Towards a theoretical model of dashboard acceptance and use in healthcare domain

The objective of this paper is to investigate existing factors related to the decision to adopt and use of dashboards in the healthcare domain using a systematic literature review approach. The study is part of a larger initiative on how analytics dashboards can support decisions in value-based prostate cancer treatment and care. Although many studies have been undertaken to evaluate the implementation of health information technologies in the healthcare sector, as far as we know, none of these studies provides a framework for dashboards use in the healthcare context. We believe that the resulting model from our study provides the necessary first step in developing empirical evidence for the acceptance and use of the dashboards in the healthcare domain

Investigating Analytics Dashboards’ Support for the Value-based Healthcare Delivery Model

Improving the value of care is one of the essential aspects of Value-Based Healthcare (VBHC) model today. VBHC is a new HC delivery model which is centered on patient health outcomes and improvements. There is anecdotal evidence that the use of decision aid tools like dashboards can play a significant role in the successful implementation of VBHC models. However, there has been little or no systematic studies and reviews to establish the extent to which analytics dashboards are used to support patient care in a VBHC delivery context. This paper bridges this knowledge gap through a systematic review of the existing literature on dashboards in the HC domain. Our study reveals dashboard capabilities as an enabling tool for value improvements and provides insight into the design of dashboards. This study concludes by highlighting a few gaps, question, and need for research in the future

Ageism in the discourse and practice of designing digital technology for older persons:A scoping review

Background and Objectives Involving older persons in the design process of digital technology (DT) promotes the development of technologies that are appealing, beneficial, and used. However, negative discourse on aging and ageism are potential underlying factors that could influence which and how DTs are designed and how older persons are involved in the design process. This scoping review investigates the explicit and implicit manifestations of ageism in the design process of DT. Research Design and Methods Seven databases were screened for studies reporting on the design of DT with older persons between January 2015 and January 2020. Data regarding study and DT characteristics, discourse about older persons, and their involvement in the design process were extracted, coded, and analyzed using critical discourse analysis. Results Sixty articles met the inclusion criteria and were included in the analysis. Various forms of exclusion of older persons from the design process were identified, such as no or low involvement, upper-age limits, and sample biases toward relatively “active,” healthy and “tech-savvy” older persons. Critical discourse analysis revealed the use of outdated language, stereotypical categorizations, and/or design decisions based on ageism in 71.7% of the studies. Discussion and Implications A discrepancy was found between an “ideal” discourse regarding the involvement of older persons throughout the design process and actual practice. Manifestations of ageism, errors, and biases of designing DT with older persons are discussed. This article calls for more authentic inclusion of older persons and higher awareness toward the implications of ageism in the design process of DT

Evaluating and improving the usability of a mHealth platform to assess postoperative dental pain

DATA AVAILABILITY : The data underlying this article will be shared on reasonable request to the corresponding author.OBJECTIVES : The use of interactive mobile health (mHealth) applications to monitor patient-reported postoperative pain outcomes is an emerging area in dentistry that requires further exploration. This study aimed to evaluate and improve the usability of an existing mHealth application. MATERIALS AND METHODS : The usability of the application was assessed iteratively using a 3-phase approach, including a rapid cognitive walkthrough (Phase I), lab-based usability testing (Phase II), and in situ pilot testing (Phase III). The study team conducted Phase I, while providers and patients participated in Phase II and III. RESULTS : The rapid cognitive walkthrough identified 23 potential issues that could negatively impact user experience, with the majority classified as system issues. The lab-based usability testing yielded 141 usability issues.; 43% encountered by patients and 57% by dentists. Usability problems encountered during pilot testing included undelivered messages due to mobile phone carrier and service-related issues, errors in patients’ phone number data entry, and problems in provider training. DISCUSSION : Through collaborative and iterative work with the vendor, usability issues were addressed before launching a trial to assess its efficacy. CONCLUSION : The usability of the mHealth application for postoperative dental pain was remarkably improved by the iterative analysis and interdisciplinary collaboration.LAY SUMMARY : In this research study, we wanted to understand how much pain patients were feeling after getting dental treatment. To figure this out, we used a mobile phone app where patients could tell us how much pain they had. Before starting this main study on a large group of patients, we wanted to make sure the app was easy to use. We tried different ways to test the app and make it better. We asked the study team, dentists, and patients for feedback. Dentists and patients talked about problems with the app and how hard it was to use. When we did a test run at real dental places, we found more issues like messages not getting through, mistakes when entering phone numbers, problems with training, and registration issues. The main thing we learned is that it is important to check if an app is easy to use in different ways and to include feedback from dentists and patients. We worked closely with the company that made the app to fix these problems before starting the main study to see if the app could help patients with their dental pain after surgery.Agency for Healthcare Research and Quality.https://academic.oup.com/jamiaopenhj2024Dental Management SciencesSDG-03:Good heatlh and well-bein

Feedback of patient-reported outcomes to healthcare professionals for comparing health service performance: a scoping review

Objective: Patient-reported outcomes (PROs) provide self-reported patient assessments of their quality of life, daily functioning, and symptom severity after experiencing an illness and having contact with the health system. Feeding back summarised PROs data, aggregated at the health-service level, to healthcare professionals may inform clinical practice and quality improvement efforts. However, little is known about the best methods for providing these summarised data in a way that is meaningful for this audience. Therefore, the aim of this scoping review was to summarise the emerging approaches to PROs data for &lsquo;service-level&rsquo; feedback to healthcare professionals. Setting: Healthcare professionals receiving PROs data feedback at the health-service level. Data sources: Databases selected for the search were Embase, Ovid Medline, Scopus, Web of Science and targeted web searching. The main search terms included: &lsquo;patient-reported outcome measures&rsquo;, &lsquo;patient-reported outcomes&rsquo;, &lsquo;patient-centred care&rsquo;, &lsquo;value-based care&rsquo;, &lsquo;quality improvement&rsquo; and &lsquo;feedback&rsquo;. Studies included were those that were published in English between January 2009 and June 2019. Primary and secondary outcome measures: Data were extracted on the feedback methods of PROs to patients or healthcare providers. A standardised template was used to extract information from included documents and academic publications. Risk of bias was assessed using Joanna Briggs Institute Levels of Evidence for Effectiveness. Results: Overall, 3480 articles were identified after de-duplication. Of these, 19 academic publications and 22 documents from the grey literature were included in the final review. Guiding principles for data display methods and graphical formats were identified. Seven major factors that may influence PRO data interpretation and use by healthcare professionals were also identified. Conclusion: While a single best format or approach to feedback PROs data to healthcare professionals was not identified, numerous guiding principles emerged to inform the field.</jats:sec

Aligning Concerns in Telecare:Three Concepts to Guide the Design of Patient-Centred E-Health

The design of patient-centred e-health services embodies an inherent tension between the concerns of clinicians and those of patients. Clinicians’ concerns are related to professional issues to do with diagnosing and curing disease in accordance with accepted medical standards. In contrast, patients’ concerns typically relate to personal experience and quality of life issues. It is about their identity, their hopes, their fears and their need to maintain a meaningful life. This divergence of concerns presents a fundamental challenge for designers of patient-centred e-health services. We explore this challenge in the context of chronic illness and telecare. Based on insights from medical phenomenology as well as our own experience with designing an e-health service for patients with chronic heart disease, we emphasise the importance – and difficulty – of aligning the concerns of patients and clinicians. To deal with this, we propose a set of concepts for analysing concerns related to the design of e-health services: A concern is (1) meaningful if it is relevant and makes sense to both patients and clinicians, (2) actionable if clinicians or patients – at least in principle – are able to take appropriate action to deal with it, and (3) feasible if it is easy and convenient to do so within the organisational and social context. We conclude with a call for a more participatory and iterative approach to the design of patient-centred e-health services

Optimizing the Collection and Use of Patient-Generated Health Data

This dissertation aims to examine the collection and use of digital patient-generated health data (PGHD) in real-world settings, including existing barriers from the perspectives of patients and healthcare providers, and possible approaches to optimizing the process. In Chapter One, the potential of PGHD to improve health and wellness, particularly for individuals with chronic conditions, as well as known barriers to PGHD collection and use, are described. One chronic condition in particular, atrial fibrillation (AF), is then introduced as a use case for PGHD. Chapter Two contains an integrative review synthesizing findings from eleven studies reporting patients’ and providers’ needs when collecting and using PGHD, and identifying convergence and divergence between needs. Chapter Three contains a quantitative evaluation of sustained engagement, currently a major barrier to collection of PGHD, in a group of adults self-monitoring AF, as well as predictors and moderators of engagement that come from an adapted version of the Unified Theory of Acceptance and Use of Technology (UTAUT). These individuals were previously enrolled in the randomized, controlled trial, the iPhone® Helping Evaluate Atrial Fibrillation Rhythm through Technology (iHEART). In Chapter Four, the adapted UTAUT model is explored in more detail through a qualitative investigation of sustained engagement with patients, healthcare providers, and research coordinators involved in the iHEART trial. Chapter Five summarizes the findings of this dissertation, including strengths and limitations, and elicits implications for the intersection of health policy and clinical practice, design, nursing, and future research from the findings

Development and assessment of evidence-based strategies towards increased feasibility and transparency of investigator-initiated clinical trials in Switzerland

This work addresses the obligation to minimize research waste by identifying barriers and needs for support in important processes of clinical research and by proposing efficient strategies to improve the quality of research practice. Major sources of waste in clinical research have been identified by the “Increasing Value, Reducing Waste” series in The Lancet in 2014. Two considerations in this series address the problem of inefficient trial management and insufficient research transparency. Collected evidence suggests that inefficient management and monitoring of the procedural conduct of trials are a major source of waste even in well-designed studies addressing important questions. The absence of a continuous oversight of established trial processes endanger completion of trials in a set timeframe or even cause premature discontinuation. Increasing feasibility of clinical trials by providing an evidence-based strategy to effectively support the conduct of clinical trials at the University Hospital of Basel that has the potential to be transferred to the whole academic network for clinical research in Switzerland was aspired in this thesis. Along with feasibility, it is important that information of a trial including results is publicly available. In Switzerland, prospective registration of a clinical trial in a primary trial registry has been made mandatory by law in 2014 (Art 56 Human Research Act). We analyzed research transparency in terms of trial registration and results publication in a local setting in Switzerland to assess the successful implementation and enforcement of national efforts and identify potential barriers. In a first step, we systematically reviewed existing evidence on effective monitoring strategies both in the medical literature and across international clinical research stakeholder groups. Monitoring strategies varied in their methodological approach but the effectiveness of risk-based and triggered approaches could be shown with moderate certainty. However, we did not find evidence on the effect of these methods on the overall trial conduct. Based on these findings, we then engaged local, national and international stakeholder representatives in the creation of a comprehensive risk-tailored approach integrating monitoring in the broader context of trial management. We systematically reviewed information on risk indicators commonly used to guide monitoring in the academic setting and in industry and identified risk elements extended to the overall management of a clinical trial. In order to continuously visualize the status of identified risk elements throughout the study conduct, we initiated the user-centered development of a supporting study dashboard. The final risk-tailored approach consisted of the following components: A study-specific risk assessment prior to study start, selection and development of data based pathways addressing the identified risks, and the continuous visualization of the status of risk elements in a study dashboard. The generic content of the dashboard provides continuous information and support for risk indicators applicable to almost all clinical trials (Data quality, Recruitment, Retention, and Safety management) and the optional content is based on further study-specific items identified during the risk assessment (e.g. Follow-up visits, Re-consent process, Sampling management, Imaging quality). User-testing of the risk assessment and study dashboards developed on the basis of the assessment revealed that the continuous oversight of most critical elements and support of managing these elements efficiently supports the work routine of principle investigators, trial managers and trial monitors. In a second project of this thesis, we assessed current trial registration and publication for clinical intervention studies approved by the Ethics Committee North and Central Switzerland (EKNZ) in the last five years. Registration of all clinical trials would provide an overview of what research is being conducted at present and registries constitute an ideal platform for the publication and dissemination of research results.. Identifying factors influencing registration and potential barriers provides a basis for further initiatives to increase trial registration. Prospective trial registration has increased over the last five years and trials with higher risk category, multicenter trials and trials taking advantage of Clinical Trials Unit services were associated with higher registration rates. Although prospective trial registration prevalence has improved within the last five years within the EKNZ approved studies, a strong need for support in the registration process was identified in our qualitative evaluation. The impact of this work - and whether it eventually increases feasibility and transparency in clinical research critically depends on its implementation, evaluation, and refinement. Sharing current knowledge on effective monitoring strategies with trialists and monitors to choose evidence-based strategies for their trials constitutes a major support for investigator-initiated trials in the academic environment. The advancement of a risk-based trial monitoring approach into a comprehensive risk-tailored approach supporting the overall conduct of a trial and considering trial monitoring as an integrative part of trial management has the potential to efficiently optimize study processes. While an uptake of the study specific risk assessment and the use of a study dashboard as a standard process would be aspired for all RCTs in the future, improving the timeline and resources needed for the development of a study specific dashboard will be important to advance the generation of affordable and efficient dashboards for investigator-initiated trials. Sharing evidence on the registration behavior and perceived barriers by researchers in the local setting of the EKNZ helps to understand underlying processes and test measures for improvement. Supporting researchers in the process of trial registration and educating research institutes and investigators about the need and advantages of trial registration, has the potential to facilitate the implementation of automated processes and SOPs ensuring the registration of all clinical trials. Establishing trial registries as a primary platform for sharing research results should be aspired in the future

A dashboard-based system for supporting diabetes care

[EN] Objective To describe the development, as part of the European Union MOSAIC (Models and Simulation Techniques for Discovering Diabetes Influence Factors) project, of a dashboard-based system for the management of type 2 diabetes and assess its impact on clinical practice. Methods The MOSAIC dashboard system is based on predictive modeling, longitudinal data analytics, and the reuse and integration of data from hospitals and public health repositories. Data are merged into an i2b2 data warehouse, which feeds a set of advanced temporal analytic models, including temporal abstractions, care-flow mining, drug exposure pattern detection, and risk-prediction models for type 2 diabetes complications. The dashboard has 2 components, designed for (1) clinical decision support during follow-up consultations and (2) outcome assessment on populations of interest. To assess the impact of the clinical decision support component, a pre-post study was conducted considering visit duration, number of screening examinations, and lifestyle interventions. A pilot sample of 700 Italian patients was investigated. Judgments on the outcome assessment component were obtained via focus groups with clinicians and health care managers. Results The use of the decision support component in clinical activities produced a reduction in visit duration (P¿¿¿.01) and an increase in the number of screening exams for complications (P¿<¿.01). We also observed a relevant, although nonstatistically significant, increase in the proportion of patients receiving lifestyle interventions (from 69% to 77%). Regarding the outcome assessment component, focus groups highlighted the system¿s capability of identifying and understanding the characteristics of patient subgroups treated at the center. Conclusion Our study demonstrates that decision support tools based on the integration of multiple-source data and visual and predictive analytics do improve the management of a chronic disease such as type 2 diabetes by enacting a successful implementation of the learning health care system cycle.This work was supported by the European Union in the Seventh Framework Programme, grant number 600914.Dagliati, A.; Sacchi, L.; Tibollo, V.; Cogni, G.; Teliti, M.; Martinez-Millana, A.; Traver Salcedo, V.... (2018). A dashboard-based system for supporting diabetes care. Journal of the American Medical Informatics Association. 25(5):538-547. https://doi.org/10.1093/jamia/ocx159S538547255Sim, I., Gorman, P., Greenes, R. A., Haynes, R. B., Kaplan, B., Lehmann, H., & Tang, P. C. (2001). Clinical Decision Support Systems for the Practice of Evidence-based Medicine. Journal of the American Medical Informatics Association, 8(6), 527-534. doi:10.1136/jamia.2001.0080527Palmer, A. 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Journal of the American Medical Informatics Association, 23(4), 791-795. doi:10.1093/jamia/ocv213Bottomly, D., McWeeney, S. K., & Wilmot, B. (2015). HitWalker2: visual analytics for precision medicine and beyond. Bioinformatics, 32(8), 1253-1255. doi:10.1093/bioinformatics/btv739Fabris, C., Facchinetti, A., Fico, G., Sambo, F., Arredondo, M. T., & Cobelli, C. (2015). Parsimonious Description of Glucose Variability in Type 2 Diabetes by Sparse Principal Component Analysis. Journal of Diabetes Science and Technology, 10(1), 119-124. doi:10.1177/1932296815596173Hassenzahl, M., Wiklund-Engblom, A., Bengs, A., Hägglund, S., & Diefenbach, S. (2015). Experience-Oriented and Product-Oriented Evaluation: Psychological Need Fulfillment, Positive Affect, and Product Perception. International Journal of Human-Computer Interaction, 31(8), 530-544. doi:10.1080/10447318.2015.106466