270 research outputs found

    From chaos to clarity : designing eHealth to support self-management in stroke care

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    Introduction: Currently healthcare is shifting from a paternalistic model to a more patient-centered model in which patients’ involvement and self-management play a crucial role. Information and communication technology has the potential to shift the balance of power and responsibility from healthcare professionals to patients and citizens. To provide patients with health information systems and eHealth services which meet their needs and support them throughout their care and rehabilitation processes, there is a need of involving them not only in their care processes but also in the design and evaluation of eHealth. Aim: The overall aim of this research was to explore how a health information system or eHealth service (in this context an electronic care and rehabilitation planning tool) used by post-discharge stroke patients can be designed to improve patient self-management and collaboration between patients, their next-of-kin and different care professionals. Methods: A design research strategy was employed in this thesis project where an online care and rehabilitation planning was designed and evaluated to contribute to the knowledge base on patient involvement in both design of eHealth and in their care through use of eHealth. In study I, the current care and rehabilitation processes of post-discharge stroke patients in Stockholm County Council were explored using a qualitative case study. Data were collected through interviews and observations. Study II explored the stroke patients’ information needs and potential eHealth services were suggested by the researchers and discussed with the patients. An interactive prototype ‘My care plan’ was designed and improved based on the participants’ input. Data for this study were collected through focus groups and usability tests. Study III was mainly a document study where the authors explored the Swedish current infrastructure for health information exchange. In study IV, the prototype was evaluated from both care professionals’ and aphasia patients’ perspective. Results: Based on the patients’ risk factors and disabilities, post-discharge stroke patients’ involvement throughout the care and rehabilitation processes varied significantly. The analysis of patients’ information needs resulted in design of an interactive care and rehabilitation planning tool ‘My care plan’ which consisted mainly of a rehabilitation plan and necessary health and administrative information. The results from the evaluation of the care and rehabilitation planning tool showed that despite some challenges and limitations with using the tool, both care professionals and stroke patients were positive towards using it. The Swedish national health information exchange platform provides opportunities for information exchange, however needs to be further evaluated from a patient perspective to determine how it can support and impact on patient empowerment and collaboration in care. Conclusions: The main contribution of this thesis is involvement of chronically ill patients suffering from several cognitive and physical disabilities in the design and evaluation of eHealth services. Despite several challenges throughout this research project, a deep understanding about this patient group’s needs throughout their care and rehabilitation processes was gained. The thesis also provides an early exploration of the Swedish national health information exchange platform. As this is an area rapidly evolving and of high priority in Sweden today, the results presented in this thesis will provide important input to future research, development and policy in this field

    From outcome monitoring towards patient value improvement in cardiac care

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    How Can eHealth Meet the Hearing and Communication Needs of Adults With Hearing Impairment and their Significant Others? A Group Concept Mapping Study

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    Objectives: To seek the perspectives of key stakeholders regarding: (1) how eHealth could help meet the hearing and communication needs of adults with hearing impairment and their significant others; and (2) how helpful each aspect of eHealth would be to key stakeholders personally. / Design: Group concept mapping, a mixed-methods participatory research method, was used to seek the perspectives of key stakeholders: adults with hearing impairment (n = 39), significant others (n = 28), and hearing care professionals (n = 56). All participants completed a short online survey before completing one or more of the following activities: brainstorming, sorting, and rating. Brainstorming required participants to generate ideas in response to the focus prompt, “One way I would like to use information and communication technologies to address the hearing and communication needs of adults with hearing loss and their family and friends is to….” The sorting task required participants to sort all statements into groups that made sense to them. Finally, the rating task required participants to rate each of the statements according to “How helpful would this idea be to you?” using a 5-point Likert scale. Hierarchical cluster analysis was applied to the “sorting” data to develop a cluster map using the Concept Systems software. The “rating” data were subsequently analyzed at a cluster level and an individual-item level using descriptive statistics. Differences in cluster ratings between stakeholder groups were examined using Kruskal-Wallis tests. / Results: Overall, 123 statements were generated by participants in response to the focus prompt and were included in subsequent analyses. Based on the “sorting” data and hierarchical cluster analysis, a seven-cluster map was deemed to be the best representation of the data. Three key themes emerged from the data, including using eHealth to (1) Educate and Involve Others; (2) Support Aural Rehabilitation; and (3) Educate About and Demonstrate the Impacts of Hearing Impairment and Benefits of Hearing Rehabilitation. Overall median rating scores for each cluster ranged from 3.97 (educate and involve significant others) to 3.44 (empower adults with hearing impairment to manage their hearing impairment from home). / Conclusions: These research findings demonstrate the broad range of clinical applications of eHealth that have the capacity to support the implementation of patient- and family-centered hearing care, with self-directed educational tools and resources typically being rated as most helpful. Therefore, eHealth appears to be a viable option for enabling a more biopsychosocial approach to hearing healthcare and educating and involving significant others in the hearing rehabilitation process without adding more pressure on clinical time. More research is needed to inform the subsequent development of eHealth interventions, and it is recommended that health behavior change theory be adhered to for such interventions

    Effective implementation and monitoring of telehealth and telecare in Ireland: learning from international best practice.

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    This document synthesises the information provided in a number of papers relating to Telecare/Telehealth commissioned by and developed for the National Disability Authority between 2014 and 2017. The papers in question were developed by researchers in Work Research Centre (WRC), the National Disability Authority and the University of Ulster, and this report has taken key learning and information from each of them to create this composite briefing paper

    Front-Line Physicians' Satisfaction with Information Systems in Hospitals

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    Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

    Understanding the links : the exploration of care transitions between hospital and continued rehabilitation in the home after stroke

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    Background: Uncoordinated care transitions are known to be a risk of a substantial burden for patients and significant others with a risk of adverse events, rehospitalisation and dissatisfaction with services. After acute hospital care, people with stroke often need continued rehabilitation which entails a care transition such as from hospital to continued rehabilitation in the home environment. Aims: The overall aims of this thesis were to generate knowledge about and describe the care transition process from hospital to the home from the perspective of people with stroke, significant others and healthcare professionals. In addition, the aim was to investigate the concept of participation in a co-design of person-centred care transitions. Methods and participants: Four papers were included. Paper I and II were based on a prospective observational study including 190 people with stroke and 89 significant others. Data were collected from medical records by standardized questionnaires, performance-based tests, and from the Stockholm Region computerized register of healthcare contacts. Paper I was a prospective observational study where data were analysed with descriptive statistics and regression analysis to explore associations between healthcare utilization and independent variables. Paper II was a cross-sectional study where regression analysis was used to explore associations between perceived quality and independent variables. Paper III was a qualitative grounded theory study of the care transition process including 16 people with stroke, 7 significant others and 48 healthcare professionals. Data was collected through focus group interviews, individual interviews, and interviews in dyads. Paper IV included 3 people with stroke, 1 significant other, 10 healthcare professionals and 1 facilitator. Data was collected using observations, field-notes, interviews and questionnaires and was analysed by qualitative content analysis to investigate how participation manifests itself in a co-design process. Results: A majority had a very mild or mild stroke. There was a large variation in the number of visits with the neurorehabilitation team and other outpatient contacts which seemed to correspond to the level of functioning and stroke severity. The perceived quality of the care transitions indicated that there is room for improvements in the discharge process, especially regarding preparation for discharge and support for self-management post-discharge. Few clinical characteristics were associated with the perceived quality of the care transition. The care transition was described to consist of several parallel processes in need of synthetization and coordination in order to provide care transitions based on the needs of people with stroke and significant others. Patients and significant others described the care transition as a transformation from a passive attendant at the hospital to becoming an uninformed agent at home after discharge. The manifestation of participation in a co-design process was shown to be affected by multifactorial interrelated links such as the composition of groups, the climate and adaptations among the participants, the balancing of roles and power, a shared understanding, leadership and adaptive process. Participation varied between individuals, groups, steps within the process and the topic of conversation. Conclusion: The care transition from hospital to continued rehabilitation in the home needs to be adapted to the varying needs of people with stroke and significant others. The preparation for discharge and information and support for self-management need to be enhanced. Patients and significant others need to be involved in their care during all steps of the care transition process. A perceptive dialogue between patients/significant others, healthcare professionals and across organizations is needed to facilitate coordinated and person-centred care transitions. Participation in a co-design process needs to be asserted continuous reflection, discussion and adaption in order to facilitate the unique knowledge and experience of the involved stakeholders

    Intelligent Systems for Sustainable Person-Centered Healthcare

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    This open access book establishes a dialog among the medical and intelligent system domains for igniting transition toward a sustainable and cost-effective healthcare. The Person-Centered Care (PCC) positions a person in the center of a healthcare system, instead of defining a patient as a set of diagnoses and treatment episodes. The PCC-based conceptual background triggers enhanced application of Artificial Intelligence, as it dissolves the limits of processing traditional medical data records, clinical tests and surveys. Enhanced knowledge for diagnosing, treatment and rehabilitation is captured and utilized by inclusion of data sources characterizing personal lifestyle, and health literacy, and it involves insights derived from smart ambience and wearables data, community networks, and the caregivers’ feedback. The book discusses intelligent systems and their applications for healthcare data analysis, decision making and process design tasks. The measurement systems and efficiency evaluation models analyze ability of intelligent healthcare system to monitor person health and improving quality of life

    eRehabilitation after stroke: the interplay between the effectiveness, the implementation and the context

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    Stroke is a relatively common condition with a large impact on patients’ lives. Rehabilitation treatment aims to support patients in coping with the physical, mental, cognitive and social consequences of stroke. Recently, there is an increasing interest in the application of digital technologies (eRehabilitation) in healthcare in general, including in stroke rehabilitation. ERehabilitation may include physical and cognitive exercise programs, patient information and education, e-consultations, physical activity tracking and serious gaming, preferably all together in one digital environment.Although there is evidence on the effectiveness and feasibility of eRehabilitation, the uptake of eRehabilitation in specialized stroke rehabilitation facilities has been slow, warranting the need for implementation research. The aim of this thesis was to provide insight in the complex interplay between the effectiveness, the implementation strategy and the context of eRehabilitation after stroke, as delivered in a specialized rehabilitation facility, in order to improve future use of eRehabilitation in specialized stroke rehabilitation facilities. LUMC / Geneeskund

    Intelligent Systems for Sustainable Person-Centered Healthcare

    Get PDF
    This open access book establishes a dialog among the medical and intelligent system domains for igniting transition toward a sustainable and cost-effective healthcare. The Person-Centered Care (PCC) positions a person in the center of a healthcare system, instead of defining a patient as a set of diagnoses and treatment episodes. The PCC-based conceptual background triggers enhanced application of Artificial Intelligence, as it dissolves the limits of processing traditional medical data records, clinical tests and surveys. Enhanced knowledge for diagnosing, treatment and rehabilitation is captured and utilized by inclusion of data sources characterizing personal lifestyle, and health literacy, and it involves insights derived from smart ambience and wearables data, community networks, and the caregivers’ feedback. The book discusses intelligent systems and their applications for healthcare data analysis, decision making and process design tasks. The measurement systems and efficiency evaluation models analyze ability of intelligent healthcare system to monitor person health and improving quality of life
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