15 research outputs found

    Cardiovascular System in Preeclampsia and Beyond.

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    Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness

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    Introduction Adrenal incidentalomas are lesions that are incidentally identified while scanning for other conditions. While most are benign and hormonally non-functional, around 20% are malignant and/or hormonally active, requiring prompt intervention. Malignant lesions can be aggressive and life-threatening, while hormonally active tumours cause various endocrine disorders, with significant morbidity and mortality. Despite this, management of patients with adrenal incidentalomas is variable, with no robust evidence base. This project aimed to establish more effective and timely management of these patients. Methods We developed a web-based, electronic Adrenal Incidentaloma Management System (eAIMS), which incorporated the evidence-based and National Health Service–aligned 2016 European guidelines. The system captures key clinical, biochemical and radiological information necessary for adrenal incidentaloma patient management and generates a pre-populated outcome letter, saving clinical and administrative time while ensuring timely management plans with enhanced safety. Furthermore, we developed a prioritisation strategy, with members of the multidisciplinary team, which prioritised high-risk individuals for detailed discussion and management. Patient focus groups informed process-mapping and multidisciplinary team process re-design and patient information leaflet development. The project was partnered by University Hospital of South Manchester to maximise generalisability. Results Implementation of eAIMS, along with improvements in the prioritisation strategy, resulted in a 49% reduction in staff hands-on time, as well as a 78% reduction in the time from adrenal incidentaloma identification to multidisciplinary team decision. A health economic analysis identified a 28% reduction in costs. Conclusions The system’s in-built data validation and the automatic generation of the multidisciplinary team outcome letter improved patient safety through a reduction in transcription errors. We are currently developing the next stage of the programme to proactively identify all new adrenal incidentaloma cases

    Analysis of Barriers to the Deployment of Health Information Systems: a Stakeholder Perspective

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    © 2018 The Author(s). This paper argues that the cross-analysis of barriers with stakeholders provides a richer picture than analyzing the barriers on their own, as most of the literature in this area does. To test this hypothesis, we used the data from 33 interviews across 19 different types of stakeholders that were involved in a telemedicine system for the Chronically-ill Patient. Our findings show encouraging results. For instance, it was found that the group of stakeholders who are directly related to the governance and policy-making identified most of the barriers. This finding may imply that this group is more aware of the challenges when implementing HIS, or it may suggest that this group poses more resistance due to the current economic and Organizational models in health care. It was also found that some barriers are cited by all stakeholders whereas others not, suggesting that some barriers may be more relevant than others

    Evaluating health information system interventions using analytical and modeling methods

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    In recent years the value of the use of evaluation methods in all aspects of economic sectors, including the field of health care, has been increasingly recognized. The thrust of this paper is to explore the potential use of a) Cost-Benefit Analysis and b) Simulation and Modeling methods in estimating the value of Health Information System (HIS) projects. These methods were chosen for consideration as the most appropriate, primarily because CBA can measure delivered value of HIS interventions by weighting cost and benefits and identifying what is more socially desirable, while Simulation and Modeling tools can be used to estimate the future value of health care changes concerning HIS. The paper discusses these two families of methods, their evaluation potential is analyzed, and arguments for and against the use of each method are presented. Finally, methodological considerations and limitations are discussed and areas for future research are suggested

    Evaluating health information system interventions using analytical and modeling methods

    No full text
    In recent years the value of the use of evaluation methods in all aspects of economic sectors, including the field of health care, has been increasingly recognized. The thrust of this paper is to explore the potential use of a) Cost-Benefit Analysis and b) Simulation and Modeling methods in estimating the value of Health Information System (HIS) projects. These methods were chosen for consideration as the most appropriate, primarily because CBA can measure delivered value of HIS interventions by weighting cost and benefits and identifying what is more socially desirable, while Simulation and Modeling tools can be used to estimate the future value of health care changes concerning HIS. The paper discusses these two families of methods, their evaluation potential is analyzed, and arguments for and against the use of each method are presented. Finally, methodological considerations and limitations are discussed and areas for future research are suggested

    Home blood‐pressure monitoring in a hypertensive pregnant population: cost‐minimization study

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    Objective Traditional blood‐pressure monitoring in hypertensive pregnant women requires frequent visits to the maternity outpatient services. Home blood‐pressure monitoring (HBPM) could offer a cost‐saving alternative that is acceptable to patients. The aim of this study was to undertake a health economic analysis of HBPM compared with traditional monitoring in hypertensive pregnant women. Methods This was a cost‐minimization study of hypertensive pregnant women who had HBPM with or without the adjunct of a smartphone application (App), via a specially designed pathway, and a control group managed according to the local protocol of regular hospital visits for blood‐pressure monitoring. Outcome measures were the number of outpatient visits, inpatient bed stays and investigations performed. Maternal, fetal and neonatal adverse outcomes were also recorded. Health economic analysis was performed using direct cost comparison of the study dataset and process scenario modeling. Results The HBPM group included 108 women, of whom 29 recorded their results on the smartphone App and 79 in their notes. The control group comprised 58 patients. There were significantly more women with chronic hypertension in the HBPM group than in the control group (49.1% vs 25.9%, P = 0.004). The HBPM group had significantly longer duration of monitoring (9 weeks vs 5 weeks, P = 0.004) and started monitoring at an earlier gestational age (30.0 weeks vs 33.6 weeks, P = 0.001) compared with the control group. Despite these differences, the mean saving per week for each patient using HBPM compared with traditional monitoring was £200.69, while for each HBPM patient using the smartphone App, the weekly saving was £286.53 compared with the control group. The process modeling method predicted weekly savings of between £98.32 and £245.80 per patient using HBPM compared with traditional monitoring. Conclusion HBPM in hypertensive pregnancy appears to be cost saving compared with traditional monitoring, without compromising maternal, fetal or neonatal safety. Larger studies are required to confirm these findings
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