On-Cloud Motherhood Clinic: A Healthcare Management Solution for Rural Communities in Developing Countries

Background: Modern telecommunication infrastructure enables bridging of the digital divide between rural and urban healthcare services, promoting the provision of suitable medical care and support. Thus far, there has been some positive impacts to applying mobile health (m-Health) solutions, but their full potential in relation to cloud computing has is yet to be realised. It is imperative to develop an innovative approach for addressing the digital divide in a context of developing country. Method: Adopting a design science research approach (DSR), this study describes an innovative m-Health solution utilising cloud computing that enables healthcare professionals and women in rural areas to achieve comprehensive maternal healthcare support. We developed the solution framework through iterative prototyping with stakeholders’ participation, and evaluated the design using focus groups. Results: The cloud-based solution was positively evaluated as supporting healthcare professionals and service providers. It was perceived to help provide a virtual presence for evaluating and diagnosing expectant mothers’ critical healthcare data, medical history, and in providing necessary service support in a virtual clinic environment. Conclusions: The new application offers benefits to target stakeholders enabling a new practice-based paradigm applicable in other healthcare management. We demonstrated utilities to address target problems as well as the mechanism propositions for meeting the information exchange demand for better realisation of practical needs of the end users. Available at: https://aisel.aisnet.org/pajais/vol12/iss1/3

Patient and healthcare professional eHealth literacy and needs for systemic sclerosis support: a mixed methods study

OBJECTIVES: We engaged patients with systemic sclerosis (SSc) and healthcare professionals to assess electronic health (eHealth) literacy and needs relating to web-based support using internet-based information and communication technologies (ICT). METHODS: We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional survey in patients (n=101) and professionals (n=47). Next, we conducted three focus groups with patients, family members and professionals (n=17). RESULTS: Of patients, 89.1% used ICT at least weekly for private communication. Patients reported relatively high comprehension of eHealth information ([Formula: see text] =6.7, 95% CI: 6.2 to 7.3, range 1-10), yet were less confident evaluating information reliability ([Formula: see text] =5.8, 95% CI: 5.1 to 6.4) and finding eHealth apps ([Formula: see text] =4.8, 95% CI: 4.2 to 5.4). Patients and professionals reported little experience with web-based self-management support. Focus groups revealed 'considering non-ICT-accessible groups' and 'fitting patients' and professionals' technology' as crucial for acceptability. In relation to understanding/appraising eHealth, participants highlighted that general SSc information is not tailored to individual's disease course. Recommendations included 'providing timely, understandable and safe information' and 'empowering end-users in ICT and health decision-making skills'. Professionals expressed concerns about lacking resources. Patients were concerned about data security and person-centredness. Key eHealth drivers included 'addressing end-user perceptions' and 'putting people at the centre of technology'. CONCLUSIONS: Patients and professionals need education/training to support uptake of eHealth resources. Key elements include guiding patients to timely/reliable information and using eHealth to optimise patient-provider communication. Design that is responsive to end-users' needs and considers individuals with limited eHealth literacy and/or ICT access appears to be critical for acceptability

Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar

Regional data exchange to improve care for veterans after non-VA hospitalization: a randomized controlled trial

BACKGROUND: Coordination of care, especially after a patient experiences an acute care event, is a challenge for many health systems. Event notification is a form of health information exchange (HIE) which has the potential to support care coordination by alerting primary care providers when a patient experiences an acute care event. While promising, there exists little evidence on the impact of event notification in support of reengagement into primary care. The objectives of this study are to 1) examine the effectiveness of event notification on health outcomes for older adults who experience acute care events, and 2) compare approaches to how providers respond to event notifications. METHODS: In a cluster randomized trial conducted across two medical centers within the U.S. Veterans Health Administration (VHA) system, we plan to enroll older patients (≥ 65 years of age) who utilize both VHA and non-VHA providers. Patients will be enrolled into one of three arms: 1) usual care; 2) event notifications only; or 3) event notifications plus a care transitions intervention. In the event notification arms, following a non-VHA acute care encounter, an HIE-based intervention will send an event notification to VHA providers. Patients in the event notification plus care transitions arm will also receive 30 days of care transition support from a social worker. The primary outcome measure is 90-day readmission rate. Secondary outcomes will be high risk medication discrepancies as well as care transitions processes within the VHA health system. Qualitative assessments of the intervention will inform VHA system-wide implementation. DISCUSSION: While HIE has been evaluated in other contexts, little evidence exists on HIE-enabled event notification interventions. Furthermore, this trial offers the opportunity to examine the use of event notifications that trigger a care transitions intervention to further support coordination of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT02689076. "Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization." Registered 23 February 2016

Attitudes and perception of healthcare workers in health facilities with regards to the 'Intention to Use' of the Road to Health Booklet (RtHB)

Introduction: That low and middle income countries (LMICs) are plagued with high burdens of disease and limited health resources is well documented in the literature. These two realities necessitate the availability of good quality and reliable information to enable the efficient distribution of recourses and services. Growing recognition of the importance of health information has seen the introduction of numerous health information systems (HIS). The goal of these HIS is to attain preventative and curative treatment for those that need them, in adequate quantities, promptly, reliably and at equitable cost. Amongst the variety of HIS is the Road-to-Health Booklet (RtHB) in South Africa. This is a paper-based, patient-held medical record given to new mothers, intended to monitor all contact children have with the healthcare system. Due to the dearth of local research and increasing need for strong HIS, more research is needed in the implementation of the HIS and its use by healthcare workers (HCWs) in the African context. Methods: The aim of this study is to explore and understand the influence HCWs' attitudes and perceptions have on the implementation of the RtHB within the Khayelitsha Sub-District of Cape Town, South Africa. A qualitative case study was conducted utilising in-depth interviews, naturalistic observations, document review and mind mapping to explore HCWs' attitudes and perceptions on the RtHB. A combination of purposive and snowball sampling was used to identify participants with insights on the RtHB

The PATCH program for caregivers of children with gastrostomy tubes: promoting and teaching confidence for the home

The PATCH Program: Promoting and Teaching Confidence for the Home is a distinct approach developed to address the problem of high emergency department visit (8.6%) and hospital readmission rates (3.9%) associated with pediatric gastrostomy tube (GT) placement (Goldin et al., 2016). Recent literature regarding negative outcomes associated with pediatric GT placement identified the failure of current GT education and training practices to properly prepare caregivers to manage care in the home (Berman et al., 2017; Franklin & Rodger, 2003; Russell, Jewell, Poskey, & Russell, 2018). Developed by an occupational therapist, the PATCH Program offers an innovative approach to reducing facility rates of negative pediatric GT-related outcomes through family-centered education and self-efficacy enhancing components. Theory-based and evidence-driven, the PATCH Program integrates problem-solving training, formal education, and interactive skills practice to empower caregivers in developing the skills and self-efficacy needed to manage their children’s GT care. Adopting an occupational therapy perspective, the PATCH Program acknowledges that effective home management of a child’s GT care is the product of careful integration of familial context, skills, resources, and support systems. This doctoral project (1) summarizes the theory and evidence base supporting the PATCH Program’s development, (2) describes the PATCH Program curriculum and approaches, and (3) outlines future directions for PATCH Program implementation, including evaluation, dissemination, and funding. The PATCH Program demonstrates the value occupational therapy offers to supporting families in successfully managing a child’s medically complex condition, to reducing post-surgical emergency department visits and hospital readmissions, and to promoting health and wellness among caregivers and families

Health Checkup and Telemedical Intervention Program for Preventive Medicine in Developing Countries: Verification Study

Background: The prevalence of non-communicable diseases is increasing throughout the world, including developing countries. / Objective: The intent was to conduct a study of a preventive medical service in a developing country, combining eHealth checkups and teleconsultation as well as assess stratification rules and the short-term effects of intervention. / Methods: We developed an eHealth system that comprises a set of sensor devices in an attaché case, a data transmission system linked to a mobile network, and a data management application. We provided eHealth checkups for the populations of five villages and the employees of five factories/offices in Bangladesh. Individual health condition was automatically categorized into four grades based on international diagnostic standards: green (healthy), yellow (caution), orange (affected), and red (emergent). We provided teleconsultation for orange- and red-grade subjects and we provided teleprescription for these subjects as required. / Results: The first checkup was provided to 16,741 subjects. After one year, 2361 subjects participated in the second checkup and the systolic blood pressure of these subjects was significantly decreased from an average of 121 mmHg to an average of 116 mmHg (P<.001). Based on these results, we propose a cost-effective method using a machine learning technique (random forest method) using the medical interview, subject profiles, and checkup results as predictor to avoid costly measurements of blood sugar, to ensure sustainability of the program in developing countries. / Conclusions: The results of this study demonstrate the benefits of an eHealth checkup and teleconsultation program as an effective health care system in developing countries

An evaluation of healthcare quality management strategy : a case study of the City of Ekurhuleni

Abstract: Health care is a fundamental right of every citizen in South Africa, and a robust health system that is easily accessible is necessary to fulfil this right. Availability and entry to quality health care is a basic right of all South African citizen and is enshrined in the Constitution of South Africa. This research focused upon exploring the management of healthcare quality. The other objective of the study was to also explore the process strategy in the City of Ekurhuleni and how the administrative processes are managed within a Metropolitan. The study also focused on exploring the quality of healthcare systems and to identify availability, accessibility, acceptability of services in facilities of the City of Ekurhuleni...M.Tech. (Operations Management

Employer Perspectives on Youth with Disabilities in the Workplace

This publication features the experiences of employers in their own words. Employers write about how they became involved in providing work experiences for youth with disabilities, what made it work, and what they recommend to individuals and organizations representing youth. These perspectives can provide guidance to those with an interest in ensuring that youth with disabilities obtain access to a range of work-based experiences

Implementation of a Wellness Program to Address Health Disparities in a Vulnerable Population

Purpose: The purpose of this project was to implement a Wellness program to address the health disparities in a vulnerable population. The population targeted was a local population that was served at a mental health facility for socioeconomically disadvantaged. The program focused on improving knowledge of cardiovascular health, empowerment and communication skills. Significance: The significance of the project is the improvement in ones wellness by provision of education, empowerment and communication skills. The attaining of these skills can translate into other areas of wellness and improved health outcomes. Populations at risk due to socioeconomic and racial differences can benefit from programs targeted to their specific needs. Methods: The methodology utilizing the theoretical framework of self-efficacy included the assessment of needs, the obtainment of stakeholder support from the organization, the implementation of the educational program and awareness campaign followed by evaluation of participants. Project Outcomes: Participants benefited from cardiovascular screening, educational counseling and skills regarding cardiovascular health, communication and self-efficacy. High risk real time identification of hypertensive individuals occurred. Faculty and staff improved their knowledge of subject area and supported the program by embracing the content alongside the patient participants. Clinical Relevance: The project can act as a template for replication in other facilities or to focus on other commonly seen health issues. Sustainability based on easy replication and low cost and applicability to high risk vulnerable populations provides significant value in today’s health care climate