56,498 research outputs found
Integrated care and the working record
By default, many discussions and specifications of electronic health records or integrated care records often conceptualize the record as a passive information repository. This article presents data from a case study of work in a medical unit in a major metropolitan hospital. It shows how the clinicians tailored, re-presented and augmented clinical information to support their own roles in the delivery of care for individual patients. This is referred to as the working record: a set of complexly interrelated clinician-centred documents that are locally evolved, maintained and used to support delivery of care in conjunction with the more patient-centred chart that will be stored in the medical records department on the patient’s discharge. Implications are drawn for how an integrated care record could support the local tailorability and flexibility that underpin this working record and hence underpin practice
Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome: a systematic review
Background. Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments has been advocated as part of clinical care to aid the recognition of psychosocial problems, to inform clinical decision making, to monitor therapeutic response and to facilitate patient-doctor communication. However, their adoption is not without cost and the benefit of their use is unclear. Method. A systematic review was conducted. We sought experimental studies that examined the addition of routinely administered measures of HRQoL to care in both psychiatric and non-psychiatric settings. We searched the following databases: MEDLINE, EMBASE, CINAHL, PsycLIT and Cochrane Controlled Trials Register (to 2000). Data were extracted independently and a narrative synthesis of results was presented. Results. Nine randomized and quasi-randomized studies conducted in non-psychiatric settings were found. All the instruments used included an assessment of mental well-being, with specific questions relating to depression and anxiety. The routine feedback of these instruments had little impact on the recognition of mental disorders or on longer term psychosocial functioning. While clinicians welcomed the information these instruments imparted, their results were rarely incorporated into routine clinical decision making. No studies were found that examined the value of routine assessment and feedback of HRQoL or patient needs in specialist psychiatric care settings. Conclusions. Routine HRQoL measurement is a costly exercise and there is no robust evidence to suggest that it is of benefit in improving psychosocial outcomes of patients managed in non-psychiatric settings. Major policy initiatives to increase the routine collection and use of outcome measures in psychiatric settings are unevaluated
HealthPartners: Consumer-Focused Mission and Collaborative Approach Support Ambitious Performance Improvement Agenda
Presents a case study of a nonprofit healthcare organization that exhibits the six attributes of an ideal healthcare delivery system as defined by the Fund, including information continuity, care coordination and transitions, and system accountability
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Visualizing pain data for wheelchair users: A ubiquitous approach
Copyright @ 2005 Rinton PressWe describe a wireless enabled solution for the vizualisation of pain data. Our approach uses pain drawings to record spatial location and type of pain and enables data collection with appropriate time stamping, thus providing a means for the seldom-recorded (but often attested) time-varying nature of pain, with consequential impact on monitoring the effectiveness of patient treatment regimes. Moreover, since the implementation platform of our solution is that of a Personal Digital Assistant (PDA), data collection takes place ubiquitously, providing back pain sufferers with mobility problems (such as wheelchair users) with a convenient means of logging their pain data and of seamlessly uploading it to a hospital server using WiFi technology. Stakeholder results show that, notwithstanding problems related to PDA data input, our approach is generally perceived to be an easy to use and convenient solution to the challenges of
anywhere/anytime data collection
New directions in Indigenous service population estimation
Accurate assessments of the number of people who access goods or services in a particular location are crucial to the equitable allocation of resources and the delivery of services. In particular, Indigenous Australians are an important subpopulation for whom such estimates would be useful, given the high levels of Indigenous temporary mobility. The authors review previous estimates of service populations relevant to Indigenous Australians and find that there is no currently accepted method for quantification.The paper argues that any attempt to develop a single measure of service populations for all services at a place is likely to meet only limited success. Instead, service populations should be estimated on a service-by-service basis. It then gives a hypothetical example of how the Indigenous service populations of hospitals might be estimated using existing administrative data and a geographical approach. It concludes by arguing that access to key datasets remains the most important barrier to the estimation of Indigenous service populations.Authored by Francis Markham, Jess Bath, John Taylor and Bruce Doran
Effectiveness and cost-effectiveness of a novel, group self-management course for adults with chronic musculoskeletal pain: study protocol for a multicentre, randomised controlled trial (COPERS)
Introduction: Chronic musculoskeletal pain is a
common condition that often responds poorly to
treatment. Self-management courses have been
advocated as a non-drug pain management
technique, although evidence for their effectiveness
is equivocal. We designed and piloted a
self-management course based on evidence for
effectiveness for specific course components and
characteristics.
Methods/analysis: COPERS (coping with persistent
pain, effectiveness research into self-management) is
a pragmatic randomised controlled trial testing the
effectiveness and cost-effectiveness of an intensive,
group, cognitive behavioural-based, theoretically
informed and manualised self-management course
for chronic pain patients against a control of best
usual care: a pain education booklet and a relaxation
CD. The course lasts for 15 h, spread over 3 days,
with a –2 h follow-up session 2 weeks later. We aim
to recruit 685 participants with chronic
musculoskeletal pain from primary, intermediate and
secondary care services in two UK regions. The
study is powered to show a standardised mean
difference of 0.3 in the primary outcome, pain-related
disability. Secondary outcomes include generic
health-related quality of life, healthcare utilisation,
pain self-efficacy, coping, depression, anxiety and
social engagement. Outcomes are measured at 6 and
12 months postrandomisation. Pain self-efficacy is
measured at 3 months to assess whether change
mediates clinical effect.
Ethics/dissemination: Ethics approval was given
by Cambridgeshire Ethics 11/EE/046. This trial will
provide robust data on the effectiveness and
cost-effectiveness of an evidence-based, group
self-management programme for chronic
musculoskeletal pain. The published outcomes will
help to inform future policy and practice around such
self-management courses, both nationally and
internationally.
Trial registration: ISRCTN24426731
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