Focal Spot, Fall/Winter 1994

https://digitalcommons.wustl.edu/focal_spot_archives/1068/thumbnail.jp

Longitudinal Patient Records: A Re-Examination of the Possibility

It has long been recognized that the Longitudinal Patient Record (LPR) has been defined as “A life-long incremental process where each clinical encounter is merely an updating of the file” (Gabrieli, 1997) Understanding the health condition of patient longitudinally is very important to the care of the patient. However, it is not clear to what extent a longitudinal patient record is in fact possible, since a true longitudinal patient record would need to include all information for a patient, from cradle to grave, across all healthcare providers and systems, across all corporate or geographic or national boundaries. Compiling or maintaining such a record is a problem of staggering practical difficulties. Yet, there is no doubt of the potential benefit to the patient of the availability of such a record to the patient’s caregivers and providers. In this thesis, we re-examine the possibility of a longitudinal patient record, both in its pure logical sense, and in a practical sense. One point of view that we stress is to model the longitudinal patient record not so much as a static thing, but rather as a functional entity. That is, the longitudinal patient record is understood as a set of processes that provide the physician or other clinician decision maker (or for that matter the patient himself) with whatever longitudinal view of the patient information is available and practical to serve the current context of decision making. That is, the model we suggest is one of making the most out of whatever patient information is available to the decision maker

The barriers and facilitators influencing the sustainability of hospital-based interventions: a systematic review

Acknowledgements University of Stirling for providing financial support for open access costs Funding This review was funded by the Chief Scientist Office, grant number GCA/17/26. JC, PC and EAD are employed by the Nursing, Midwifery and Allied Health Professions Research Unit, which is funded by the Chief Scientist Office in Scotland.Peer reviewedPublisher PD

An empirical study of patient-centered hospital clinical process: dimensions, antecedents and outcomes

JEL Classification System: I110, M14Differing from disease-center or physician-centered clinical practice, patient-centered practice emphasizes patients' individual differences, patient participation in clinical decision-making, physician-patient communication, and patient experience and satisfaction in the treatment process. Focusing on the patient-centered practice in Chinese hospitals, this study aims to answer three research questions: What constitutes a patient-centered clinical process? How do different patient-centered clinical process dimensions affect patient-based outcomes? What are the antecedents that determine the different patient-centered clinical process dimensions? A variety of qualitative and quantitative research methods were used, including literature analysis, case study, factor analysis, and linear regression analysis. In our study, patient-centered clinical processes defined as a clinical process that contributes to a cooperative partnership between healthcare personnel, patients and their families, to ensure that clinical decisions can respect the patient's needs, ideas and wishes, and that the patients are entitled to have access to education and support needed in decision making, prompting patients to participate in clinical processes, so that they get a better perceived value and service experience. The core of patient-centered clinical process is the interactive and collaborative partnership of physicians, nurses, and patients, which can be expressed as a number of patient-perceived dimensions, including diagnosis and treatment, nursing, communication, management and information. This study theoretically added insights on the definition and core dimensions of the patient-centered clinical process, the relationship between different dimensions and the patient outcome, especially within the context of a unique health system in China. These findings and conclusions could be useful for management practice in Chinese hospitals. However, these implications may be limited due to the small data collection sample and cross-sectional study design.Ao contrário da prática clínica centrada na doença ou no médico, a prática clínica focada no paciente enfatiza as diferenças individuais dos pacientes, a sua participação na tomada de decisão clínica, a comunicação entre médico-paciente, e a experiência e a satisfação do pacienteno processo de tratamento. Este estudo centra-se na prática clínica focada em pacientes em hospitais Chineses, procurando responder a três perguntas de investigação: O que constitui um processo clínico focado no paciente (PCCP)? De que forma as dimensões do PCCP influenciam os resultados em termos do paciente? Quais os antecedentes que determinam as diferentes dimensões do PCCP? Neste estudo foram usados métodos de investigação qualitativos e quantitativos, incluindo análise de literatura, caso de estudo, análise fatorial e regressão linear. Neste estudo, o PCCP é definido como um processo clínico que contribui para uma parceria cooperativa entre os profissionais de saúde, pacientes e as suas famílias, assegurando que as decisões clínicas respeitam as necessidades, ideias e desejos do paciente, e que os pacientes têm direito a ter acesso à educação e suporte necessários para a tomada de decisão. A participação dos pacientes no processo clínico deve ser promovida, de forma a assegurar uma melhor experiência de serviço e valor percecionado pelos pacientes. O centro do PCCP é de facto a parceria interativa e colaborativa entre médicos, enfermeiros e pacientes, que pode ser expressa por um conjunto de dimensões percecionadas pelos pacientes, tais como diagnóstico e tratamento, enfermagem, comunicação, gestão e informação. Este estudo contribui com conhecimento teórico acerca da definição e das dimensões chave de um processo clínico focado no paciente, e das relações existentes entre as diferentes dimensões e os resultados para o paciente, particularmente no contexto de um único sistema de saúde na China. Os resultados e conclusões deste estudo podem ser úteis para a prática de gestão nos hospitais Chineses. Contudo, estas implicações estão limitadas devido à reduzida dimensão da amostra de dados e ao desenho do estudo transversal

MS

thesisHealth information systems are networks of computers employed by health care enterprises to facilitate the delivery of their health care product. Computers originally entered the medical domain solely as tools aimed at the business functions of the hospital. Having demonstrated their utility in this area, computers were perceived by certain innovators to have usefulness in the clinical domain. As clinical computer applications were successfully developed and implemented, they have over time been merged together into systems offering multiple areas of functionality directly impacting the clinical aspects of health care delivery. Such health information systems have now assumed major importance in the provision of health care in a complex medical environment. Although the focus of substantial investment for development and implementation, relatively little work has been done to assess the value of such health information systems. The business information technology literature and the medical informatics literature each include only a small number of published reports examining the value question in an incomplete manner. No generally accepted valuation strategy has been developed for information systems in either the business or health care domains. Several valuation methods with potential applicability to health information systems have evolved: cost-effectiveness / cost- benefit analysis, return on investment, information economics, measurement systems, the Strassmann approach, the Japanese approach, and the strategic value approach. None of these valuation strategies is clearly superior; each has different strengths and weaknesses. A matrix comparing these strategies on the bases of explicitness and ease of implementation is proposed. Intermountain Health Care (IHC) has been instrumental in the development of health information systems and a leader in the application of such technology in clinical health care delivery. IHC's HELP system has played a seminal role as a catalyst to the development of the health information system industry. Although both historically and functionally important, detailed financial information regarding HELP'S origins and implementation no longer exists. Current IHC budget information demonstrates the major financial commitment underway within this health care enterprise totaling approximately $157 million over the last decade and with additional expenditures of$47 to $61 million projected annually through fiscal year 2004. The complex budgetary relationships between HELP and the other health information systems at LDS Hospital further obscure the magnitude of the information technology investment within this institution. Benefits of health information systems are potentially most substantial within the domain of clinical integration. IHC has not implemented any formal valuation strategy for its health information systems, but the ad hoc measurement systems valuation approach applied to date is practical, flexible, and the most appropriate of the available systems. Adequate valuation of health information systems cannot readily be achieved given the existing traditional hierarchical accounting structure; an alternative accounting framework patterned after a relational database is proposed

Describing the use of social media as a point-of-care tool in facility-based emergency care in Africa

Background Despite privacy and legal concerns, social media is used to provide real-time clinical support to emergency care providers. It can be particularly beneficial for those in Africa, who might lack adequate training or access to information. This PhD aimed to describe the use of social media as a point-of-care telemedicine tool in facility-based emergency care in Africa, to further inform its use. Methods A scoping review was conducted to map available literature on use, benefits, and risks associated with social media as a point-of-care platform. A mixed methods approach was then taken using a cross-sectional survey and semi-structured interviews to obtain a comprehensive description of use of social media as a point-of-care tool in facility-based emergency care in Africa. Results The scoping review identified 13 publications describing use of social media as a point-of-care tool in emergency medical settings. No studies were located in low-income countries. All studies evaluated WhatsApp use for real-time consultations, and those that assessed reliability found it to be highly reliable for consultations. A total of 70 emergency care providers in African facilities responded to the survey; nearly all worked in low- or lower-middle-income countries. Responses showed that clinicians use social media multiple times each day, primarily to share and receive advice. The majority felt social media positively impacts patient and provider experiences and improves speed and safety. Finally, eight African emergency care providers were interviewed to gain an in-depth understanding of how social media use impacts emergency care. All participants noted routine use for a range of professional purposes, including consultations, administrative tasks, and education. Concerns were mentioned by all participants, including legality, privacy, and lack of employer regulations. Conclusions This dissertation provides insight into social media use of African emergency care physicians, showing that social media use in this group is ubiquitous. Most clinicians use social media multiple times each day for a range of point-of-care purposes, and many feel social media is positively impacting both the patient and provider experiences. Post-doctoral work will focus on developing a framework to guide use of social media in facility-based emergency care in the African setting