Reorganization Of Health Care Research Articles

Post-pandemic patient safety: have the characteristics of incidents with harm changed? Comparative observational study in primary care via review of medical records with a trigger tool

BackgroundThe COVID-19 pandemic generated or accelerated healthcare changes, some of which persist thereafter (e.g., healthcare reorganisation, remote consultation). Such changes entail novel risks for patient safety.MethodsAimTo compare the characteristics of patient safety incidents with harm (PSIH) in primary care before the pandemic and at present.Design and settingCross-sectional, comparative, observational study conducted within the entire Primary Care Service of the Madrid region with observations at two time points (2018 and 2021/2022).ParticipantsPatients > 18 years of age with at least one consultation in the previous year. The necessary sample size was established at N1 = 2,000 for the first time point and N2 = 2,700 for the second. Sampling was performed by simple randomisation for the first group and by clusters followed by simple randomisation for the second.Main measurementsAge, gender, presence of PSIH in the medical record, and characteristics of the PSIH, specifically avoidability, severity, place of occurrence, nature, and contributory factors. Triggers validated in primary care were employed to screen the patients’ medical records and those containing any trigger were reviewed by three nurse-physician teams who underwent previous training.AnalysisComparative analysis using Fisher’s exact test.ResultsA total of 63 PSIHs and 25 PSIHs were found for the first and second samples, respectively. The comparison of the characteristics of PSIH before the pandemic and currently was: avoidable 62% vs. 52% (p = 0.47), mild 51% vs. 48% (p = 0.57), in the primary care setting 73% vs. 64% (p = 0.47), respectively. Although no statistically significant differences were observed globally in the nature of the incidents (p = 0.13), statistically significant differences were found for diagnostic errors, with pre-pandemic rates of 6% vs. 20% at present (p < 0.05). Finally, no significant differences were found in the contributory factors.ConclusionsNo differences were found in the avoidability, severity, place of occurrence, or contributory factors of PSIHs before the pandemic and currently. In terms of the nature of these incidents, the outcomes revealed an increase in diagnostic errors (excluding diagnostic tests), which could be attributed to a greater frequency of remote consultations and a decrease in the longitudinality of care resulting from the shortage of professionals.

The impact of SARS-CoV-2 (COVID-19) pandemic on educational and professional growth of young Italian epileptologists: a survey of the Young Epilepsy Section-Italian chapter.

In March 2020, the World Health Organization declared the coronavirus-related disease SARS-CoV-2 infection pandemic. Italy was one of the most affected countries and managed the emergency also by a health care reorganization. The Education and Career Development Task Force of the Young Epilepsy Section-Italy (YES-I) designed a survey to assess the impact of the pandemic on the training and work of young epileptologists (< 40years). Fifty-three responses were collected: 45.3% were resident, 9.4% PhD students and the remainder specialists. Clinical activity changed for most (83%) during the pandemic. Educational activity at epilepsy centers was reduced for 35.8% of the survey participants, while 30.2% of research projects involving patients participation were stopped to switch mainly to COVID-19-related research. For 73.6% of survey participants, attending online courses and congresses was easier in terms of cost and organization, although for 50.9% the level of training was lower in quality. In contrast, 58.5% rated the webinars organized by YES-I very educational. Less than 50% of the clinicians used telemedicine in the pandemic period and continue to use it. Despite several positive aspects of virtual medicine, a small number (32.1%) of our interviewees were satisfied from telemedicine and few of them (30.2%) reported that it led to improvement of clinical practice. Our survey showed that the pandemic has had a negative impact on training, research and clinical activity in the epilepsy field; moreover, it underlined the critical aspects of virtual communication methods in order to improve its use for the future.

Advanced nursing practise as a preventive approach for adults with intellectual disabilities

Abstract Background Various barriers impede access to preventive health services for people with intellectual disabilities in Germany. As a result, they are more likely to suffer from certain chronic diseases. Internationally, Advanced Nursing Practice (ANP) has proven to be a suitable approach to care for this group. In Germany, ANP is not yet widespread. The aim of this study is to improve healthcare for people with intellectual disabilities through ANP-led case management. Methods A randomized controlled trial was conducted in an urban community setting. Inclusion criteria were: ICD-10 diagnosis F70-F79, age ≥18 and care level ≤3. The intervention group (IG) received four outreach home visits focused on prevention and health promotion. The control group (CG) received usual care. Allocation was done using computer-assisted, permuted block randomization. Researchers were blinded during data collection and analysis. The primary outcome was health status after 12 months (t2) (WHODAS). Secondary outcomes were health status after 6 months (t1), health-related quality of life (HQOL) after 6 and 12 months (EQ5D-VAS), and resilience after 6 and 12 months (RS-11). Analysis was performed via ANCOVA with Bonferroni correction at a significance level of 0.025. Results 214 participants were randomized. At t2, 176 participants remained (IG: n = 85, CG: n = 91). Health status at t2 showed a mean difference (MD) of -4.58 points in favor of the IG (p = 0.01). For resilience, a MD of + 1.95 (t2) points in favor of the IG was obtained (p = 0.05). We measured a MD for HQOL of -1.19 (p = 0.72) in favor of the CG. Conclusions A clinically relevant effect of ANP-led case management was achieved on the health status, but not on resilience and HQOL. ANP for people with intellectual disabilities can contribute to health promotion and thereby improve the community health. Therefore, ANP can be used as an innovative approach in the course of reorganization of healthcare for vulnerable populations in Germany. Key messages • ANP-led case management can have a clinically relevant effect on the heal status of people with intellectual disabilities over the course of one year. • ANP-led case management can be seen as a new approach to health promotion and disease prevention in Germany.

Exploring the interplay of discourses, jurisdictions and restratification in medicine and the implications for intraprofessional collaboration

This study builds on calls to explore the tensions and dynamics of intraprofessional collaboration and boundary work. It reaches beyond the literature describing the micro-level strategies deployed by physician subgroups to establish legitimacy and defend jurisdictions in the face of health care re-organization. Specifically, it offers a view of how macrosocial imperatives shape intraprofessional boundaries, relations, and the possibilities for collaboration. Drawing on empirical data from a case study of intraprofessional collaboration in caring for patients with diabetes - a clinical context in which patients commonly receive care from family physicians (FPs) and specialist physicians (SPs) – Foucault's concept of governmentality and the sociology of the professions are employed to make visible the sociohistorical construction of intraprofessional collaboration within discourses of evidence-based medicine, and its implications for the [re-]negotiation of professional jurisdictions and restratification of the medical profession. This analysis contributes to the intraprofessional literature through two analytical moves. First, it outlines the discursive mechanisms through which the meso-level deployment of the referral-consultation process provides an arena for SPs to maintain and reinforce their position of influence at both the micro-level of daily clinical work and across broader health care delivery. Second, it provides an understanding of how the transmission of governmental rationality in diabetes occurs through the social relations between SPs and FPs, making the restratification of medicine possible without tension or conflict.

Evidence on bringing specialised care to the primary level—effects on the Quadruple Aim and cost-effectiveness: a systematic review

BackgroundTo achieve the Quadruple Aim of improving population health, enhancing the patient experience of care, reducing costs and improving professional satisfaction requires reorganisation of health care. One way to accomplish this aim is by integrating healthcare services on different levels. This systematic review aims to determine whether it is cost-effective to bring a hospital specialist into primary care from the perspectives of commissioners, patients and professionals.MethodsThe review follows the PRISMA guidelines. We searched PubMed, Scopus and EBSCO (CINAHL and Academic Search Ultimate) for the period of 1992–2022. In total, 4254 articles were found, and 21 original articles that reported on both quality and costs, were included. The JBI and ROBINS-I tools were used for quality appraisal. In data synthesis, vote counting and effect direction plots were used together with a sign test. The strength of evidence was evaluated with the GRADE.ResultsCost-effectiveness was only measured in two studies, and it remains unclear. Costs and cost drivers for commissioners were lower in the intervention in 52% of the studies; this proportion rose to 67% of the studies when cost for patients was also considered, while health outcomes, patient experience and professional satisfaction mostly improved but at least remained the same. Costs for the patient, where measured, were mainly lower in the intervention group. Professional satisfaction was reported in 48% of the studies; in 80% it was higher in the intervention group. In 24% of the studies, higher monetary costs were reported for commissioners, whereas the clinical outcomes, patient experience and costs for the patient mainly improved.ConclusionsThe cost-effectiveness of the hospital specialist in primary care model remains inconclusive. Only a few studies have comprehensively calculated costs, evaluating cost drivers. However, it seems that when the service is well organised and the population is large enough, the concept can be profitable for the commissioner also. From the patient’s perspective, the model is superior and could even promote equity through improved access. Professional satisfaction is mostly higher compared to the traditional model. The certainty of evidence is very low for cost and low for quality.Trial registrationPROSPERO CRD42022325232, 12.4.2022.

How Do Professional Associations Influence Health System Transformation? Lessons from Ontario, Canada

Introduction: Internationally, there are increasing collaborative efforts to transform health care systems in ways that align with the principles of integrated care. Within the Canadian context, the current province-wide reorganization of health care into Ontario Health Teams (OHTs) is an example of a large-scale system transformation, requiring collaboration between system stakeholders at macro-, meso- and micro-levels. Literature on the topic inter-organizational collaboration does not fulsomely consider the role of local professional associations in health system transformations. There is value in examining the role of professional associations in influencing health system transformations, as they have significant expertise and influence, particularly in the domain of health policy. &#x0D; Methods: We used a qualitative descriptive approach to explore the research question: what strategies have local professional associations used to influence the development of Ontario Health Teams? We collected data from eight, 60-minute interviews with senior level leaders from eight professional associations. Interviews were transcribed and data were analyzed using content analysis to construct four descriptive themes. &#x0D; Results: During times of health system transformation, professional associations balance the functions of: (1) supporting members, (2) negotiating with government, (3) collaborating with stakeholders, and (4) reflecting on their role. In this presentation, we focus primarily on themes #2 and #3, given the specific relevance of governance, leadership, and collaboration. In both themes, participants emphasized the importance of findings areas of alignment with the government and other stakeholders; and using shared aims as way to amplify their influence. Characteristics of a “good” collaborator included consistent demonstration of mutual respect, clear communication, and interest in building trusting relationships. Participants also described barriers to collaboration, such as power imbalances and lack of role clarity. These challenges were heightened within the context of the “low rules” OHT rollout, in which OHTs had a high degree of control in adapting their team structures to ideally meet the needs of their local care partners and patient population(s),&#x0D; Conclusion and Implications: Professional associations are highly connected groups, deeply engaged with their members (often frontline clinicians) and regularly engaged with other key stakeholders and decision-makers (e.g., government). PAs play a critical role in influencing health system transformations, by bringing forward practical solutions to government that reflect the needs of their members, often frontline clinicians. Sharing insights from this work with an international audience could support global dialogues with health system leaders, policymakers, and researchers about leveraging the strengths of professional associations to enhance large-scale health system transformations via strategic collaboration.&#x0D; Next Steps: This research was conducted to fulfill the requirements of the Health System Impact Fellowship (doctoral level, funded by the Canadian Institutes of Health Research). We have continued to engage selected professional associations in building a collaborative framework, grounded in their experiences of participating the development of Ontario Health Teams.

HTA47 An Overview of the Challenges in the HTA of Interventions Involving Healthcare Reorganisation

HTA47 An Overview of the Challenges in the HTA of Interventions Involving Healthcare Reorganisation

Becoming active in the micro-politics of healthcare re-organisation: The identity work and political activation of doctors, nurses and managers

The changing organisation and governance of healthcare work represents a persistent focus of micro-politics. Whilst there is a developed literature describing the micro-political struggles that occur amongst healthcare occupations, there is little understanding about how, when and why actors become politically aware and active. Framed by research on political activation and the concept of identity work, this paper reports on a narrative interview study with 65 people, specifically doctors, nurses and managers, working in the English healthcare system. The narratives show that healthcare workers become increasingly aware of and engaged in micro-political activities through incremental stages based on their accumulating experiences. These stages are opportunities for identity work as actors make sense of their experiences of micro-politics, their occupational affiliations and their evolving sense of self. This identity work is shaped by actors' changing views about the morality of playing politics, the emotional implications of their engagement, and their deepening political commitments. The study shows that political socialisation and activation can vary between occupations and rather than assuming political affiliations are given or acquired the papers highlights the reflective agency of healthcare actors.

REORGANIZATION OF THE RURAL HOSPITAL IN THE CONDITIONS OF WAR

With the onset of a large-scale invasion russian troops, the health care system has experienced unprecedented stress, as have many other areas. In Ukraine, the number of wounded defenders, as well as civilians, who need long-term treatment and further rehabilitation is constantly increasing.&#x0D; Depending on how quickly we adapt to the conditions of war, the combat effectiveness of the defense forces, the preservation of the lives of our defenders, the reduction of disability, lethality, and fast and high-quality rehabilitation depends. All state doctors faced the question of immediate reorganization of health care in the hospital to provide the necessary assistance to the wounded.&#x0D; The need to reorganize the hospital network has been relevant almost since the first year of independence. Ukraine, which spends twenty-six times less on health care than the average EU country, has the second largest hospital network.&#x0D; All state doctors faced the question of immediate reorganization of health care in the hospital to provide the necessary assistance to the wounded.&#x0D; Depending on how quickly we adapt to the conditions of war, the combat effectiveness of the defense forces, the preservation of the lives of our defenders, the reduction of disability and lethality, and the rapid and high-quality rehabilitation depend on it.&#x0D; Adaptation of health care as a whole and in an individual region has many features. I would like to pay attention to this issue - we live in the same state, but different regions have their own military circumstances: some regions are under missile strikes and constant fire control of the enemy, and here we can talk about providing only emergency aid to save the lives of the wounded, and others they are "in the rear", where it is calmer, and can deal with the wounded until full recovery, physical and psychological rehabilitation.&#x0D; In this article, we want to share a small experience of providing medical care to the wounded in "rear" rural hospitals, which due to modern circumstances were forced to re-equip themselves and provide adequate medical care to the wounded.&#x0D; The goal of the work. Justification of effective management in the field of providing medical services at the level of a rural hospital in the conditions of martial law in the country.&#x0D; For example, let's take the "Lysetsk hospital" of the Lysetsk settlement council, which has 185 beds.&#x0D; Conclusions:&#x0D; &#x0D; &#x0D; &#x0D; In less than a year, the village hospital was transformed into a medical facility for the treatment of not only the wounded, but also people with accompanying serious somatic diseases.&#x0D; Close cooperation between "CNP" Lysetska hospital", medical university and the village village council created good conditions for the implementation of the ideas of reforming medicine and providing high-quality medical care.&#x0D; Inviting migrant specialists to work, dynamic redistribution of the hospital's bed fund, targeted reloading of vacated premises, repurposing of some departments made it possible to save jobs.&#x0D; All these transformations are possible only in those cases when the hospital staff led by the general director take an active position and do not state the facts that prevent work, but look for ways to overcome them.&#x0D; &#x0D; &#x0D;

Exploring how Professional Associations Influence Health System Transformation: The Case of Ontario Health Teams.

Health care system transformations that align with the principles of integrated care require the collaborative efforts of various macro-, meso- and micro-level stakeholders. Understanding the roles of various system actors can improve collaboration in ways that support purposeful health system change. Professional associations (PAs) have considerable influence, but little is known about the strategies they use to influence health system transformation. Using a qualitative descriptive approach, eight interviews with 11 senior level leaders from local PAs were conducted to learn about the strategies used to influence the province-wide reorganization of health care into Ontario Health Teams. During times of health system transformation, PAs balance: (1) supporting members, (2) negotiating with government, (3) collaborating with stakeholders, and (4) reflecting on their role. The enactment of these various functions demonstrates the strategic nature of PAs, and showcases their ability to evolve in ways that align with the dynamic nature of healthcare. PAs are highly connected groups, deeply engaged with their members and regularly engaged with other key stakeholders and decision-makers. PAs play a critical role in influencing health system transformations, by bringing forward practical solutions to government that reflect the needs of their members, often frontline clinicians. PAs strategically seek opportunities for collaboration with stakeholders that can amplify their message. Insights from this work could support health system leaders, policymakers, and researchers in leveraging the role of PAs in health system transformations via strategic collaboration.

Impact of the healthcare reorganization of the Local Health Authority services in Rieti (Italy) during the SARS-CoV-2 pandemic.

The need to contain the spread of the SARS-CoV-2 pandemic has forced national and local organizations to define and implement targeted emergency response and management measures. As the knowledge about the infection grew, a wider range of organizational measures were deployed. This study involves the SARS-CoV-2 infected people managed by the Local Health Authority of Rieti (Italy). Diagnostic test waiting times and hospital admission rates in the Province of Rieti are investigated as the pandemic evolved. Trends were analyzed in relation to the tempora spreading of SARS-CoV-2, to the organizational actions taken by the Local Health Authority of Rieti, and to the deployment of actions across the territory. A municipalities classification of the province of Rieti was conducted after a cluster analysis based on the diagnostic test waiting times and the hospital admission rates. Our findings show a declining trend, thus indicating a possible positive effect of the measures taken to contain the pandemic. The cluster analysis of the municipalities of the Province of Rieti makes evident an inhomogeneous geographical distribution of examined parameters (diagnostic test waiting times and the hospital admission rates), demonstrating the capability of Local Health Authority of Rieti to reach even the most disadvantaged areas and implying that the differences are due to the demographical variabilities. Despite some limitations, this study outlines the importance of management measures in response of the pandemic. These measures should adapt to social, cultural and geographical nature of the territory involved. The findings of the present study will contribute to the update of further pandemic preparedness plans of the Local Health Authorities.

Use of Telemedicine Healthcare Systems in Pediatric Assistance at Territorial Level: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF)

Technological innovation can contribute to a reorganization of healthcare, particularly by supporting the shift in the focus of care from the hospital to the territory, through innovative citizen-centered models, and facilitating access to services in the territory. Health and social care delivery modalities, enabled by telemedicine, are crucial in this regard. The objective of this Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, is to define a standard for its use at the territorial level in various declinations in the pediatric field; this paper also identifies priority areas for its application and the types of services that most require intervention and investment. The changes that are underway in digital transformation in all sectors are unstoppable, and for the digital transformation to take place in a productive sense, the contribution of not only all health professionals, but also of patients, is necessary. From this perspective, authors from different backgrounds were involved in the drafting of this Consensus and, in the future, other figures, primarily patients, are expected to be involved. In fact, this belongs to the vision of connected care, in which the citizen/patient actively participates in the treatment path so that they are assisted in a personalized, predictive and preventive way. The future scenario must be able to provide for the involvement of patients from the initial stages of planning any treatment path, even in the pediatric age, and increasing, where possible, the proximity of the health service to the families.

The Telecardiology Revolution: From Emergency Management to Daily Clinical Practice.

Aims: Telecardiology is one of the most widespread applications of telemedicine. We aimed to report the design and development of a telecardiology system in the sanitary district of Cosenza, one of the largest in Italy, with a complex orography, and healthcare reorganization needs, for the management of the emergency network and daily clinical practice. Methods: Our telecardiology network connects 8 hospitals, 9 first aid centers, 20 local 118-EMS stations, 1 helicopter station, 8 hospital emergency departments, 59 hospital departments, and 3 catheterization laboratories. All data are centralized on a dedicated server, accessible from any location for real-time assessment. The quality, source, and timing of the electrocardiograms transmitted were evaluated. Results: From October 2015 to December 2019, a total of 389,970 ECGs were transmitted. The quality of ECGs was optimal in 52%, acceptable in 42%, and poor in 6% of the cases. The number of poor-quality ECGs was only 3% in the last 2 years. Out of the total, 145,097 (37.2%) were transmitted from the emergency departments and 5318 (1.4%) from the 118-EMS. Of interest, a sizable part of the ECG was related to routine clinical practice, comprising 110,556 (28.3%) from the cardiology department and 79,256 (20.3%) from other noncardiovascular departments. Finally, the average reporting time was significantly decreased compared to reporting times without a telecardiology system (5–10 vs. 45–90 min). Conclusion: Our telecardiology system provides efficient cardiology assistance for all types, settings, and phases of cardiovascular diseases.

COVID-19 impact on the diagnosis of Inborn Errors of Metabolism: Data from a reference center in Brazil.

The COVID-19 pandemic led to the reorganization of health care in several countries, including Brazil. Inborn Errors of Metabolism (IEM) are a group of rare and difficult to diagnose genetic diseases caused by pathogenic variants in genes that code for enzymes, cofactors, or structural proteins affecting different metabolic pathways. The aim of this study was to evaluate how COVID-19 affected the diagnosis of patients with IEM during the first year of the pandemic in Brazil comparing two distinct periods: from March 1st, 2019 to February 29th, 2020 (TIME A) and from March 1st, 2020 to February 28th, 2021 (TIME B), by the analysis of the number of tests and diagnoses performed in a Reference Center in South of Brazil. In the comparison TIME A with TIME B, we observe a reduction in the total number of tests performed (46%) and in the number of diagnoses (34%). In both periods analyzed, mucopolysaccharidoses (all subtypes combined) was the most frequent LD suspected and/or confirmed. Our data indicates a large reduction in the number of tests requested for the investigation of IEM and consequently a large reduction in the number of diagnoses caused by the COVID-19 pandemic leading to a significant underdiagnosis of IEM.

Monitoring the activities of Italian colposcopy clinics before and during the COVID-19 pandemic.

To evaluate the impact of healthcare reorganization during the severe acute respiratory syndrome coronavirus 2 pandemic on Italian colposcopy clinic activities, focusing on cervical excision procedures, follow-ups for conservative management of low-grade lesions, and follow-ups post cervical excision. Retrospective study conducted in 14 Italian colposcopy clinics. The number and clinical characteristics of cervical excisions, follow-ups for conservative management of low-grade lesions, and follow-ups after cervical excision were compared between the period March 1, 2019 to February 29, 2020 (pre-pandemic) and March 1, 2020 to February 28, 2021 (pandemic) with a Poisson regression analysis. In the pandemic period, the number of cervical excisions was reduced by 8.8% (95% confidence interval [CI]=-15.6% to -2%; p=0.011). Excisions were less frequently performed in the operating room (-35.1%; 95% CI=-47.6% to -22.6%; p<0.001), the number of patients from spontaneous screening was reduced by -14.0% (95% CI=-23.4% to -4.6%; p=0.003), and the CO2-laser technique was used less frequently (-30%; 95% CI=-45.1% to -15.0%; p<0.001). As compared to the pre-pandemic period, the number of follow-ups for conservative management of low-grade lesions was reduced by -26.7% (95% CI=-39.0% to -14.4%; p<0.001), and the follow-up appointments after cervical excision were reduced by -51.0% (95% CI=-58.1% to -43.9%; p<0.001). The most significant impact of the healthcare reorganization during the coronavirus disease 2019 pandemic was on follow-ups after cervical excision. The resumption of disrupted activities should follow a risk-based prioritization, starting from women in follow-up after cervical excision. It is advisable that the trend of performing cervical excision as an outpatient procedure is maintained in the post-pandemic period.

The effect of Covid-19 in digital media use of Finnish physicians – Four wave longitudinal panel survey

BackgroundCovid-19 pandemic has boosted digitalization in healthcare, as mobility restrictions and social distancing rules have made healthcare providers to adopt digital tools to replace or complement face-to-face interactions. PurposeWe discuss the effects of Covid-19 pandemic on physicians’ use of digital media. We examine whether Covid-19 conditions have changed how physicians use internet resources for information search, how they engage in social media, and their attitude towards online events. Basic proceduresThe study was done as a longitudinal panel survey in four waves. The sample was a panel including active physicians in Finland. The panel was updated annually. Identical surveys were administered in 2018, 2019, 2020 and 2021. Spring 2020 was the time when Finland executed mobility restrictions and re-organization of healthcare because of pandemic. Comparing results of the survey before and after Covid-19 restrictions gives us a unique opportunity to do comparative analysis of Covid-19 effects. Main findingsOur results show that the use of digital media for information search stayed relatively stable without statistically significant change during the four-year period covered in the study. The use of social media rose steadily from 2018 to 2021 with no significant difference in the trend. However, there was a significant change in the attitude of Finnish physicians on online events. Year 2021, the attitude remained in this more positive level. Principal conclusionsAs use of digital media including social media was already high prior Covid-19 in Finland, our results do not show significant change because of special circumstances introduced in 2020. However, our results show that the attitudes towards online events turned more positive during Covid-19 related restrictions. This could indicate that Covid-19 era has triggered a change that might continue also when pandemic related restrictions will be removed.

Assessment of Readiness for the Implementation of the Hospital Health Information System Under Primary Health Care Reorganization in Selected Hospitals in Kalutara District

<strong>Introduction: </strong>Organizational resources and technical structures such as hardware and software are very essential requirements in the redesign of electronic projects. (Ajam, 2011) Before implementation of Hospital Health Information System (HHIS) in primary health care institutions it is essential to conduct an assessment of readiness of institutions. <strong>Objective: </strong>To assess the readiness for the implementation of Hospital Health Information System under primary health care reorganization in selected Hospitals in Kalutara District. <strong>Methodology: </strong>Cross-sectional study was carried out in Divisional Hospitals Bandaragama, Gonaduwa and Haltota. A readiness assessment tool was used to study readiness in Technology and Infrastructure, Human Resources, and Workflow. Technology and infrastructure readiness and workflow readiness were assessed by interviewing medical officers in charge (MOICs) of relevant three hospitals and by direct observation. For assessment of human resource readiness, a validated and pretested self-administered questionnaire was used for all staff supposed to be involved in the operational process of proposed HHIS in selected hospitals. <strong>Results and discussion:</strong> Although all three Hospitals show a total readiness of more than 50%, technology, infrastructure readiness and workflow readiness of Divisional Hospital Gonaduwa and Haltota are less than 50%. Higher level of Human resource readiness has increased the total readiness of these two hospitals more than 50%. However, divisional hospital Bandaragama shows more than 50% readiness of all three types. <strong>Conclusions and recommendations:</strong> It is important to have more than 50% of readiness for all three major sections of the tool individually.

Patient prioritization and management during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic affected the healthcare system in a major way generally. Healthcare re-organization of resources and manpower, establishing management protocols and specific patients’ pathways are all evolving with the continuously changing situation. Neuro-vascular management and its re-organization are part of these global measures to cope with this pandemic in a way to establish less risky patients’ pathways, help in patients’ triage, protecting the staff by introducing training and applying safety measures and to manage neuro-vascular emergencies and elective activity. We here describe the situation of the pandemic affecting neuro-vascular interventions and propose our recommendations for patients’ triage, resources management and organization, remote solutions and preparations for any future waves.

A framework analysis on dystonic patients' experiencies of first-wave of COVID-19 pandemic

The first wave of the SARS-CoV2 pandemic imposed healthcare reorganization in order to tackle the infection spread. Prioritizing COVID-19 related management risked leaving rare chronic diseases without proper care response. This study aims at analysing the dystonic patients' (DPs) experiences during the pandemic.

COVID-19 and regional differences in the timeliness of hip-fracture surgery: an interrupted time-series analysis.

BackgroundIt is of great importance to examine the impact of the healthcare reorganization adopted to confront the COVID-19 pandemic on the quality of care provided to non-COVID-19 patients. The aim of this study is to assess the impact of the COVID-19 national lockdown (March 9, 2020) on the quality of care provided to patients with hip fracture (HF) in Piedmont and Emilia-Romagna, two large regions of northern Italy severely hit by the pandemic.MethodsWe calculated the percentage of HF patients undergoing surgery within 2 days of hospital admission. An interrupted time-series analysis was performed on weekly data from December 11, 2019 to June 9, 2020 (≈6 months), interrupting the series in the 2nd week of March. The same data observed the year before were included as a control time series with no “intervention” (lockdown) in the middle of the observation period.ResultsBefore the lockdown, 2-day surgery was 69.9% in Piedmont and 79.2% in Emilia-Romagna; after the lockdown, these proportions were equal to 69.8% (–0.1%) and 69.3% (–9.9%), respectively. While Piedmont did not experience any drop in the amount of surgery, Emilia-Romagna exhibited a significant decline at a weekly rate of –1.29% (95% CI [−1.71 to −0.88]). Divergent trend patterns in the two study regions reflect local differences in pandemic timing as well as in healthcare services capacity, management, and emergency preparedness.