Evaluation of an audit and feedback intervention to reduce gentamicin prescription errors in newborn treatment (ReGENT) in neonatal inpatient care in Kenya: a controlled interrupted time series study protocol

Background Medication errors are likely common in low- and middle-income countries (LMICs). In neonatal hospital care where the population with severe illness has a high mortality rate, around 14.9% of drug prescriptions have errors in LMICs settings. However, there is scant research on interventions to improve medication safety to mitigate such errors. Our objective is to improve routine neonatal care particularly focusing on effective prescribing practices with the aim of achieving reduced gentamicin medication errors. Methods We propose to conduct an audit and feedback (A&F) study over 12 months in 20 hospitals with 12 months of baseline data. The medical and nursing leaders on their newborn units had been organised into a network that facilitates evaluating intervention approaches for improving quality of neonatal care in these hospitals and are receiving basic feedback generated from the baseline data. In this study, the network will (1) be expanded to include all hospital pharmacists, (2) include a pharmacist-only professional WhatsApp discussion group for discussing prescription practices, and (3) support all hospitals to facilitate pharmacist-led continuous medical education seminars on prescription practices at hospital level, i.e. default intervention package. A subset of these hospitals (n = 10) will additionally (1) have an additional hospital-specific WhatsApp group for the pharmacists to discuss local performance with their local clinical team, (2) receive detailed A&F prescription error reports delivered through mobile-based dashboard, and (3) receive a PDF infographic summarising prescribing performance circulated to the clinicians through the hospital-specific WhatsApp group, i.e. an extended package. Using interrupted time series analysis modelling changes in prescribing errors over time, coupled with process fidelity evaluation, and WhatsApp sentiment analysis, we will evaluate the success with which the A&F interventions are delivered, received, and acted upon to reduce prescribing error while exploring the extended package’s success/failure relative to the default intervention package. Discussion If effective, these theory-informed A&F strategies that carefully consider the challenges of LMICs settings will support the improvement of medication prescribing practices with the insights gained adapted for other clinical behavioural targets of a similar nature. Trial registration PACTR, PACTR202203869312307. Registered 17th March 2022

Healthcare workers’ perspectives on participatory system dynamics modelling and simulation: designing safe and efficient hospital pharmacy dispensing systems together

With increasingly complex safety-critical systems like healthcare being developed and managed, there is a need for a tool that permits decision-makers to better understand the complexity, test various strategies and guide effective changes. System Dynamics (SD) modelling is an effective approach that can aid strategic decision-making in healthcare systems but has been underutilised partly due to the challenge of engaging healthcare stakeholders in the modelling process. This paper, therefore, investigates the applicability of a participatory SD approach based on healthcare workers' perspectives on ease of use (usability) and usefulness (utility). The study developed an interactive simulation dashboard platform which facilitated participatory simulation for exploring various hospital pharmacy staffing level arrangements and their impacts on interruptions, fatigue, workload, rework, productivity and safety. The findings reveal that participatory SD approach can enhance team learning by converging on a shared mental model, aid decision-making and identifying trade-offs. The implications of these findings are discussed as well as experience and lessons learned on modelling facilitation.Practitioner Summary: This paper reports the perspectives of healthcare workers, who were engaged with a participatory system dynamics modelling and simulation process for hospital pharmacy staffing level management. Evaluative feedback revealed that the participatory SD approach can be a valuable tool for participatory ergonomics by helping the participants gain a deeper understanding of the complex dynamic interactions between workload, rework, safety and efficiency

What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

A Systems-Based Patient Aid Design Artifact for Active Medication Management in Type 2 Diabetes

In this dissertation, I explore the use of the Abstraction-Decomposition Space (ADS) alongside Hierarchical Task Analysis (HTA) to guide the design of a minimalist patient aid for active medication management in type 2 diabetes. The goal is to address a practical problem, but in addition, this study seeks to address a theoretical problem that is prevalent in design research in Information Systems (IS) today. The practical problem concerns the need for IT-based care delivery models to support patients in the interim period between in-person visits. In this vein, I present a bare-minimum design that focuses on the most essential functionality required to achieve remote insulin titration using the ADS and HTA. The theoretical problem, on the other hand, pertains to the limitations resulting from taking a tool-focused view in design research which inhibits our ability to produce generalized knowledge about IT systems in their contexts. The study proposes an alternative view based on work systems. The overarching thesis is that a work systems view provides for knowledge at a more abstract and generalizable level, yielding contributions beyond mere software packages. Moreover, the study highlights the artifact-building methodology used to delineate the rationale behind the design and to balance evaluation-dominant design research. In this vein, I conducted document analysis and semi-structured interviews with patients and care providers to develop the ADS, then used it alongside HTA to develop and test the usability of twelve user scenarios implemented on a large mobile form factor

Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care: a mixed-method study protocol

IntroductionThere is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an 'at-a-glance' overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined.MethodsThis mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop.Ethics and disseminationThis study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University's Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations

Contributions to improve human-computer interaction using machine learning

181 p. (eng.) 189 p. (eus.)This PhD thesis contributes on designing and applying data mining techniques targeting the improvement of Human Computer Interaction (HCI) in different contexts. The main objectives of the thesis are to design systems based on data mining methods for modelling behaviour on interaction and use data. Moreover, having to work often in unsupervised learning contexts has lead to contribute methodologically to clustering validation regardless of the context; an unsolved problem in machine learning. Cluster Validity Indexes (CVIs) partially solve this problem by providing a quality score of the partitions, but none of them has proven to robustly face the broad range of conditions. In this regard, in the first contribution several CVI decision fusion (voting) approaches are proposed, showing that they are promising strategies for clustering validation.In the Human-Computer Interaction context, the contributions are structured in three different areas. The accessibility area is analysed in the first one where an efficient system to automatically detect navigation problems of users, with and without disabilities, is presented. The next contribution is focused on the medical informatics and it analyses the interaction in a medical dashboard used to support the decision-making of clinicians (SMASH). On the one hand, connections between visual and interaction behaviours on SMASH are studied. On the other hand, based on the interaction behaviours observed in SMASH, two main cohorts of users are automatically detected and characterised: primary (pharmacists) vs secondary (non-pharmacists).Finally, two contributions on the e-Services area are made, focusing on their interaction and use respectively. In the first one, potential students aiming to enrol the University of the Basque Country (UPV/EHU) are satisfactorily modelled based on the interactive behaviours they showed in the web of this university. The second one, empirically analyses and characterises the use of e-Government services in different European countries based on survey data provided by EurostatDoktorego-tesi honek, hainbat testuingurutan, Pertsona-Konputagailu Elkarrekintzaren (PKE) hobekuntzarako datuen meatzaritzako teknikak diseinatzen eta aplikatzen laguntzen du. Tesiaren helburu nagusiak datu-meatzaritzako metodoetan oinarritutako sistemak diseinatzea da, elkarrekintza- eta erabilera-datuen portaera modelatzeko. Gainera, gainbegiratu gabeko ikasketa-testuinguruekin sarritan lan egin behar izanak, datuen testuinguru guztiei zuzendutako clusteringa baliozkotzeari buruzko ekarpen metodologikoa egitera bultzatu gaitu. Kluster baliozkotze indizeek (CVI) partizioen kalitate-neurri bat ematen duten heinean, arazo hau partzialki ebazten dute, baina horietako batek ere ez du erakutsi egoeren espektro handiari aurre egiteko gaitasuna. Ildo honetatik, lehen kontribuzioan CVIen arteko erabaki-fusioen (bozketa) hainbat sistema proposatzen ditugu, eta klusteringa baliozkotzeko estrategia eraginkorrak direla erakusten dugu.Pertsona-Konputagailu Elkarrekintzaren testuinguruan, ekarpenak hiru arlotan egituratuta daude. Irisgarritasun arloa lehenengo kontribuzioan aztertzen da, sistema eraginkor bat aurkeztuz, desgaitasuna duten eta desgaitasuna ez duten erabiltzaileen nabigazio-arazoak automatikoki detektatzen dituena.Hurrengo ekarpena informatika-medikoan zentratzen da eta medikuei erabakiak hartzeko jardueretan laguntzeko erabiltzen den osasun-arbela mediko baten (SMASH) elkarrekintza aztertzen du. Batetik, SMASH arbelean portaera bisualen eta interaktiboen arteko loturak aztertzen dira. Bestalde, SMASH arbelean antzemandako portaera interaktiboen arabera, bi erabiltzaile talde nagusi detektatu eta ezaugarritu dira: lehen mailakoak (farmazialariak) eta bigarren mailakoak (ez farmazialariak).Azkenik, bi kontribuzio egiten dira zerbitzu elektronikoen (e-Zerbitzuen) arloan, elkarrekintza eta erabileran oinarrituz, hurrenez hurren. Lehenengoan, Euskal Herriko Unibertsitatean (UPV/EHU) izena eman nahi duten ikasle potentzialak modu eraginkorrean modelatu dira unibertsitate honen webgunean erakutsitako jokabide interaktiboen arabera. Bigarrenean, gobernuko e-Zerbitzuen erabilera aztertu da Europako hainbat herrialdetan, Eurostatek emandako inkesta-datuetan oinarrituzEsta tesis doctoral contribuye al diseño y la aplicación de técnicas de minería de datos dirigidas a la mejora de la Interacción Persona-Computadora (IPC) en diferentes contextos. Los objetivos principales de la tesis son diseñar sistemas basados en métodos de minería de datos para modelar el comportamiento en datos de interacción y uso. Además, como los contextos de aprendizaje no supervisado han sido una constante en nuestro trabajo, hemos contribuido metodológicamente a la validación de clustering independientemente del contexto de los datos; problema no resuelto en el aprendizaje automático. Los índices de validación de cluster (CVI) resuelven parcialmente este problema al proporcionar un valor cuantitativo de calidad de las particiones, pero ninguno de ellos ha demostrado poder enfrentarse de manera robusta en una amplia gama de condiciones. En este sentido, en la primera contribución se proponen varios sistemas de fusión de decisiones (votaciones) entre CVIs, demostrando que son estrategias prometedoras para la validación de cluster.En el contexto de Interacción-Persona Computador, las contribuciones están estructuradas en tres áreas diferentes. En la primera de ellas se analiza el área de accesibilidad, presentando un sistema eficiente para detectar automáticamente los problemas de navegación de los usuarios, con y sin discapacidad.La siguiente contribución se centra en la informática médica y analiza la interacción en una pizarra médica web (SMASH) utilizada para asistir en la toma de decisiones de los médicos. Por un lado, se estudian las conexiones entre los comportamientos visuales y de interacción en SMASH. Por otro lado, en base a los comportamientos de interacción observados en SMASH, se detectan y caracterizan automáticamente dos grupos principales de usuarios: primario (farmacéuticos) y secundario (no farmacéuticos).Finalmente, se realizan dos contribuciones en el área de servicios electrónicos, centrándose en su interacción y uso, respectivamente. En la primera, se modelan satisfactoriamente los estudiantes que potencialmente desean matricularse en la Universidad del País Vasco (UPV / EHU), en función de los comportamientos interactivos que muestran en la web de esta universidad. La segunda contribución, analiza empíricamente y caracteriza el uso de los servicios de gobierno electrónico en diferentes países europeos en base a datos de encuestas proporcionados por Eurostat

Innovation in Diabetes - Ideas and Initiatives

A collection of multiple reports on MyDiabetesMyWay (MDMW). Included reports are: MyDiabetesMyWay Patient Portal; MyDiabetesMyWay e-learning hub (Moodle) ; SCI-diabetes/ MDMW Communication Portal- Tools for Remote Communication/ Consultation; Risk Modelling for Care Planning- integration into Informatics Dashboard for Clinical Use; Access to Chronic Medication Service (CMS) and Pharmaceutical Care Planning Medication and Lifestyle Coaching; Multi-media Diabetes Resources; Promoting Diabetes Education; Tele-Pharmacy; Understanding my diabetes medication; Pharmaceutical Industry and Medical Technology (PIMTs); An on-line and interactive education system for young people with type 1 diabetes to understand self-management for their lifestyle; Proof of Concept study to deliver personalised use of information to support diabetes management and behaviour change; right information; right time; right way; Virtual promotion of physical activity for people with type 2 diabetes; Remote foot ulcer management: RAPID (Reducing Amputation in People with Diabetes); Diabetic foot screening – development of technology; Portable capillary HbA1c testing for diagnosis and self-monitoring of diabetes; Possibility of mobile phone adaption for testing; Web app for decision support for patients with type 1 diabetes undertaking sport or exercise; Online level 3 structured education for type 1 diabetes; My Diabetes My Way electronic personal health record – uptake at scale; TeleClinics for diabetes; Develop a diabetes sim / game in which the main character has diabetes. Young people need to keep the sim / character alive as they face the various challenges of life or the game; Development of meaningful automated glucose data to in-patient clinical areas; In-patient Care: Integrated eHealth solutions to improve patient care, safety and outcomes; Innovative model of care to address the 'process of care' in managing people with long term conditions; Young Persons Remote Clinic Consultation; Maximise use of the data to support self-management of patients with co-morbidities; Virtual practice outreach and education in primary care

Facilitating the Process of Change: Exploring Alternate Approaches to Behavioural Design

The adoption of healthy lifestyle habits can have a profound impact on individual health and wellbeing on a global scale. This research investigates the use of behavioural insights in interactive digital health technologies, and the potential for these tools to motivate personal behaviour change for improved health and wellness. Explorations into this space have revealed the controversial nature of behaviour change which has motivated a search for alternative methods of facilitating the habit formation process. This shift away from the traditional approach of behavioural design has resulted in one that educates and encourages users to use these behavioural techniques on themselves instead in order to allow human agency to flourish. Design-based explorations that lead to the design of an educational wellness tool and investigates the applications of behavioural insights, using methods borrowed from interaction design, are the focus of this work.Interaction designHabitsBehavioural insightsBehaviour chang