Providers and Patients Caught Between Standardization and Individualization: Individualized Standardization as a Solution Comment on “(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare”

Abstract In their 2017 article, Mannion and Exworthy provide a thoughtful and theory-based analysis of two parallel trends in modern healthcare systems and their competing and conflicting logics: standardization and customization. This commentary further discusses the challenge of treatment decision-making in times of evidence-based medicine (EBM), shared decision-making and personalized medicine. From the perspective of systems theory, we propose the concept of individualized standardization as a solution to the problem. According to this concept, standardization is conceptualized as a guiding framework leaving room for individualization in the patient physician interaction. The theoretical background is the concept of context management according to systems theory. Moreover, the comment suggests multidisciplinary teams as a possible solution for the integration of standardization and individualization, using the example of multidisciplinary tumor conferences and highlighting its limitations. The comment also supports the authors’ statement of the patient as co-producer and introduces the idea that the competing logics of standardization and individualization are a matter of perspective on macro, meso and micro levels

Meeting patients’ health information needs in breast cancer center hospitals – a multilevel analysis

Abstract Background Breast cancer patients are confronted with a serious diagnosis that requires them to make important decisions throughout the journey of the disease. For these decisions to be made it is critical that the patients be well informed. Previous studies have been consistent in their findings that breast cancer patients have a high need for information on a wide range of topics. This paper investigates (1) how many patients feel they have unmet information needs after initial surgery, (2) whether the proportion of patients with unmet information needs varies between hospitals where they were treated and (3) whether differences between the hospitals account for some of these variation. Methods Data from 5,024 newly-diagnosed breast cancer patients treated in 111 breast center hospitals in Germany were analyzed and combined with data on hospital characteristics. Multilevel linear regression models were calculated taking into account hospital characteristics and adjusting for patient case mix. Results Younger patients, those receiving mastectomy, having statutory health insurance, not living with a partner and having a foreign native language report higher unmet information needs. The data demonstrate small between-hospital variation in unmet information needs. In hospitals that provide patient-specific information material and that offer health fairs as well as those that are non-teaching or have lower patient-volume, patients are less likely to report unmet information needs. Conclusion We found differences in proportions of patients with unmet information needs between hospitals and that hospitals’ structure and process-related attributes of the hospitals were associated with these differences to some extent. Hospitals may contribute to reducing the patients’ information needs by means that are not necessarily resource-intensive.http://deepblue.lib.umich.edu/bitstream/2027.42/109539/1/12913_2014_Article_601.pd

The ENTWINE iCohort Study, a multinational longitudinal web-based study of informal care

Informal care is a key pillar of long-term care provision across Europe and will likely play an even greater role in the future. Thus, research that enhances our understanding of caregiving experiences becomes increasingly relevant. The ENTWINE iCohort Study examines the personal, psychological, social, economic, and geographic factors that shape caregiving experiences. Here, we present the baseline cohort of the study and describe its design, recruitment methods, data collection procedures, measures, and early baseline findings. The study was conducted in nine countries: Germany, Greece, Ireland, Israel, Italy, the Netherlands, Poland, Sweden, and the United Kingdom. The study comprised a web- based longitudinal survey (baseline + 6-month follow-up) and optional weekly diary assessments, conducted separately with caregivers and care recipients. From 14 August 2020 to 31 August 2021, 1872 caregivers and 402 care recipients were enrolled at baseline. Participants were recruited via Facebook, and to a lesser extent via the study website or caregiver/patient organisations. Caregiver participants were predominantly female (87%) and primary caregivers (82%), with a median age of 55 years. A large proportion (80%) held at least post-secondary education, and two-thirds were married/partnered. Over half of the caregivers were employed (53%) and caring for a person with multiple chronic conditions (56%), and nearly three-quarters were caring for either a parent (42%) or a spouse/partner (32%). About three-quarters of care recipient participants were female (77%), not employed (74%), and had at least post-secondary education (77%), with a median age of 55 years. Over half of the care recipients were married/partnered (59%), receiving care primarily from their spouses/partners (61%), and diagnosed with multiple chronic conditions (57%). This study examining numerous potential influences on caregiving experiences provides an opportunity to better understand the multidimensional nature of these experiences. Such data could have implications for developing caregiving services and policies, and for future informal care research.<br/

The ERATOSTHENES Centre of Excellence (ECoE) as a digital innovation hub for Earth observation

The "EXCELSIOR" H2020 Widespread Teaming Phase 2 Project: ERATOSTHENES: EXcellence Research Centre for Earth SurveiLlance and Space-Based MonItoring Of the EnviRonment is supported from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 857510 for a 7 year project period to establish a Centre of Excellence in Cyprus. As well, the Government of the Republic of Cyprus is providing additional resources to support the establishment of the ERATOSTHENES Centre of Excellence (ECoE) in Cyprus. The ECoE seeks to fill the gap by assisting in the spaceborne Earth Observation activities in the Eastern Mediterranean and become a regional key player in the Earth Observation (EO) sector. There are distinct needs and opportunities that motivate the establishment of an Earth Observation Centre of Excellence in Cyprus, which are primarily related to the geostrategic location of the European Union member state of Cyprus to examine complex scientific problems and address user needs in the Eastern Mediterranean, Middle East and Northern Africa (EMMENA), as well as South-East Europe. An important objective of the ECoE is to be a Digital Innovation Hub and a Research Excellence Centre for EO in the EMMENA region, which will establish an ecosystem where state-of-the-art sensing technology, cutting-edge research, targeted education services, and entrepreneurship come together. It is based on the paradigm of Open Innovation 2.0 (OI2.0), which is founded on the Quadruple Helix Model, where Government, Industry, Academia and Society work together to drive change by taking full advantage of the cross-fertilization of ideas. The ECoE as a Digital Innovation Hub (DIH) adopts a two-axis model, where the vertical axis consists of three Thematic Clusters for sustained excellence in research of the ECoE in the domains of Atmosphere and Climate, Resilient Societies and Big Earth Data Management, while the horizontal axis is built around four functional areas, namely: Infrastructure, Research, Education, and Entrepreneurship. The ECoE will focus on five application areas, which include Climate Change Monitoring, Water Resource Management, Disaster Risk Reduction, Access to Energy and Big EO Data Analytics. This structure is expected to leverage the existing regional capacities and advance the excellence by creating new programs and research, thereby establishing the ECoE as a worldclass centre capable of enabling innovation and research competence in Earth Observation, actively participating in Europe, the EMMENA region and the global Earth Observation arena. The partners of the EXCELSIOR consortium include the Cyprus University of Technology as the Coordinator, the German Aerospace Center (DLR), the Leibniz Institute for Tropospheric Research (TROPOS), the National Observatory of Athens (NOA) and the Department of Electronic Communications, Deputy Ministry of Research, Innovation and Digital Policy

Providers and Patients Caught Between Standardization and Individualization: Individualized Standardization as a Solution

In their 2017 article, Mannion and Exworthy provide a thoughtful and theory-based analysis of two parallel trends in modern healthcare systems and their competing and conflicting logics: standardization and customization. This commentary further discusses the challenge of treatment decision-making in times of evidence-based medicine (EBM), shared decision-making and personalized medicine. From the perspective of systems theory, we propose the concept of individualized standardization as a solution to the problem. According to this concept, standardization is conceptualized as a guiding framework leaving room for individualization in the patient physician interaction. The theoretical background is the concept of context management according to systems theory. Moreover, the comment suggests multidisciplinary teams as a possible solution for the integration of standardization and individualization, using the example of multidisciplinary tumor conferences and highlighting its limitations. The comment also supports the authors' statement of the patient as co-producer and introduces the idea that the competing logics of standardization and individualization are a matter of perspective on macro, meso and micro levels

Report from an ongoing research project: The Cologne Research and Development Network (CoRe-Net) and the value-based approach to healthcare

With the BMBF's funding program Structural Development in Health Services Research the Cologne Research and Development Network CoRe-Net is being set up by various partners from both clinical practice and health services research. The network focuses on the further development of healthcare according to the concept of learning organizations. On the basis of three research projects, the Cologne network CoRe-Net aims to establish itself in a sustainable manner and analyze healthcare delivery for two vulnerable patient groups. The two groups include a) deceased patients in Cologne and b) people suffering from heart disease and an associated mental comorbidity. The Cologne network CoRe-Net is based on M.E. Porter's value-based healthcare approach

Patient participation in multidisciplinary tumour conferences in breast cancer care (PINTU): a mixed-methods study protocol

Introduction A central instrument of multidisciplinary care is the multidisciplinary tumour conference (MTC). In MTCs, diagnosis and treatment of cancer patients are discussed, and therapy recommendations are worked out. As we found previously, patients participate in MTCs in some breast cancer centres in the state of North Rhine-Westphalia, Germany. However, studies on risks and benefits of patient participation have not provided substantiated findings. Therefore, the study's objective is to analyse differences between MTCs with and without patient participation. Methods and analysis This is an exploratory mixed-methods study. MTCs in six breast and gynaecological cancer centres in North Rhine-Westphalia, Germany, are examined. MTCs will be conducted with and without patient participation. First, interviews with providers concentrating on the feasibility of patient participation and quality of decision-making will be carried out, transcribed and analysed by means of content analysis. Second, videotaped or audiotaped participatory observations in MTCs will be executed. Video data or transcribed audio data from video and audio recordings will be coded using the established Observational Assessment Rating Scale for MTCs and analysed by comparing centres with and without patient participation. Third, all patients will fill out a questionnaire before and after MTC, including questions on psychosocial situation, decision-making and expectations before and experiences after MTC. The questionnaire data will be analysed by means of descriptive and multivariate statistics and pre-post-differences within and between groups. Ethics and dissemination Consultation and a positive vote from the ethics committee of the Medical Faculty of the University of Cologne have been obtained. For all collected data, relevant data protection regulations will be adhered to. All personal identifiers from patients and providers will be pseudonymised, except video recordings. Dissemination strategies include a discussion with patients and providers in workshops about topics such as feasibility, risks and benefits of patient participation in MTCs