Promoting Clinical Engagement and Cross-sector Collaboration Through Changes in Workforce, Use of Technology, and Improved Business Systems

Published version made available here with permission from publisher.Background: Cross-sectoral collaboration across health care settings has the potential to deliver efficiencies as well as improve health care outcomes. There is a need for better understanding and awareness of models, mechanisms and strategies that enhance crosssectoral collaboration in Australia. Improved cross-sectoral collaboration is supported by a number of changes in workforce, use of technology and improved business systems. This review seeks to summarise these programs for those who may be seeking to engage in this area as a means of determining the range of options and possible proven benefits. Methodology: This study employs a mixed methods approach. A pragmatic literature review was undertaken to determine the relevant collaborative care models and review current programs Australia-wide that implement these models. Programs were selected from searching the grey and indexed medical literature as well as suggestions obtained from relevant stakeholders. Criteria for inclusion included having description in the peer reviewed and grey literature, ability to represent a unique model, extent of current use and description of outcomes of the intervention. Additional qualitative semi-structured interviews were conducted to elucidate more detailed information about technology, workforce and business systems. This information is summarised in the report and details about the individual programs are included as an appendix to this report. Results: Fifteen models were reviewed for this report. Qualitative semi-structured interview data were employed to supplement findings from the literature review. Key mechanisms of these models are described specifically focusing on the use of technology, workforce and business systems. Facilitators and barriers were identified and explored

Reducing the Rate of Falls in Hospice Patients: A Fall Prevention Pilot Program

Background and Evidence Problem: As the population ages, there is an increase in the incidents of falls. Falls are the predominant cause of both nonfatal and fatal injuries among adults aged 65 years and older (Bergen et al., 2016). Extensive research has been conducted in fall prevention in hospitals, skilled nursing, and rehabilitation units. End-of-life care in a hospice setting presents a greater challenge in risk identification and prevention of falls. A local hospice had 457 falls between July 2018 to mid-March 2019 with a lack of consistent, detailed, fall education and documentation. Evidence-Based Practice Intervention: Utilizing the American Geriatrics Society/British Geriatrics Society Fall Prevention Guidelines (American Geriatrics Society, 2011) and the Center of Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, & Injuries (STEADI) Initiative [Stevens & Phelan, 2013], the project leader created and implemented an evidence-based, multifactorial, multidisciplinary fall prevention program within the hospice setting. The anticipated measurable impact is to reduce fall rates and increase nursing fall prevention documentation in hospice care. During the course of this project, hospice teams adopted a higher standard of fall assessment, documentation, and intervention tactics. The effectiveness and cost benefit analysis may serve as a model for other hospice facilities and may be considered for registered nurse (RN) and licensed vocational nurse (LVN) curricula, continuing education, and hospice certification. PICO: Among hospice patients greater than 60 years of age living in the home/hospice setting, does implementing a multidisciplinary and multifactorial fall prevention program, compared to current fall risk interventions, result in reduced rate of falls by 30% and increased nurse knowledge and documentation intervention compliance by 90% in 3 months? Project Process: Three 1-hour, in-person educational presentations were completed for the pilot teams. Additional one-on-one sessions and a recorded presentation documented compliance. A validated pre- and post-test served as a final confirmation of the pilot teams’ fall prevention knowledge, techniques, and required documentation. The final stage of the project was comprised of a 90-day follow-up fall-rate report and audit of nursing fall-documentation compliance. Outcomes Achieved: The fall rate during the study period was reduced by 31.8%. The pre- and post-test results did not appear to be statistically significant. Initial analysis of documentation improvement was minimal during this first phase of the pilot program. Conclusions and Implications for Nursing Practice: Research indicates 30 million older adults (65 years of age and older) fall each year resulting in approximately 30,000 deaths (Bergen et al., 2016; Centers for Disease Control and Prevention, 2019). Hospice patients are particularly vulnerable due to comorbid conditions. Falls of elderly patients result in substantial medical costs, premature death, and preventable pain and suffering. Many of these falls can be averted. Fall prevention is essential and can best be accomplished utilizing a multifactorial and multidisciplinary approach to assess fall risk and to implement evidence-based preventive strategies (Eckstrom et al., 2016; McKenzie et al., 2017)

Remote Rehabilitation: A solution to Overloaded & Scarce Health Care Systems

The population across Northern Europe is aging. Coupled with socio-economic challenges, health care systems are at risk of overloading and incurring unsustainable high costs. Rehabilitation services are used disproportionately by older people. One solution pertinent to rural areas is to change the model of rehabilitation to incorporate new technologies. This has the potential to free resources and reduce costs. However, implementation is challenging. In the Northern Periphery and Artic Programme (NPA), the Smart sensor Devices for rehabilitation and Connected health (SENDoc) project [1] is focused on introducing wearable sensor systems among elderly communities to support their rehabilitation. It is important to understand the context into which change is introduced. Therefore, an overview of the current state of health care systems in the four partner countries is presented, defining the concept of rehabilitation and how remote rehabilitation is currently delivered. Advantages (e.g. enhanced outcomes, less cost and enhanced patient engagement), and disadvantages of remote rehabilitation (e.g. complexity involved in the use of technology, design and safety issues) are discussed. It is concluded that the key advantage of remote rehabilitation is the potential to support change in patient behaviour, empowering active participation and living independently, with less need to travel for face-to-face sessions. Remote rehabilitation can make enhance quality of health care service delivery. However, all relevant stakeholders including medical staff and patients should be included in the design of the technology employed with a focus on simplicity, usability and robustness. Compliance with Security and the new GDPR regulation will be key to supporting remote rehabilitation. In addition, the diversity of available platforms and devices must also be supported to ensure interoperability. Finally, remote rehabilitation needs to be further validated in practice. Attempts to implement and sustain change should be cognisant of local and current organization of health care and of existing enablers and barriers

A Possible Mobile Health Solution in Orthopedics and Trauma Surgery: Development Protocol and User Evaluation of the Ankle Joint App

Background: Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients’ young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis. Objective: In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile health (mHealth)–based rehabilitation programs after ankle sprains are rare. The aim of this study was to expose any issues present in the development process of a medical app as well as associated risks and chances. Methods: The development process of the Ankle Joint App was defined in chronological order using a protocol. The app’s quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n=20) and voluntary athletes (n=20). Results: A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app’s content provides actual medical literature, training videos, and a log function. Excellent interrater reliability (interrater reliability=0.92; 95% CI 0.86-0.96) was obtained. The mean overall score for the Ankle Joint App was 4.4 (SD 0.5). The mean subjective quality scores were 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had mean scores of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6). Conclusions: The data obtained demonstrate that mHealth-based rehabilitation programs might be a useful tool for patient education and collection of personal data. The achieved (user) MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to obtain funded evidence for the ankle joints app’s effects on economical and medical aspects in comparison with established nondigital therapy paths