to personalized healthcare. This approach places humans at its core, aiming to augment, not replace, human capabilities and integrate in current processes. The primary research question guiding this study is: “How can Human-Centered AI principles be considered when designing an AI-as-a-service platform that democratizes access to personalized healthcare?” This informed both our research direction and investigation. Our approach involves a design fiction methodology, engaging clinicians from different domains to gather their perspectives on how AI can meet their needs by envisioning potential future scenarios and addressing possible ethical and social challenges. Additionally, we incorporate Meta-Design principles, investigating opportunities for users to modify the AI system based on their experiences. This promotes a platform that evolves with the user and considers many different perspectives

Patient Relationship Management: A CRM Approach to Patient Care

In the business world, customer relationship management is used to retain customer loyalty in order to increase revenue. Healthcare organizations can build the same kind of relationship with patients, and it can also offer more tangible benefits. The first benefit is by using the same hospital a patient’s treatment history should be relatively well known by the organization. Oftentimes, different hospitals use different patient information systems which are not always compatible with each other. If a patient keeps changing the hospital, his or her medical record can be scattered around various sites. Ideally, if the patient is treated by the same physician in every visit, that physician will get more familiar with the patient, which could improve treatment.  The most tangible benefit, however, is time. If the patient goes to the same physician every time, there is no need for long check-ups at the beginning of each visit

Designing Shared Decision-Making: A Set of Tools to Tailor Post-Surgery Pain Management Plans for Patients

Master of DesignArt and DesignUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/156121/1/DeepBlue_BhaganeOewel_2019_MDes_Thesis.pd

Interwoven Care: Creating opportunities for richer conversations between case managers and patients

Master of Design in Integrative DesignUniversity of Michiganhttps://deepblue.lib.umich.edu/bitstream/2027.42/136864/1/ABidkar_2017_MDes-Thesis.pd

Empowering community health workers with mobile health: learnings from two projects on non-communicable disease care

Community-based healthcare is a promising approach to tackling workforce shortage in healthcare, especially in low- and middle-income countries. Community health workers (CHWs) are lay cadres that bridge healthcare disparities by living in the community where they should provide basic health services, mainly through education. However, high attrition rates and underperformance of these health workers limit the scope of such programs. In addition, mobile health is not the hoped-for silver bullet to solve the two challenges. This paper examines two pilot projects using mobile health for non-communicable disease care from an empowerment perspective. We propose design knowledge of mobile health for the structural empowerment of CHWs. Furthermore, we evaluate their psychological empowerment by analyzing mobile health's intended and unintended consequences. Finally, our study demonstrates how the empowerment of CHWs could help overcome the persisting challenges and lead to a sustainable and resilient health system

EMPOWERING COMMUNITY HEALTH WORKERS WITH MOBILE HEALTH: LEARNINGS FROM TWO PROJECTS ON NON-COMMUNICABLE DISEASE CARE

Community-based healthcare is a promising approach to tackling workforce shortage in healthcare, especially in low- and middle-income countries. Community health workers (CHWs) are lay cadres that bridge healthcare disparities by living in the community where they should provide basic health services, mainly through education. However, high attrition rates and underperformance of these health workers limit the scope of such programs. In addition, mobile health is not the hoped-for silver bullet to solve the two challenges. This paper examines two pilot projects using mobile health for non-communicable disease care from an empowerment perspective. We propose design knowledge of mobile health for the structural empowerment of CHWs. Furthermore, we evaluate their psychological empowerment by analyzing mobile health\u27s intended and unintended consequences. Finally, our study demonstrates how the empowerment of CHWs could help overcome the persisting challenges and lead to a sustainable and resilient health system

Distributed Computing and Monitoring Technologies for Older Patients

This book summarizes various approaches for the automatic detection of health threats to older patients at home living alone. The text begins by briefly describing those who would most benefit from healthcare supervision. The book then summarizes possible scenarios for monitoring an older patient at home, deriving the common functional requirements for monitoring technology. Next, the work identifies the state of the art of technological monitoring approaches that are practically applicable to geriatric patients. A survey is presented on a range of such interdisciplinary fields as smart homes, telemonitoring, ambient intelligence, ambient assisted living, gerontechnology, and aging-in-place technology. The book discusses relevant experimental studies, highlighting the application of sensor fusion, signal processing and machine learning techniques. Finally, the text discusses future challenges, offering a number of suggestions for further research directions

Risk communication in a patient decision aid for radiotherapy in breast cancer:How to deal with uncertainty?

Background and aim: Patient decision aids for oncological treatment options, provide information on the effect on recurrence rates and/or survival benefit, and on side-effects and/or burden of different treatment options. However, often uncertainty exists around the probability estimates for recurrence/survival and side-effects which is too relevant to be ignored. Evidence is lacking on the best way to communicate these uncertainties. The aim of this study is to develop a method to incorporate uncertainties in a patient decision aid for breast cancer patients to support their decision on radiotherapy. Methods: Firstly, qualitative interviews were held with patients and health care professionals. Secondly, in the development phase, thinking aloud sessions were organized with four patients and 12 health care professionals, individual and group-wise. Results: Consensus was reached on a pictograph illustrating the whole range of uncertainty for local recurrence risks, in combination with textual explanation that a more exact personalized risk would be given by their own physician. The pictograph consisted of 100 female icons in a 10 x 10 array. Icons with a stepwise gradient color indicated the uncertainty margin. The prevalence and severity of possible sideeffects were explained using verbal labels. Conclusions: We developed a novel way of visualizing uncertainties in recurrence rates in a patient decision aid. The effect of this way of communicating risk uncertainty is currently being tested in the BRASA study (NCT03375801)

Surviving mothers and lost babies - burden of stillbirths and neonatal deaths among women with maternal near miss in eastern Ethiopia:a prospective cohort study

Background: Although maternal near miss (MNM) is often considered a 'great save' because the woman survived life-threatening complications, these complications may have resulted in loss of a child or severe neonatal morbidity. The objective of this study was to assess proportion of perinatal mortality (stillbirths and early neonatal deaths) in a cohort of women with MNM in eastern Ethiopia. In addition, we compared perinatal outcomes among women who fulfilled the World Health Organization (WHO) and the sub-Saharan African (SSA) MNM criteria. Methods: In a prospective cohort design, women with potentially life-threatening conditions (PLTC) (severe postpartum hemorrhage, severe pre-(eclampsia), sepsis/severe systemic infection, and ruptured uterus) were identified every day from January 1st, 2016, to April 30th, 2017, and followed until discharge in the two main hospitals in Harar, Ethiopia. Maternal and perinatal outcomes were collected using both sets of criteria. Numbers and proportions of stillbirths and early neonatal deaths were computed and compared. Results: Of 1054 women admitted with PTLC during the study period, 594 women fulfilled any of the MNM criteria. After excluding near misses related to abortion, ectopic pregnancy or among undelivered women, 465 women were included, in whom 149 (32%) perinatal deaths occurred: 132 (88.6%) stillbirths and 17 (11.4%) early neonatal deaths. In absolute numbers, the SSA criteria picked up more perinatal deaths compared to the WHO criteria, but the proportion of perinatal deaths was lower in SSA group compared to the WHO (149/465, 32% vs 62/100, 62%). Perinatal mortality was more likely among near misses with antepartum hemorrhage (adjusted odds ratio (aOR) = 4.81; 95% CI = 1.76-13.20), grand multiparous women (aOR = 4.31; 95% confidence interval CI = 1.23-15.25), and women fulfilling any of the WHO near miss criteria (aOR = 4.89; 95% CI = 2.17-10.99). Conclusion: WHO MNM criteria pick up fewer perinatal deaths, although perinatal mortality occurred in a larger proportion of women fulfilling the WHO MNM criteria compared to the SSA MNM criteria. As women with MNM have increased risk of perinatal deaths (in both definitions), a holistic care addressing the needs of the mother and baby should be considered in management of women with MNM