Evaluation Of Digital Health Interventions Research Articles

Healthcare management in a post-pandemic world: Lessons learned and future preparedness: A review

This review paper examines the profound impacts of the COVID-19 pandemic on healthcare management, highlighting lessons learned and proposing strategies for future preparedness. It explores the immediate challenges healthcare systems face, such as resource allocation and staff shortages. It discusses the rapid adaptations and innovations that emerged, including the expansion of telehealth and digital health technologies. The paper also reviews policy and management adjustments. It applies theoretical frameworks like organizational change, crisis management, and health systems resilience to understand these changes. Key findings emphasize the importance of resilience, flexibility, and innovation in healthcare management. Recommendations for practice and policy focus on enhancing public health infrastructure, investing in digital health, and fostering international cooperation. The paper concludes with directions for future research, including the evaluation of digital health interventions and strategies to address healthcare disparities, underscoring the need for a robust, adaptive, and equitable healthcare system in the post-pandemic world.

HEALTHCARE MANAGEMENT IN A POST-PANDEMIC WORLD: LESSONS LEARNED AND FUTURE PREPAREDNESS - A REVIEW

This review paper examines the profound impacts of the COVID-19 pandemic on healthcare management, highlighting lessons learned and proposing strategies for future preparedness. It explores the immediate challenges healthcare systems face, such as resource allocation and staff shortages. It discusses the rapid adaptations and innovations that emerged, including the expansion of telehealth and digital health technologies. The paper also reviews policy and management adjustments. It applies theoretical frameworks like organizational change, crisis management, and health systems resilience to understand these changes. Key findings emphasize the importance of resilience, flexibility, and innovation in healthcare management. Recommendations for practice and policy focus on enhancing public health infrastructure, investing in digital health, and fostering international cooperation. The paper concludes with directions for future research, including the evaluation of digital health interventions and strategies to address healthcare disparities, underscoring the need for a robust, adaptive, and equitable healthcare system in the post-pandemic world.
 Keywords: Covid-19 Pandemic, Healthcare Management, Digital Health Technologies, Crisis Management Theory, Healthcare System Resilience.

Interprofessional Needs Analysis and User-Centred Prototype Evaluation as a Foundation for Building Individualized Digital Education in Dementia Healthcare Supported by Artificial Intelligence: A Study Protocol.

Continuous profession-specific training is necessary to provide high-quality care for people with dementia. Research shows the need for more educational programmes that are personalized and responsive to the learning needs and preferences of staff. Digital solutions supported by artificial intelligence (AI) may be a means of making these improvements. There is a lack of formats that support learners in selecting the right content according to their learning needs and preferences. The project "My INdividual Digital EDucation.RUHR" (MINDED.RUHR) addresses this problem and seeks to develop an automatized delivery system for individual learning content using AI. The sub-project presented here aims to achieve the following: (a) explore learning needs and preferences regarding behavioural changes in people with dementia, (b) develop learning nuggets, (c) evaluate the feasibility of the digital learning platform, and (d) identify optimization criteria. Following the first phase of the framework for the design and evaluation of digital health interventions (DEDHI), we use a qualitative approach with focus group interviews for exploration and development, and co-design workshops and expert audits to evaluate the developed learning nuggets. The developed e-learning tool is the first step in supporting the digital training of healthcare professionals in the context of caring for people with dementia, individualized through AI.

O116 Clinical innovation network analysis (CINA) and readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review

Abstract Introduction Increasing numbers of digital health interventions (DHIs) for remote postoperative monitoring have recently been developed and evaluated. We aimed to review DHIs for postoperative monitoring and evaluate their readiness for implementation into routine care. Methods This systematic review identified studies on implementation and evaluation of DHIs for postoperative monitoring published before 31st December 2021 (PROSPERO ID: CRD42021264289). Studies which included postoperative monitoring use-cases for general postoperative recovery or specific complications were defined according to their IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) stages of innovation. A novel clinical innovation network analysis (CINA) using co-authorship and citations of previous work was used to examine collaboration and progression. The WHO framework for monitoring and evaluating DHIs was used for narrative synthesis. Results Seventy-five novel DHIs were identified from 7,605 records. Of these, 76.0% (n= 57/75) were classed as early-stage innovations (IDEAL stage 1 & 2a), and none had achieved routine implementation. There is limited evidence of collaboration based on co-authorship or citations, with 91.3% (n=63/69) of studies beyond IDEAL stage 1 without prior publications. There were notable differences in evaluation, with clear omissions in evaluation across all use-cases: more than 4/5 studies did not consider the feasibility, accessibility, or impact of these interventions on the cost, efficiency or quality of care. Conclusion Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.

Evaluation Methods Applied to Digital Health Interventions: What Is Being Used beyond Randomised Controlled Trials?—A Scoping Review

Despite the potential of digital health interventions (DHIs), evaluations of their effectiveness face challenges. DHIs are complex interventions and currently established evaluation methods, e.g., the randomised controlled trial (RCT), are limited in their application. This study aimed at identifying alternatives to RCTs as potentially more appropriate evaluation approaches. A scoping review was conducted to provide an overview of existing evaluation methods of DHIs beyond the RCT. Cochrane Central Register of Controlled Trials, MEDLINE, Web of Science, and EMBASE were screened in May 2021 to identify relevant publications, while using defined inclusion and exclusion criteria. Eight studies were extracted for a synthesis comprising four alternative evaluation designs. Factorial designs were mostly used to evaluate DHIs followed by stepped-wedge designs, sequential multiple assignment randomised trials (SMARTs), and micro randomised trials (MRTs). Some of these methods allow for the adaptation of interventions (e.g., SMART or MRT) and the evaluation of specific components of interventions (e.g., factorial designs). Thus, they are appropriate for addressing some specific needs in the evaluation of DHIs. However, it remains unsolved how to establish these alternative evaluation designs in research practice and how to deal with the limitations of the designs.

Development stage of novel digital health interventions for postoperative monitoring: protocol of a systematic review

IntroductionThe postoperative period represents a time where patients are at a high-risk of morbidity, which warrants effective surveillance. While digital health interventions (DHIs) for postoperative monitoring are promising, a coordinated,...

Economic Evaluation of Digital Health Interventions: Methodological Issues and Recommendations for Practice.

Health care interventions are increasingly being delivered through digital technologies, offering major opportunities for delivering more health gains from scarce health care resources. Digital health interventions (DHIs) raise distinct challenges for economic evaluations compared with drugs and medical devices, not least due to their interacting, evolving features. The implications of the distinctive nature of DHIs for the methodological choices underpinning their economic evaluation is not well understood. This paper provides an in-depth discussion of distinct features of DHIs and how they might impact the design, measurement, analysis and reporting of cost-effectiveness analysis conducted alongside both randomised and non-randomised studies. These include aspects related to choice of comparator, costs and benefits assessment, study perspective and type of economic analysis. We argue that typical methodological standpoints, such as taking a health service perspective, focusing on health-related benefits and adopting cost-utility analyses, as typically adopted in the economic evaluation of non-digital technologies (pharmaceutical drugs and medical devices), are unlikely to be appropriate for DHIs. We illustrate how these methodological aspects can be appropriately addressed in an evaluation of a digitally supported, remote rehabilitation programme for patients with Long Covid in England. We highlight several methodological considerations for improving practice and areas where further methodological work is required.

The role of digital health in palliative care for people living with HIV in sub-Saharan Africa: A systematic review.

In 2018, 26.6 million people were living with HIV in sub-Saharan Africa. Palliative care services are recommended for people living with HIV at all stages from diagnosis through to end-of-life. However, the provision of palliative care in sub-Saharan Africa is limited, leading to little or no access for the majority of patients. Digital technologies in sub-Saharan Africa present an opportunity to improve access to palliative care for people living with HIV in the region. This review synthesised literature on digital health interventions for palliative care for people living with HIV in sub-Saharan Africa and assessed their effects on patient outcomes. Literature searches were conducted in MEDLINE, Embase, PsycINFO and Global Health. Inclusion and exclusion criteria were applied. Two independent reviewers conducted study screening, data extraction and quality appraisal. A narrative synthesis was performed to draw together and report findings across heterogeneous studies. Reporting of this review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist. Out of 4117 records, 25 studies were included, covering 3592 people living with HIV, across 21 countries. Studies included three randomised controlled trials, three qualitative, three pre- and post-test, two observational, two case series, six cross-sectional and six mixed methods studies. Telemedicine was the most reported digital health intervention, with 12 studies demonstrating the effectiveness of digital health interventions. Emerging evidence suggests digital health interventions can be effective in facilitating patient-provider communication and health professional decision-making as a part of palliative care for people living with HIV. There is a need for further development and evaluation of digital health interventions alongside determining optimal approaches to their implementation as a part of palliative care provision in sub-Saharan Africa.

A mixed methods study for the evaluation of a digital health solution for cancer multidisciplinary team meetings using simulation-based research methods.

e14063 Background: Simulation-based research (SBR) methods involve setting up structured scenarios to replicate real-world situations, with the aim of eliciting real-world reactions and behaviours. SBR is useful for the evaluation of new healthcare solutions without compromising patient safety or navigating complex ethical review processes. However, there are few trials using SBR methods for the evaluation of digital health interventions (DHIs), the adoption of which has been hindered in the NHS due to a lack of evidence-base for their efficacy. SBR methods could be an appropriate tool for testing digital solutions. Methods: The Institute of Global Health Innovation (IGHI) developed a series of simulated lung cancer multidisciplinary team (MDT) meetings to test the NAVIFY Tumor Board solution by Roche Diagnostic Information Solutions, a digital solution for the preparation and conduct of cancer MDTs. To provide an environment for participants to evaluate the capabilities of the NAVIFY Tumor Board solution, 10 simulation sessions were organised in which groups of five to six clinicians were recruited to discuss up to 10 mock patient cases across two simulated MDTs, first using standard tools commonly used to conduct MDTs and then using the NAVIFY Tumor Board solution. The cases were developed by the study team at IGHI and consultants in respiratory medicine and oncology. 56 healthcare professionals (respiratory physicians, oncologists, radiologists, histopathologists, clinical nurse specialists and thoracic surgeons) were recruited. The sessions were video recorded and observations were noted by the study team, followed by a focus group in which participants provided feedback about their experience of the simulated MDTs. Results: Through this study we were able to generate evidence and multi-professional recommendations for Roche regarding the functionality, usability and applicability of the solution in the NHS, as well as beneficial features and those which could be improved. Participants reported that the simulations were realistic and a meaningful way of conducting evaluations of digital health solution without impacting clinical practice or patient safety. Conclusions: This study demonstrated the utility and validity of testing commercial tools in simulated settings to generate meaningful insights from endusers. SBR methods were shown to be an acceptable way for frontline practicing clinicians to participate in the testing and development of digital health tools in a standardised setting.

Digital health, gender and health equity: invisible imperatives.

A growing body of evidence shows the use of digital technologies in health—referred to as eHealth, mHealth or ‘digital health’—is improving and saving lives in low- and middle-income countries. Despite this prevalent and persistent narrative, very few studies examine its effects on health equity, gender and power dynamics. This journal supplement addresses these invisible imperatives by going beyond traditional measures of coverage, efficacy and cost-effectiveness associated with digital health interventions, to unpack different experiences of health workers and beneficiaries. The collection of papers presents findings from a cohort of implementation research projects in Africa, Asia, Latin America and the Middle East, and two commentaries offer observations from learning-oriented evaluative activities across the entire cohort. The story emerging from this cohort is comprised of three themes: (i) digital health can positively influence health equity; (ii) gender and power analyses are essential; and (iii) digital health can be used to strengthen upward and downward accountability. These findings, at the individual project level and at the level of the cohort, provide encouraging recommendations on how to approach the design, implementation and evaluation of digital health interventions to address the Sustainable Development Goals agenda of leaving no one behind.

Designing and Undertaking a Health Economics Study of Digital Health Interventions.

This paper introduces and discusses key issues in the economic evaluation of digital health interventions. The purpose is to stimulate debate so that existing economic techniques may be refined or new methods developed. The paper does not seek to provide definitive guidance on appropriate methods of economic analysis for digital health interventions. This paper describes existing guides and analytic frameworks that have been suggested for the economic evaluation of healthcare interventions. Using selected examples of digital health interventions, it assesses how well existing guides and frameworks align to digital health interventions. It shows that digital health interventions may be best characterized as complex interventions in complex systems. Key features of complexity relate to intervention complexity, outcome complexity, and causal pathway complexity, with much of this driven by iterative intervention development over time and uncertainty regarding likely reach of the interventions among the relevant population. These characteristics imply that more-complex methods of economic evaluation are likely to be better able to capture fully the impact of the intervention on costs and benefits over the appropriate time horizon. This complexity includes wider measurement of costs and benefits, and a modeling framework that is able to capture dynamic interactions among the intervention, the population of interest, and the environment. The authors recommend that future research should develop and apply more-flexible modeling techniques to allow better prediction of the interdependency between interventions and important environmental influences.