Attending unintended transformations of health care infrastructure

Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. <br><br> Theory and methods: Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices. <br><br> Results: This paper develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT. <br><br> Conclusion and discussion: The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into health care practices and outcomes

Exploring, describing, and mapping the constitutive elements of patient-reported outcomes (PROs) used in clinical practice

Abstract Background: The functionality and purpose of patient-reported outcomes (PROs) have evolved as a result of their digitalisation and extended application in clinical practice. The diffusion of PROs on various organisational levels in different sectors and disease areas has further shaped their usage and construction. Thus, this paper identifies the main elements constituting a PRO in the context of clinical practice. The aim is to create a concept map (PRO Elements) grounded in the extant literature, translating, combining, and mediating different interpretations of PRO among stakeholders, to enhance users’ understanding and use of PROs with a particular focus on patient participation. Methods: The study is based on a systematic document analysis—a sub-study of an extensive scoping review (PubMed, Embase, CINAHL, Scopus) of PROs and patient participation in clinical practice. Results: The mapping of PRO reveals that, in clinical practice, a combination of eight main elements constitutes a PRO— validated questionnaire(s), developers, content, measures, mediation, respondents, data, and outcomes – forming the concept map called PRO Elements. Conclusion: The article provides an interdisciplinary mapping, presentation, and discussion of PROs’ constitutive elements, with an emphasis on patient participation. The holistic conceptualisation map illustrates various types of PROs that may prompt stakeholders to engage in discourse on the development, implementation, and evaluation of PROs to create more coherent and beneficial applications

The Purpose of Patient-Reported Outcome (PRO) Post Its Digitalization and Integration into Clinical Practice: An Interdisciplinary Redefinition Resembling PROs Theoretical and Practical Evolvement

Patient-reported outcomes (PROs) digitalization and integration into clinical practice has widened its purpose, which makes it relevant to reconceptualize PRO accordingly. Therefore, this study aims to describe and critically discuss the purposes of PRO and to suggest an interdisciplinary definition of PRO aligned with current applications. The findings in this study are based on a formerly conducted scoping review on PRO and patient participation; hence, a sub-study focusing on the purpose of PRO. The purposes of PRO pertain to research and drug testing; quality and economy; patient-centered care; politicization and democratization; and organization and culture. The suggested definition describes PRO as a validated questionnaire; developed in collaboration between patients, clinicians, and other pertinent stakeholders; systematically applied; mediated digitally or paper-based; completed directly by the patient, with assistance or by a qualified proxy; composed of generic, disease-specific, condition-specific or preference-based measures; consisting of content pertaining to the patient&rsquo;s physical and mental health condition, functioning, symptoms, well-being or health-related quality of life (HRQoL); providing objective and/or subjective outcomes, and individual and/or population data. An alternative understanding of PRO is meant to enhance the link between purposes and definitions of PRO, facilitating interdisciplinary stakeholder discussions on PRO, potentially improving future PRO interventions