Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

Editorial: choosing new targets for rheumatoid arthritis therapeutics: too interesting to fail?

No abstract available

Mental health services required after disasters: Learning from the lasting effects of disasters

Extent: 13p.Disasters test civil administrations’ and health services’ capacity to act in a flexible but well-coordinated manner because each disaster is unique and poses unusual challenges. The health services required differ markedly according to the nature of the disaster and the geographical spread of those affected. Epidemiology has shown that services need to be equipped to deal with major depressive disorder and grief, not just posttraumatic stress disorder, and not only for victims of the disaster itself but also the emergency service workers. The challenge is for specialist advisers to respect and understand the existing health care and support networks of those affected while also recognizing their limitations. In the initial aftermath of these events, a great deal of effort goes into the development of early support systems but the longer term needs of these populations are often underestimated. These services need to be structured, taking into account the pre-existing psychiatric morbidity within the community. Disasters are an opportunity for improving services for patients with posttraumatic psychopathology in general but can later be utilized for improving services for victims of more common traumas in modern society, such as accidents and interpersonal violence.A. C. McFarlane and Richard William

Lessons Learned: Exploratory study of a HIV/AIDS prevention intervention for African American women who have experienced intimate partner violence

Given the prevalence and co-occurring nature of HIV and intimate partner violence among African American women there is a need for a risk reduction intervention. This study explored the results from an exploratory study of an HIV/AIDS prevention intervention for African-American women who have experienced intimate partner violence. The emphasis of this study is to identify lessons learned to guide future research. Recruitment for the feasibility study was done in two waves over a period of three months. During the first wave, 22 participants were recruited for the intervention group, and in the second wave, 25 participants were in the control group. Pre-post tests were used to evaluate the mean differences between the groups on the three domain measures the intervention was designed to impact (Capacity Building, Sexual Safety Planning, Life Skills). Participants in the treatment group increased their HIV knowledge and decreased reports of alcohol and drug use, while increasing their sexual assertiveness skills, though overall statistical findings indicated that there was no significant difference between the treatment and control group in regards to overall capacity building, sexual safety planning, and life skills. There is a need to find additional motivators to keep participants engaged, as attrition for both groups was unusually high. Shortening sessions or duration of the intervention to accommodate the multiple demands on these women’s lives, and potentially delivering some of the curriculum through technology may be an option for future interventions. Further attention to how African American women can reduce their risks for IPV and their heightened risk for HIV by looking closely at structural inequalities, the social determinants of health, and other contributing factors is a necessary consideration for a successful intervention

A system dynamics-based simulation study for managing clinical governance and pathways in a hospital

This paper examines the development of clinical pathways in a hospital in Australia based on empirical clinical data of patient episodes. A system dynamics (SD)-based decision support system (DSS) is developed and analyzed for this purpose. System dynamics was used as the simulation modeling tool because of its rigorous approach in capturing interrelationships among variables and in handling dynamic aspects of the system behavior in managing healthcare. The study highlights the scenarios that will help hospital administrators to redistribute caseloads amongst admitting clinicians with a focus on multiple Diagnostic Related Groups (DRG’s) as the means to improve the patient turnaround and hospital throughput without compromising quality patient care. DRG’s are the best known classification system used in a casemix funding model. The classification system groups inpatient stays into clinically meaningful categories of similar levels of complexity that consume similar amounts of resources. Policy explorations reveal various combinations of the dominant policies that hospital management can adopt. The analyses act as a scratch pad for the executives as they understand what can be feasibly achieved by the implementation of clinical pathways given a number of constraints. With the use of visual interfaces, executives can manipulate the DSS to test various scenarios. Experimental evidence based on focus groups demonstrated that the DSS can enhance group learning processes and improve decision making. The simulation model findings support recent studies of CP implementation on various DRG’s published in the medical literature. These studies showed substantial reductions in length of stay, costs and resource utilization

Evaluating case studies of community-oriented integrated care.

This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub - both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into 'wicked problems', and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. The conversation concludes seven aspects of COIC that warrant further attention

Understanding Hope: A Review of Measurement and Construct Validity Research

Hope has been discussed by philosophers, theologians, educators, and scientists, to name but a few groups of people, over the preceding two millennia. During the last 15 years, C. R. Snyder and his colleagues at the University of Kansas have developed a theory and associated measures of the hope construct that have received extensive, detailed attention both within and outside the field of psychology. In this chapter, we describe Snyder\u27s hope model and some of the research findings that have supported the validity of this construct. Beginning with a conceptual definition of hope, we move to relevant findings about the usefulness of hope in the lives of individuals in various life arenas. We describe measures developed for assessing hope in children and adults, as well as current issues associated with the validity of hope measurement. Finally, we discuss future directions for further investigation of hope

Improving Community Adaptation Outcomes for Youth Graduating from Residential Mental Health Programs: A Synthesis Review (FULL REPORT)

The focus of this synthesis review was to understand the capacity of systems of care and integrated program models to foster successful community adaptation for children and youth graduating from children\u27s residential mental health treatment

CoMFORT ventilation mask project - Lessons learned from the field

This paper reports and discusses some key methods and findings of the inter-disciplinary design team undertaking a three year study into improving comfort for paediatric users of Non Invasive Ventilation (NIV) in the NHS. The project proposes a novel use of 3D scanning and printing technologies to offer a bespoke mask provision service. Five "lessons" are proposed and contextualised with example scenarios from the project. Key findings have shown the importance of 1. Visual communication methods 2. Involving diverse stakeholder groups 3. Getting hands on with enabling technologies 4. Designing and making test rigs 5. Going around, not stopping at obstacles We conclude that the visual and tangible methods favoured by 3D designers can help to achieve project aims in interdisciplinary projects. They can improve project outcomes by encouraging engagement with collaborators and stakeholders, as well as building up tacit knowledge of the project context, the enabling technologies and the materials. This paper also identifies opportunities for areas of related future research