Health Care Efforts Research Articles

Data-Driven Healthcare: Challenges and Opportunities for Interactive Visualization

The healthcare industry's widespread digitization efforts are reshaping one of the largest sectors of the world's economy. This transformation is enabling systems that promise to use ever-improving data-driven evidence to help doctors make more precise diagnoses, institutions identify at risk patients for intervention, clinicians develop more personalized treatment plans, and researchers better understand medical outcomes within complex patient populations. Given the scale and complexity of the data required to achieve these goals, advanced data visualization tools have the potential to play a critical role. This article reviews a number of visualization challenges unique to the healthcare discipline.

Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature

Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and...

The Impact of Privacy Regulation and Technology Incentives: The Case of Health Information Exchanges

Health information exchanges (HIEs) are healthcare information technology efforts designed to foster coordination of patient care across the fragmented U.S. healthcare system. Their purpose is to improve efficiency and quality of care through enhanced sharing of patient data. Across the United States, numerous states have enacted laws that provide various forms of incentives for HIEs and address growing privacy concerns associated with the sharing of patient data. We investigate the impact on the emergence of HIEs of state laws that incentivize HIE efforts and state laws that include different types of privacy requirements for sharing healthcare data, focusing on the impact of laws that include requirements for patient consent. Although we observe that privacy regulation alone can result in a decrease in planning and operational HIEs, we also find that, when coupled with incentives, privacy regulation with requirements for patient consent can actually positively impact the development of HIE efforts. Among all states with laws creating HIE incentives, only states that combined incentives with consent requirements saw a net increase in operational HIEs; HIEs in those states also reported decreased levels of privacy concern relative to HIEs in states with other legislative approaches. Our results contribute to the burgeoning literature on health information technology and the debate on the impact of privacy regulation on technology innovation. In particular, they show that the impact of privacy regulation on the success of information technology efforts is heterogeneous: both positive and negative effects can arise from regulation, depending on the specific attributes of privacy laws. This paper was accepted by Anandhi Bharadwaj, information systems.

Correlates of psychological care strategies for people with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study.

To assess the ways in which healthcare professionals address psychological problems of adults with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study. Approximately 120 primary care physicians, 80 diabetes specialists and 80 nurses and dietitians providing diabetes care participated in each of 17 countries (N=4785). Multiple regression analyses were used to evaluate independent statistically significant associations of respondent attributes concerning psychological care strategies, including assessment of diabetes impact on the patient's life, assessment of depression, provision of psychological assessment and support, and coordination with mental health professionals. Psychological care strategies were positively associated with each other but differed by healthcare practice site and discipline; nurses and dietitians were less likely to assess depression than other healthcare professionals, while primary care physicians were less likely to coordinate with mental health specialists or ask patients how diabetes affects their lives. Psychological care was positively associated with healthcare professionals' beliefs that patients need help dealing with emotional issues and that clinical success depends on doing so, and also with level of psychological care training, multidisciplinary team membership and availability of resources for psychological care. There were significant between-country variations in psychological care strategies, before and after adjustment for individual-level factors, and significant country-by-covariate interactions for almost all individual-level factors investigated. Improvements in training and resources, recognition and assessment of psychological problems, and increased belief in the efficacy of psychological support may enhance healthcare professionals' efforts to address psychological problems in adults with diabetes.

Smoking cessation assisted by primary healthcare professionals

Background: The effectiveness of smoking cessation treatments have been well studied, but most smokers quit without assistance from a health professional. To further improve our understanding of how primary healthcare efforts can benefit patients who attempt to quit, we need a deeper understanding of how the process unfolds when assisted by a health professional and how this is experienced by the smoker. Objective: To construct an emergent model of the smoking cessation process assited by primary health care professional. Methods: Data were collected from videorecordings of primary healthcare office sessions to promote smoke cessation in Barcelona Province (Catalonia, Spain). Thirteen smokers and their primary healthcare professionals engaged in 24 preparatory sessions and 23 follow-up sessions. Data were analyzed according to Constant Comparative Analysis Method along with conceptual and theory frameworks. Results: Smoking cessation is a social process that is shaped by interactions and relationships with health professionals. Four categories explain the process: 1) Feeling addicted and wanting help to quit smoking; 2) Preparing to quit smoking: anticipating abstinence; 3) Managing smoking abstinence: a positive or transitional process; and 4) Controlling the urge to smoke: a central process in smoking cessation. Conclusions: Health professionals treat smoking behaviors as a health problem and supervise the process of enabling the smoker to learn how to control the urge to smoke. Learning to control smoking abstinence is not always enough to enable the individual to reorganize and restructure daily life without cigarettes. Primary healthcare nurses should be encouraged to incorporate not only logic and scientific evidence but also the subjectivity of the patient’s attitude into efforts to better respond to the changing, complex nature of the smoking cessation process.

Smoking-Cessation Treatment: Use Trends Among Non-Hispanic White and English-Speaking Hispanic/Latino Smokers, Colorado 2001-2012.

Most smokers who try to quit do not use an evidence-based treatment (EBT), and in 2001, Hispanic/Latino quit-attempters were about half as likely as non-Hispanic white (NHW) quit-attempters to use one. This study analyzed the patterns of EBT use in Colorado across a recent decade, 2001-2012. Data were from The Attitudes and Behaviors Survey, a random cross-sectional population-level telephone survey. Data included NHW and English-speaking Hispanic/Latino respondents from 2001 (n=11,872), 2005 (n=10,952), 2008 (n=12,323), and 2012 (n=13,265). Statistical analyses were conducted in 2014-2015. EBT measures included nicotine-replacement therapy, prescription cessation medication, telephone quit-line coaching, and other counseling. Bivariate and multiple logistic regression analyses evaluated associations across years between EBT use and ethnicity, adjusting for covariates. Any EBT use increased with each successive survey year, and the relative increase from 2001 to 2012 was greater among Hispanic/Latino than NHW quit-attempters (75.7% vs 38.7%). However, adjusted for covariates, Hispanic/Latino quit-attempters in 2012 were still 54% less likely to use any EBT (AOR=0.46, 95% CI=0.34, 0.63), 45% less likely to use nicotine-replacement therapy (AOR=0.55, 95% CI=0.39, 0.77), and 50% less likely to use a prescription cessation medication (AOR=0.50, 95% CI=0.30, 0.85). Ethnicity was unrelated to use of a quit-line or other counseling service. EBT use for smoking cessation has increased over the past decade, with more rapid increase among English-speaking Hispanics/Latinos compared with NHWs, but a large use gap remains. Healthcare and public health efforts are needed to clarify and overcome factors contributing to this ongoing disparity.

Stone Throwing in the Glass House.

A small girl with a unique genetic syndrome lies in bed since birth. Her brain does not work. She is in a persistent vegetative state. Recurrent seizures punctuate her intractable epilepsy. She shows no meaningful interaction. Her breathing is insufficient. Upper airway obstruction, repeated aspiration events, chronic lung disease, and scoliosis make her struggle to breathe. Her parents never wanted her to suffer. Two years ago, they agreed to a Physician Orders for Life-Sustaining Treatment (POLST). Their daughter would not undergo resuscitation. Death did not come, however. With meticulous medical care, her body grew. Her breathing worsened. Offered either palliation or a tracheostomy tube, her parents chose “trach.” With easier breathing, the girl expended fewer calories. She continued gastrostomy tube feeds and gained 10 pounds in 3 months. Now she is rehospitalized with respiratory distress. Her weight rises another 2 pounds. We put off calorie reduction for the outpatient setting. For the first time, we discharge the family home with a mechanical ventilator. Our collective health-care efforts have set up a protracted course whose likely end will come in overwhelming sepsis or ARDS, rather than allowing natural death with palliative care. How many ethical issues were raised by this case? I count more than 40 (Table ​(Table11).

Temporal Trends in Hospitalization for Acute Decompensated Heart Failure in the United States, 1998-2011.

Estimates of the numbers and rates of acute decompensated heart failure (ADHF) hospitalization are central to understanding health-care utilization and efforts to improve patient care. We comprehensively estimated the frequency, rate, and trends of ADHF hospitalization in the United States. Based on Atherosclerosis Risk in Communities (ARIC) Study surveillance adjudicating 12,450 eligible hospitalizations during 2005-2010, we developed prediction models for ADHF separately for 3 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 428 discharge diagnosis groups: 428 primary, 428 nonprimary, or 428 absent. We applied the models to data from the National Inpatient Sample (11.5 million hospitalizations of persons aged ≥55 years with eligible ICD-9-CM codes), an all-payer, 20% probability sample of US community hospitals. The average estimated number of ADHF hospitalizations per year was 1.76 million (428 primary, 0.80 million; 428 nonprimary, 0.83 million; 428 absent, 0.13 million). During 1998-2004, the rate of ADHF hospitalization increased by 2.0%/year (95% confidence interval (CI): 1.8, 2.5) versus a 1.4%/year (95% CI: 0.8, 2.1) increase in code 428 primary hospitalizations (P < 0.001). In contrast, during 2005-2011, numbers of ADHF hospitalizations were stable (-0.5%/year; 95% CI: -1.4, 0.3), while the numbers of 428-primary hospitalizations decreased by -1.5%/year (95% CI: -2.2, -0.8) (P for contrast = 0.03). In conclusion, the estimated number of hospitalizations with ADHF is approximately 2 times higher than the number of hospitalizations with ICD-9-CM code 428 in the primary position. The trend increased more steeply prior to 2005 and was relatively flat after 2005.

Hubungan Personal Hygiene dan Sanitasi Lingkungan dengan Angka Kejadian Kecacingan (Soil Transmitted Helminth) Pada Petani Sayur di Kelurahan Maharatu Kecamatan Marpoyan Damai Kota Pekanbaru

Abstrak: Personal hygiene and environmental sanitation is an important factor in the health care effort to avoid infection worms. Research has been conducted on vegetable farmers in Sub District of Marpoyan Damai Maharatu Pekanbaru City in March - May 2015 with a total sample of 50 people. The result showed that the majority of workers in the village vegetable worm disease Maharatu positive experience with this type of Ascaris lumbricoides and including minor infections. There is a relationship use of Personal Protective Equipment (PPE), health nails, wash hands, clean water, latrine quality and sewage with the incidence of the disease in Sub Maharatu worms.

Review of Selective Primary Health Care Efforts in an Urban Health Center Area in Guntur City of Andhra Pradesh

Review of Selective Primary Health Care Efforts in an Urban Health Center Area in Guntur City of Andhra Pradesh

The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events.

The purpose of this study was to examine the relationships of nurse staffing level and work environment with patient adverse events. This cross-sectional study used a combination of nurse survey data (N = 4,864 nurses), facility data (N = 58 hospitals), and patient hospital discharge data (N = 113,426 patients) in South Korea. The three most commonly nurse-reported adverse events included administration of the wrong medication or dose to a patient, pressure ulcers, and injury from a fall after admission. Multilevel ordinal logistic regression was employed to explore the relationships of nurse staffing level (number of patients assigned to a nurse) and work environment (Practice Environment Scale of the Nursing Work Index) with patient adverse events after controlling for nurse, hospital, and patient characteristics. A larger number of patients per nurse was significantly associated with a greater incidence of administration of the wrong medication or dose (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 1.007-1.016), pressure ulcer (OR = 1.01, 95% CI = 1.007-1.016), and patient falls with injury (OR = 1.02, 95% CI = 1.013-1.022). A better work environment had a significant inverse relationship with adverse events; the odds of reporting a higher incidence of adverse events were 45% lower for administration of the wrong medication or dose (OR = 0.55, 95% CI = 0.400-0.758), followed by 39% lower for pressure ulcer (OR = 0.61, 95% CI = 0.449-0.834) and 32% lower for falls with injury after admission (OR = 0.68, 95% CI = 0.490-0.939). This study found that a larger number of patients per nurse and poor work environment increase the incidence of patient adverse events, such as administration of the wrong medication or dose to a patient, pressure ulcers, and injury from falling after admission. The findings suggest that South Korean hospitals could prevent patient adverse events by improving nurse staffing and work environment. Healthcare strategies and efforts to modify adequate nurse staffing levels and better work environments for nurses are needed to improve patient outcomes.

Advanced nursing practice and research contributions to precision medicine

BackgroundGenomic discoveries in the era of precision medicine hold the promise for tailoring healthcare, symptom management, and research efforts including targeting rare and common diseases through the identification and implementation of genomic–based risk assessment, treatment, and management. However, the translation of these discoveries into tangible benefits for the health of individuals, families, and the public is evolving. PurposeIn this article, members of the Genetics Expert Panel identify opportunities for action to increase advanced practice nursing and research contributions toward improving genomic health for all individuals and populations. DiscussionIdentified opportunities are within the areas of: bolstering genomic focused advanced practice registered nurse practice, research and education efforts; deriving new knowledge about disease biology, risk assessment, treatment efficacy, drug safety and self-management; improving resources and systems that combine genomic information with other healthcare data; and advocating for patient and family benefits and equitable access to genomic healthcare resources.

Undiagnosed Diseases Network International (UDNI): White paper for global actions to meet patient needs.

In 2008, the National Institutes of Health's (NIH) Undiagnosed Disease Program (UDP) was initiated to provide diagnoses for individuals who had long sought one without success. As a result of two international conferences (Rome 2014 and Budapest 2015), the Undiagnosed Diseases Network International (UDNI) was established, modeled in part after the NIH UDP. Undiagnosed diseases are a global health issue, calling for an international scientific and healthcare effort. To meet this demand, the UDNI has built a consensus framework of principles, best practices and governance; the Board of Directors reflects its international character, as it includes experts from Australia, Canada, Hungary, Italy, Japan and the USA. The UDNI involves centers with internationally recognized expertise, and its scientific resources and know-how aim to fill the knowledge gaps that impede diagnosis. Consequently, the UDNI fosters the translation of research into medical practice. Active patient involvement is critical; the Patient Advisory Group is expected to play an increasing role in UDNI activities. All information for physicians and patients will be available at the UDNI website.

Patients' involvement in improvement initiatives: a qualitative systematic review.

Over the last 20 years, quality improvement in health has become an important strategy in health services in many countries. With the emphasis on quality health care, there has been a shift in social paradigms towards including service users in their own health on different levels. There is growing evidence in literature on the positive impact on health outcomes where patients are active participants in their personal care. There is however less information available on the broader influence of users on improvement in systems. The objective of this review was to identify the barriers and enablers to patients being involved in quality improvement efforts directed towards their own health care. This review considered studies that included adults and children of any age experiencing any health problem.The review considered studies that explored patient or user participation in quality improvement and the factors enabling and hindering this processThe qualitative component of this review considered studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Other texts such as opinion papers and reports were also considered. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. The searches using all identified keywords and index terms included the databases PubMed, PsycINFO, Medline, Scopus, EBSCOhost and CINAHL.Qualitative, text and opinion papers were considered for inclusion in this review.Closely related concepts like community involvement, family involvement, patients' involvement in their own care (for example, in the case of shared decision making), and patient centeredness in the context of a consultation were excluded. Qualitative and textual papers selected for retrieval were assessed by two independent reviewers for authenticity prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute. Qualitative and textual data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute. The above findings were pooled and through the identification of categories, a final meta-synthesis was formulated. Two synthesized findings were created from the included papers. Firstly, there are barriers to patients' participation in quality improvement in health and in spite of policy support for user involvement in quality improvement, it is a difficult strategy to implement. The second synthesized finding was that there are enablers to patients' involvement in quality improvement: when patients are involved in quality improvement efforts in health care, there are innovative, often unexpected, outcomes at different levels of the process, and sustaining these efforts is possible with ongoing individual or group support.Five categories which supported the synthesized findings were created through the meta-aggregative process. There are enablers and barriers to involving patients in quality improvement in health care that need to be considered when planning such interventions.Relationships and roles will need to be very clear from the outset. A developmental approach needs to be considered where support and training is part of the project. Where patients are truly engaged in service improvement, unexpected innovation occurs.There are many more reports and opinion papers published regarding this topic than there are rigorous research studies. This leaves the field open to the development of good methodological studies related to quality improvement and in particular to the participation of patients.

Factors Affecting Women's Disclosure of Alcohol Misuse in Primary Care: A Qualitative Study with U.S. Military Veterans

BackgroundOne in five women veterans screens positive for alcohol misuse. Women may be less likely than men to disclose alcohol use to a primary care provider (PCP), resulting in women being less likely to receive effective interventions. We sought to qualitatively examine factors that may affect women veterans' willingness to disclose alcohol use to a PCP. MethodsBetween October 2012 and May 2013, in-depth interviews were conducted with 30 women veterans at two Department of Veterans Affairs (VA) medical facilities. Qualitative data analyses identified common themes representing factors that influence women's decision to disclose alcohol use to a PCP. FindingsNine themes were endorsed by women veterans as influencing their willingness to disclose alcohol use to their PCP. Themes included provider behaviors perceived as encouraging or discouraging disclosure of alcohol misuse, perceived positive relationship with provider, negative emotions such as concerns about being judged or labeled an “alcoholic,” health concerns about drinking, non–health-related concerns about drinking, self-appraisal of drinking behavior, social support, and clinic factors. ConclusionsOur findings demonstrate the importance of social relationships, comfort with one's provider, and education on the potential harms (especially health related) associated with alcohol in encouraging disclosure of alcohol use in women veterans. Our results also support VA national health care efforts, including the provision of brief alcohol counseling and the use of primary care clinics specializing in the care of women veterans.

Community-Level Barriers to Recovery for Substance-Dependent Rural Residents

This article identifies potential barriers to substance use recovery associated with rural residence. The evidence is discussed and illustrated with examples. Fourteen specific barriers to substance abuse recovery are identified within 4 broad categories: access to treatment services, access to other professionals, access to peer support groups, and barriers to confidentiality. Although telehealth, expansion of mental health care, intensive referral, and other efforts might enhance access to care, the evidence suggests practitioners and researchers should remain aware of community-level barriers to recovery from substance use disorder and work with clients to overcome them.

Associations between safety culture and employee engagement over time: a retrospective analysis

With the growth of the patient safety movement and development of methods to measure workforce health and success have come multiple modes of assessing healthcare worker opinions and attitudes about...

A Study for Home and Mobile U-Healthcare System

Mobile technologies usage is becoming more integrated with the delivery of patient care. Mobile technology has the potential to have a positive impact on healthcare. The number of people suffering from chronic diseases is growing rapidly and poses an ever increasing strain on the health care sector. An ageing population is now the leading healthcare concern of many countries in the world. Aged patients need more healthcare efforts as they present more cases of chronic illnesses involving higher healthcare costs.

The Legal Implications of HIPAA Privacy and Public Health Reporting for Correctional Facilities.

Inmates in cramped living quarters, a situation common to correctional facilities, are especially vulnerable to disease. Cramped living conditions, coupled with above-average rates of HIV, tuberculosis, and other communicable diseases, increase inmates' risk of problematic health outcomes. Thus, high-quality health care and sustained efforts to prevent disease are especially important to improve inmate health within correctional facilities. Compliance with federal privacy restrictions pursuant to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and state disease reporting requirements will foster inmate health and assist efforts to prevent the spread of disease. This article examines the interplay between HIPAA rules and state reporting laws to preserve health information privacy and to control the spread of disease.

Big Data Technologies: New Opportunities for Diabetes Management.

The so-called big data revolution provides substantial opportunities to diabetes management. At least 3 important directions are currently of great interest. First, the integration of different sources of information, from primary and secondary care to administrative information, may allow depicting a novel view of patient's care processes and of single patient's behaviors, taking into account the multifaceted nature of chronic care. Second, the availability of novel diabetes technologies, able to gather large amounts of real-time data, requires the implementation of distributed platforms for data analysis and decision support. Finally, the inclusion of geographical and environmental information into such complex IT systems may further increase the capability of interpreting the data gathered and extract new knowledge from them. This article reviews the main concepts and definitions related to big data, it presents some efforts in health care, and discusses the potential role of big data in diabetes care. Finally, as an example, it describes the research efforts carried on in the MOSAIC project, funded by the European Commission.