MU Biodesign and Innovation Program

Jump Starting Technologies, Patent Issues, & Translational Medicine Poster SessionThe MU Biodesign and Innovation Program (MUBIP) centers its efforts off two tiers: (1) formal educational training through a biodesign and innovation fellowship and (2) interdisciplinary faculty collaboration. The Department of Surgery and College of Engineering on the University of Missouri campus in Columbia recognizes the growing need to improve patient care and desire to impact this arena through the collaborative development of MUBIP. MUBIP goals are to successfully bring new medical technologies and health care solutions into the market while producing high quality innovative professionals with the desire and knowledge to continue producing new medical technologies within our program, the University of Missouri, MU Biodesign affiliates, corporations or through the establishment of new companies resulting in economic gains. Formal Educational Training: The education tier is focused primarily on the fellowship. The experience simulates, in a compressed one-year timeframe, the phases of a start-up medical device company. The fellowship consists of a three member team including a surgeon, engineering with at least a masters degree, and business professional with a MBA. The fellowship team start date is July 1 and ends June 30. The fellowship year structure is divided into three phases that provide observation and hands-on experience in clinical, engineering and business environments. Phase 1 is clinical immersion; Phase 2 engineering design and development, finishing with Phase 3, business practices. Each phase is approximately 4 months with overlap throughout the year. In addition to observation and hands on training in each phase the fellows attend lectures related to the biodesign process, surgery, engineering and business. Lectures are presented by faculty from the Department of Surgery, College of Engineering, entrepreneurs, angel fund investors, venture capitalists, industry leaders, founders from start up companies, and other successful biodesign related individuals from the community and nationwide. Faculty, staff, residents and students are welcome to attend these lectures. Interdisciplinary Faculty Collaborations: Interdisciplinary faculty collaboration is the other tier of MUBIP. MUBIP goal is to facilitate collaboration between faculty within the University of Missouri Campus through interdisciplinary research and education. With the MUBIP mission focused to improve health care through invention and implementation of new medical technologies, we believe this can be accomplish through MUBIP guidance and support from the faculty members collaborating to build on existing relationships and form new relationships to invent innovative medical technologies. Conclusion: MU Biodesign & Innovation Program is a new innovative way to grow, build and promote new medical technologies to improve patient care. The education is a novel way to help surgeons, engineers and business people learn the process from napkin to market and prepare them for a future in medical device development. This program has the ability to impact future patient care with a generation of knowledgeable successful inventors. Collaboration is a key factor to continue improving patient care. Technologies, research and knowledge continue to grow; however, to maximize the potential of new inventions and improve patient care, it is crucial to bring engineers and surgeons together to be leaders in today's changing world

Engaging rural communities health policy

Aims & Rationale: The Alma-Ata Declaration espouses participation as a right for all citizens and important in the provision of primary health care. Australian health policy discourse encourages citizen engagement, but the extent to which this actually occurs remains unclear. Citizen engagement potentially offers considerable benefits for rural communities – a population with known health disadvantages. Drawing on results of a research project exploring the health policy implications for rural maternity care, this paper aims to (a) discuss the extent of community participation found in four rural north Queensland towns; and (b)consider how policy discourse around citizen engagement may be applied to rural health policies. Methods: Case studies of four rural north Queensland towns were completed. Observational, interview and documentary data were collected and qualitatively analysed via an inductive thematic technique. Findings: The case studies provided little indication of formal mechanisms through which community members could provide input to local health service delivery. Two communities demonstrated rapid mobilisation to rally and apply political pressure when their health services were threatened, but a distinction must be made between community action and true engagement processes. While mindful of the benefits, interviewees at all sites were particularly concerned about the barriers to successful community engagement, including: (i) overcoming community scepticism; (ii) concerns about representativeness; and (iii) community capacity. Benefits to the community: For rural communities, citizen engagement may have particular advantages in enhancing the appropriateness and responsiveness of local health services. Recommendations are made for improving rural communities' input to health policies which affect them

Health policy: outcomes for rural residents’ access to maternity care

Regular health care during pregnancy, birthing and the postnatal period is recommended for improving maternal and neonatal outcomes and accessing such care has become a common expectation for Australian families. Studies have highlighted the relative safety of birthing in rural hospitals even though these units are typically associated with low volumes of deliveries. Yet, in Queensland, the location and number of public maternity units shows a clear trend towards centralisation of services. During 1995- 2005, 43% of Queensland public maternity units closed, with the remaining units predominantly located in coastal and more populated locations. The closure of rural maternity units is not restricted to Queensland: the National Rural Health Alliance estimated 130 rural maternity units had closed across Australia throughout the decade 1996-20065. Growing numbers of closed rural maternity units raises considerable questions regarding the care accessed by rural residents. This paper presents findings from research conducted in north Queensland which examined the impact of health policy on an issue that is of central importance to rural communities—access to birthing services. A multi-dimensional understanding of access to maternity services was adopted in this study, a view which goes beyond measuring access only in terms of geographic distance. Gulliford et al have provided a constructive discussion of the multifaceted nature of access, particularly the differentiation between ‘having access’ and ‘gaining access’ to health care. Having access implies that a person has the opportunity to use a health service if they need or want it. This type of access is often measured in terms of doctors or hospital beds per capita and is dependent on the provision, and geographical allocation of resources, as well as the actual configuration of the network of health services. The authors draw attention to Mooney’s proposition that equal costs in using a service (eg costs of care, costs of travel, lost work) indicates equal access to services. On the other hand, gaining access to health care can be complicated by a variety of barriers including those of a personal nature (eg patients recognising their need to access health care); financial (that is, costs to be borne by the potential patient) or organisational (eg waiting lists)

Health policy: understanding outcomes for rural maternity care

Aims and rationale: Despite government commitments to improve rural residents' access to health services, 42% of rural maternity units throughout Queensland have closed over the last 10 years. Such closures raise concerns about equity of access and quality of maternity care for rural communities. There is little literature available which discusses the impact of health policies on rural residents' experiences of accessing maternity care, or the experiences of the health professionals who provide these services. The aims of this study are twofold: (a) critically review government health policies relevant to rural maternity care; and (b) investigate the correlation between health policy discourse and the lived experiences of rural communities in providing and accessing maternity services. Approaches: Relevant Commonwealth and Queensland health policies were identified and critically reviewed. A case study approach was then used to explore the lived experiences of both providers (midwives, GP proceduralists, hospital administrators) and users (community members) of maternity care in four rural, north Queensland towns. Data comprised documentary evidence, interviews with service providers and focus groups with community members. Findings: The reduction of rural maternity services was found to have profound, multifaceted effects on local communities. Lived experiences and policy-related outcomes are discussed within four topic areas: workforce; community engagement; quality and safety of care. Benefits to the community: Understanding policy outcomes for rural maternity units should inform the development of future health policies. Recommendations are aimed at enhancing maternity care provision and access in rural communities

Health policy and rural health services: using qualitative methodologies in policy analysis

Background: Equity, access, safety and quality are prominent themes in rural health policies at a national level. These policies often contain objectives around improving rural health services and the health status of rural Australians. It is important to consider whether these objectives are being met for rural populations to discern the appropriateness of current policies and the potential need for changes in policy approach. Objective: To understand the influence of policy on provision of, and access to, rural maternity care. Design: Analysis of policy and case studies. Setting: Four north Queensland rural towns. Participants: (a) Rural residents who recently accessed maternity care; and (b) health care professionals involved in the provision of maternity services including midwives, procedural medical practitioners and GPs. Main outcome measures: Identification of predominant themes in government policies that relate to rural maternity care and identification of outcomes for local maternity services. These findings were supplemented by insights to rural citizens’ experiences in accessing maternity care and rural clinicians’ experience in providing care. Results: The findings indicate a dearth of specific policies to support the development and continuation of rural maternity care services. Conclusions: Without detailed policy support for rural maternity care, services at each of the four case study towns appeared more vulnerable to the effects of other non-specific policies and negative environmental factors

Accessing primary health care: A meta-ethnography of the experiences of British South Asian patients with diabetes, coronary heart disease or a mental health problem

Objectives: To develop an explanatory framework of the problems accessing primary care health services experienced by British South Asian patients with a long-term condition or mental health problem. Methods: This study used meta-ethnographic methods. Published qualitative studies were identified from a structured search of six databases and themes synthesized across studies to develop a new explanatory framework. Results: Initial searches identified 951 potentially relevant records from which a total of 27 articles were identified that met inclusion and exclusion criteria. Twelve of these articles were chosen on the basis of their quality and relevance. These 12 articles described themes relating to the cultural, spatial and temporal dimensions of patient experiences of accessing and using health care. Our interpretive synthesis showed that access to primary care among British South Asians with diabetes, coronary heart disease and psychological health problems is co-constructed and negotiated over time and space along the key domains of the candidacy model of access: from help-seeking to interactions at the interface to following treatment advice. In the case of each condition, British South Asians’ claims to candidacy were constrained where their individual as well as broader social and cultural characteristics lacked fit with professionals’ ways of working and cultural typifications. Conclusion: Interventions that positively affect professionals’ capacity to support patient claims to candidacy are likely to help support British South Asians overcome a broad range of barriers to care for physical and mental health problems. </jats:p

Population-Based Pragmatic Trial of Advance Care Planning in Primary Care in the University of California Health System.

Introduction: Varying intensity of advance care planning (ACP) interventions at the population level has not been compared among seriously ill patients in primary care. This project will implement, test, and disseminate real-world scalable ACP interventions among primary care clinics across three University of California Health systems. The three ACP interventions are (1) distribution of an advance directive (AD) with targeted ACP messaging, (2) the AD, messaging, plus prompting patients to engage with the Prepare For Your Care website (PREPARE), and (3) the AD, messaging, PREPARE, plus Care Coordinator engagement with patients and clinicians. Methods: We will identify a population cohort of seriously ill primary care patients and implement the ACP interventions using electronic health record (EHR) patient portals and postal mailings. Forty-five clinics across the three health systems will be cluster randomized to one of the three ACP interventions. The primary outcome for the population cohort is AD or Physician Orders for Life-Sustaining Treatment documentation in the EHR. A subset of the population cohort will be surveyed to assess patient-centered outcomes, including care consistent with goals at baseline, 12 months, and 24 months. Caregivers will be interviewed if patients are unable to be surveyed or die. ACP documentation, goal concordant care, and among decedents, health care utilization will be compared among intervention arms. Study Implementation: Challenges and Contributions: The project is guided by a Study Advisory Group and Community Advisory Groups at each site to ensure rigorous patient-centered methods and consistency of implementation. Intervention fidelity will be evaluated using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. Challenges to implementation of this three-site health system trial and to intervention fidelity stem from site/clinic/system cultures, increasing attention to end-of-life care from payers and regulators, and growing pressures by health systems to implement ACP interventions. Stakeholder engagement is required to ensure consistent interventions across sites