Patients’ involvement in e-health services quality assessment: A system for the automatic interpretation of SMS-based patients’ feedback

AbstractPurposeEffective communication between patients and health services providers is a key aspect for optimizing and maintaining these services. This work describes a system for the automatic evaluation of users’ perception of the quality of SmsCup, a reminder system for outpatient visits based on short message service (SMS). The final purpose is the creation of a closed-loop control system for the outpatient service, where patients’ complaints and comments represent a feedback that can be used for a better implementation of the service itself.MethodsSmsCup was adopted since about eight years by an Italian healthcare organization, with very good results in reducing the no-show (missing visits) phenomenon. During these years, a number of citizens, even if not required, sent a message back, with comments about the service. The automatic interpretation of the content of those SMS may be useful for monitoring and improving service performances.Yet, due to the complex nature of SMS language, their interpretation represents an ongoing challenge. The proposed system uses conditional random fields as the information extraction method for classifying messages into several semantic categories. The categories refer to appreciation of the service or complaints of various types. Then, the system analyzes the extracted content and provides feedback to the service providers, making them learning and acting on this basis.ResultsAt each step, the content of the messages reveals the actual state of the service as well as the efficacy of corrective actions previously undertaken. Our evaluations showed that: (i) the SMS classification system has achieved good overall performance with an average F1-measure and an overall accuracy of about 92%; (ii) the notification of the patients’ feedbacks to service providers showed a positive impact on service functioning.ConclusionsOur study proposed an interactive patient-centered system for continuous monitoring of the service quality. It has demonstrated the feasibility of a tool for the analysis and notification of the patients’ feedback on their service experiences, which would support a more regular access to the service

Implementing clinical guidelines in an organizational setup

Outcomes research in healthcare has been a topic much addressed in recent years. Efforts in this direction have been supplemented by work in the areas of guidelines for clinical practice and computer-interpretable workflow and careflow models.In what follows we present the outlines of a framework for understanding the relations between organizations, guidelines, individual patients and patient-related functions. The derived framework provides a means to extract the knowledge contained in the guideline text at different granularities, in ways that can help us to assign tasks within the healthcare organization and to assess clinical performance in realizing the guideline. It does this in a way that preserves the flexibility of the organization in the adoption of the guidelines

Data Quality and Completeness in a Web Stroke Registry as the Basis for Data and Process Mining

Electronic health records often show missing values and errors jeopardizing their effective exploitation. We illustrate the re-engineering process needed to improve the data quality of a web-based, multicentric stroke registry by proposing a knowledge-based data entry support able to help users to homogeneously interpret data items, and to prevent and detect treacherous errors. The re-engineering also improves stroke units coordination and networking, through ancillary tools for monitoring patient enrollments, calculating stroke care indicators, analyzing compliance with clinical practice guidelines, and entering stroke units profiles. Finally we report on some statistics, such as calculation of indicators for assessing the quality of stroke care, data mining for knowledge discovery, and process mining for comparing different processes of care delivery. The most important results of the re-engineering are an improved user experience with data entry, and a definitely better data quality that guarantees the reliability of data analyses

Wearable kinesthetic system for capturing and classifying upper limb gesture in post-stroke rehabilitation

BACKGROUND: Monitoring body kinematics has fundamental relevance in several biological and technical disciplines. In particular the possibility to exactly know the posture may furnish a main aid in rehabilitation topics. In the present work an innovative and unobtrusive garment able to detect the posture and the movement of the upper limb has been introduced, with particular care to its application in post stroke rehabilitation field by describing the integration of the prototype in a healthcare service. METHODS: This paper deals with the design, the development and implementation of a sensing garment, from the characterization of innovative comfortable and diffuse sensors we used to the methodologies employed to gather information on the posture and movement which derive from the entire garments. Several new algorithms devoted to the signal acquisition, the treatment and posture and gesture reconstruction are introduced and tested. RESULTS: Data obtained by means of the sensing garment are analyzed and compared with the ones recorded using a traditional movement tracking system. CONCLUSION: The main results treated in this work are summarized and remarked. The system was compared with a commercial movement tracking system (a set of electrogoniometers) and it performed the same accuracy in detecting upper limb postures and movements

Caratteristiche e atteggiamenti di 201 operatori penitenziari a trent’anni dalla riforma

Thirty years on, following the approval of the prison reform bill has seen a profound change in the socio-demographic profile of correction officers. Nowadays, they are people with a higher cultural level, who are more motivated as regards the career they have chosen, whose socio-economic backgrounds are less disadvantaged and who have a higher number of years of service. However, this improved profile of correction officers has not been matched by a greater ability of prisons to carry out their rehabilitatory role; there have been no corresponding gradual changes to overcome the problems that beset the prison system: the chronic lack of facilities, the appalling state of the prison buildings, the overcrowding, lack of opportunities, staff shortages, etc. These persisting shortfalls have hindered the implementation of prison reform,and have become manifest in the deep mistrust expressed by correction officers, who, especially the youngest and most highly educated, do not believe that prison can be effective, despite the fact that the majority retain rehabilitation to be a worthy ideal. The responses given by workers also reveal a lack of faith in alternatives to prison as well as in their attitude towards the inmates. Both the prison guards and early half the correction officers consider them to be individuals destined to a life of crime due to their character traits and lifestyle. The study also highlighted that the older the correction officer and the higher the level of education, then the more favourable was their attitude towards inmates and prison reform. Overall, the findings of this research study bear witness to the essential feeling that the ideals which animated prison reform have not been met, and that the results obtained are the expression of a society which shuns diversity and those people who make its members feel ill at ease. Consequently, prison is viewed as a means for segregation, a place in which to offload the 'problem' cases who are perceived as being a threat to the survival of society and its members.Ad oltre trent’anni dall’approvazione della riforma penitenziaria si assiste ad un mutamento profondo delle caratteristiche socio-demografiche degli operatori penitenziari, che oggi risultano più attrezzati sotto il profilo culturale, più motivati nella scelta del proprio lavoro, provenienti da contesti socio-economici meno svantaggiati e con una maggiore anzianità di servizio. Tuttavia, a questa maggiore idoneità del personale penitenziario non ha fatto riscontro una maggiore capacità del carcere a svolgere la sua funzione rieducativa, attraverso un graduale superamento delle sue croniche carenze strutturali, quali istituti fatiscenti, sovraffollamento, mancanza di opportunità, carenza di personale, ecc. Questa persistente inadeguatezza ha minato l’applicazione della riforma penitenziaria, traducendosi in un sentimento di profonda sfiducia da parte degli operatori, i quali, soprattutto quelli più giovani e più istruiti, non ritengono che il carcere possa essere efficace, anche se per la maggior parte di essi la riabilitazione resta un ideale valido. Dalle risposte degli operatori si rileva un atteggiamento di sfiducia anche nei confronti delle misure alternative e degli stessi detenuti, i quali vengono percepiti dalla maggior parte dei poliziotti e da circa metà degli operatori del trattamento come soggetti fatalmente destinati a delinquere per le caratteristiche di personalità e le abitudini di vita. La ricerca ha messo altresì in evidenza che quanto più l’operatore penitenziario ha un’ età avanzata ed un più alto livello di istruzione, tanto più l’atteggiamento nei confronti del detenuto e della riforma penitenziaria tende a divenire più favorevole. In definitiva, i dati emersi dalla ricerca testimoniano sostanzialmente il venir meno degli ideali che hanno animato la riforma penitenziaria e sono l’espressione di un modello di società che in una logica di esclusione del disagio e della diversità, tende a considerare il carcere come luogo di segregazione in cui scaricare quelle situazioni problematiche che avverte come minacciose per la propria sopravvivenza

Computer-based cognitive rehabilitation: the CoRe system

This work aims at providing a tool for supporting cognitive rehabilitation. This is a wide field, that includes a variety of diseases and related clinical pictures; for this reason the need arises to have a tool available that overcomes the difficulties entailed by what currently is the most common approach, that is, the so-called pen and paper rehabilitation. Methods: We first organized a big number of stimuli in an ontology that represents concepts, attributes and a set of relationships among concepts. Stimuli may be words, sounds, 2D and 3D images. Then, we developed an engine that automatically generates exercises by exploiting that ontology. The design of exercises has been carried on in synergy with neuropsychologists and speech therapists. Solutions have been devised aimed at personalizing the exercises according to both patients’ preferences and performance. Results: Exercises addressed to rehabilitation of executive functions and aphasia-related diseases have been implemented. The system has been tested on both healthy volunteers (n 1/4 38) and patients (n 1/4 9), obtaining a favourable rating and suggestions for improvements. Conclusions: We created a tool able to automate the execution of cognitive rehabilitation tasks. We hope the variety and personalization of exercises will allow to increase compliance, particularly from elderly people, usually neither familiar with technology nor particularly willing to rely on it. The next step involves the creation of a telerehabilitation tool, to allow therapy sessions to be undergone from home, thus guaranteeing continuity of care and advantages in terms of time and costs for the patients and the National Healthcare System (NHS).Postprint (published version

Ideating Mobile Health Behavioral Support for Compliance to Therapy for Patients with Chronic Disease: A Case Study of Atrial Fibrillation Management

Poor patient compliance to therapy results in a worsening condition that often increases healthcare costs. In the MobiGuide project, we developed an evidence-based clinical decision-support system that delivered personalized reminders and recommendations to patients, helping to achieve higher therapy compliance. Yet compliance could still be improved and therefore building on the MobiGuide project experience, we designed a new component called the Motivational Patient Assistant (MPA) that is integrated within the MobiGuide architecture to further improve compliance. This component draws from psychological theories to provide behavioral support to improve patient engagement and thereby increasing patients\u27 compliance. Behavior modification interventions are delivered via mobile technology at patients\u27 home environments. Our approach was inspired by the IDEAS (Integrate, Design, Assess, and Share) framework for developing effective digital interventions to change health behavior; it goes beyond this approach by extending the Ideation phase\u27 concepts into concrete backend architectural components and graphical user-interface designs that implement behavioral interventions. We describe in detail our ideation approach and how it was applied to design the user interface of MPA for anticoagulation therapy for the atrial fibrillation patients. We report results of a preliminary evaluation involving patients and care providers that shows the potential usefulness of the MPA for improving compliance to anticoagulation therapy

Computer-Assessed Preference-Based Quality of Life in Patients with Spinal Cord Injury

Objectives. Our aims were to (1) measure quality of life (QoL) in spinal cord injury (SCI) patients using different methods and analyze differences; (2) enable targeted treatments by identifying variables that affect QoL; and (3) provide decision-makers with useful data for cost-utility analyses in SCI population. Methods. Seventy-one participants were enrolled. The computer-based tool UceWeb was used to elicit QoL in terms of utility coefficients, through the standard gamble, time trade-off, and rating scale methods. The SF36 questionnaire was also administered. Statistical analyses were performed to find predictors of QoL among collected variables. Results. Median values for rating scale, time trade-off, and standard gamble were 0.60, 0.82, and 0.85, respectively. All scales were significantly correlated. Rating scale and SF36 provided similar values, significantly lower than the other methods. Impairment level, male gender, older age, living alone, and higher education were correlated with lower QoL but accounted for only 20% of the variation in utility coefficients. Conclusions. Demographic and clinical variables are useful to predict QoL but do not completely capture utility coefficients variability. Therefore, direct preference-based utility elicitation should be strengthened. Finally, this is the first study providing data that can be used as a reference for cost-utility analyses in the Italian SCI population

Enhancing guideline-based decision support with distributed computation through local mobile application

We introduce the need for a distributed guideline-based decision support (DSS) process, describe its characteristics, and explain how we implemented this process within the European Union’s MobiGuide project. In particular, we have developed a mechanism of sequential, piecemeal projection, i.e., 'downloading' small portions of the guideline from the central DSS server, to the local DSS in the patient's mobile device, which then applies that portion, using the mobile device's local resources. The mobile device sends a callback to the central DSS when it encounters a triggering pattern predefined in the projected module, which leads to an appropriate predefined action by the central DSS, including sending a new projected module, or directly controlling the rest of the workflow. We suggest that such a distributed architecture that explicitly defines a dialog between a central DSS server and a local DSS module, better balances the computational load and exploits the relative advantages of the central server and of the local mobile device

Patient-tailored Workflow Patterns from Clinical Practice Guidelines Recommendations

Abstract MobiGuide is a project devoted to the development of a patient-centric decision support system based on computerized clinical guidelines for chronic illnesses including Atrial . In this paper we describe the process o