Design of a clinician dashboard to facilitate co-decision making in the management of non-specific low back pain

This paper presents the design of a Clinician Dashboard to promote co-decision making between patients and clinicians. Targeted patients are those with non-specific low back pain, a leading cause of discomfort, disability and absence from work throughout the world. Targeted clinicians are those in primary care, including general practitioners, physiotherapists, and chiropractors. Here, the functional specifications for the Clinical Dashboard are delineated, and wireframes illustrating the system interface and flow of control are shown. Representative scenarios are presented to exemplify how the system could be used for co-decision making by a patient and clinician. Also included are a discussion of potential barriers to implementation and use in clinical practice and a look ahead to future work. This work has been conducted as part of the Horizon 2020 selfBACK project, which is funded by the European Commission

Talk2Care: Facilitating Asynchronous Patient-Provider Communication with Large-Language-Model

Despite the plethora of telehealth applications to assist home-based older adults and healthcare providers, basic messaging and phone calls are still the most common communication methods, which suffer from limited availability, information loss, and process inefficiencies. One promising solution to facilitate patient-provider communication is to leverage large language models (LLMs) with their powerful natural conversation and summarization capability. However, there is a limited understanding of LLMs' role during the communication. We first conducted two interview studies with both older adults (N=10) and healthcare providers (N=9) to understand their needs and opportunities for LLMs in patient-provider asynchronous communication. Based on the insights, we built an LLM-powered communication system, Talk2Care, and designed interactive components for both groups: (1) For older adults, we leveraged the convenience and accessibility of voice assistants (VAs) and built an LLM-powered VA interface for effective information collection. (2) For health providers, we built an LLM-based dashboard to summarize and present important health information based on older adults' conversations with the VA. We further conducted two user studies with older adults and providers to evaluate the usability of the system. The results showed that Talk2Care could facilitate the communication process, enrich the health information collected from older adults, and considerably save providers' efforts and time. We envision our work as an initial exploration of LLMs' capability in the intersection of healthcare and interpersonal communication.Comment: Under submission to CHI202

Which strategies support the effective use of clinical practice guidelines and clinical quality registry data to inform health service delivery? A systematic review

Background Empirical evidence suggests data and insights from the clinical practice guidelines and clinical quality registries are not being fully utilised, leaving health service managers, clinicians and providers without clear guidance on how best to improve healthcare delivery. This lack of uptake of existing research knowledge represents low value to the healthcare system and needs to change. Methods Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews) were systematically searched. Included studies were published between 2000 and 2020 reporting on the attributes, evidence usage and impact of clinical practice guidelines and clinical quality registries on health service delivery. Results Twenty-six articles including one randomised controlled trial, eight before-and-after studies, eight case studies/reviews, five surveys and four interview studies, covering a wide range of medical conditions and conducted in the USA, Australia and Europe, were identified. Five complementary strategies were derived to maximise the likelihood of best practice health service delivery: (1) feedback and transparency, (2) intervention sustainability, (3) clinical practice guideline adherence, (4) productive partnerships and (5) whole-of-team approach. Conclusion These five strategies, used in context-relevant combinations, are most likely to support the application of existing high-quality data, adding value to health service delivery. The review highlighted the limitations of study design in opportunistic registry studies that do not produce clear, usable evidence to guide changes to health service implementation practices. Recommendations include exploration of innovative methodologies, improved coordination of national registries and the use of incentives to encourage guideline adherence and wider dissemination of strategies used by successful registries

Quality improvement and care coordination : implementing the CDC guideline for prescribing opioids for chronic pain

The Centers for Disease Control and Prevention (CDC) aims to save lives and prevent prescription opioid misuse, opioid use disorder (OUD), and overdose by equipping providers with the knowledge, tools, and guidance they need. The purpose of this document is to encourage careful and selective use of opioid therapy in the context of managing chronic pain through (a) an evidence-based prescribing guideline, (b) quality improvement (QI) measures to advance the integration of the CDC Guideline for Prescribing Opioids for Chronic Pain (CDC Prescribing Guideline) into clinical practice, and (c) practice-level strategies to improve care coordination. These QI measures are intended to help incorporate the science contained in the CDC Prescribing Guideline in clinical workflow.This QI framework is nimble and flexible so that healthcare systems and practice leaders can pick interventions that are responsive to the unique conditions in their practice and patient population.Recommended citation: Centers for Disease Control and Prevention. Quality Improvement and Care Coordination: Implementing the CDCGuideline for Prescribing Opioids for Chronic Pain. 2018. National Center for Injury Prevention and Control, Divisionof Unintentinal Injury Prevention, Atlanta, GA.CDC-DUIP-QualityImprovementAndCareCoordination-508.pdf201

TRAK ACL: Development of a self-management Digital Health Intervention to support optimal care in ACL rehabilitation: Scoping Review, Qualitative Study and Feasibility RCT

Background: Outcomes vary after Anterior Cruciate Ligament (ACL) reconstruction surgery and many patients do not return to previous levels of activity. This may be related to variations in evidence based rehabilitation care. It is NHS policy to avoid inappropriate variations in healthcare and to use digital health interventions (DHI) to improve access and outcomes. / Aim: This thesis explored causes of variability in care and the feasibility of a DHI to overcome them. / Objectives: 1. To identify resources used in trials of optimal ACL rehabilitation; 2. To explore stakeholder views around criteria for optimal care and reasons for variation. 3. To explore opinions of digital tools in evolving care models. 4. To determine the feasibility of undertaking a definitive randomised controlled trial (RCT) to determine effectiveness and cost-effectiveness of a specific DHI to support ACL rehabilitation. / Methods: Methods were selected to match objectives: Objective 1 was addressed with a systematically conducted scoping review; Objectives 2 & 3 through qualitative interviews with orthopaedic surgeons and physiotherapists; and Objective 3 by a randomised feasibility trial comparing a specific DHI plus Treatment as Usual (TAU) with TAU. / Results: The scoping review established that ACL rehabilitation in RCTs includes specialist equipment, a gym environment and an experienced physiotherapist. Interviews revealed that practitioners were committed to evidence-based care, but were sometimes limited by systemic factors, including lack of resources, infrequent appointments or ambiguous pathways of care. Interviewees cautiously welcomed DHIs to support care but identified concerns. Feasibility results showed 86% recruitment rate, 78% retention rate and 100% completion rate on 4 out of 5 outcomes including the primary outcome of a future trial, the Knee Osteoarthritis Outcome Score. Fidelity to the DHI showed user engagement was heavily skewed. / Conclusion: This work provides evidence to explain observed unacceptable variations in care for this patient group and suggests that a digital health intervention could help address these. A definitive trial is both warranted and feasible

Addressing priorities for surgical research in Africa : implementation of a multicentre cloud‐based peri‐operative registry in Ethiopia

Acknowledgements The Network for Perioperative and Critical care (N4PCc) authorship includes co‐ordinators and collaborators for the Ethiopian registry. AB is Chair and First Trustee of the Network for Improving Critical Care Systems and Training (UK Charity) and a volunteer with NICS‐MORU. RH is First Trustee of the Network for Improving Critical Care Systems and Training (UK Charity) and a Director (honorary) at NICS‐MORU. NICS‐MORU is a not‐for‐profit organisation based in Sri Lanka, which supported this pilot project and from which the registry originated. The pilot project has been supported by NICS‐MORU, which also partially supported FK’s fellowship period in Sri Lanka, key to the knowledge exchange and establishment of a community of practice. The project’s implementation and scale up is championed by DBU and FMOH.Peer reviewedPublisher PD

Including the voice of children:Towards patient-centered care

Patient-centered care (PCC) is characterized by the provision of care that respects and responds to individual patient preferences, needs and values, and ensures that patient’s wishes guide all clinical decisions. PCC places the patient, not the disease, at the center of health care and promotes a collaboration between patient, family, and clinicians to provide care that is tailored to the patient’s wishes and needs. Although the importance of PCC is recognized, its implementation is difficult because it requires a different mindset and changing roles of patients, parents, and clinicians. This thesis focused on scientific approaches and the development of tools to enhance PCC in children. Three aspects of PCC were examined; pediatric patient engagement, Patient Reported Outcome Measures (PROMs), and Patient Reported Experience Measures (PREMs). The first part of the thesis provides a synopsis of the existing literature on pediatric patient engagement and discusses the development of a tool to enhance pediatric patient engagement. The second part of the thesis focuses on facilitators and barriers in the implementation of PROMs in clinical practice, using the KLIK PROM portal and the PROMIS measures as an example. The last part of the thesis provides an overview of the available PREMs in pediatrics