Innovative Health Services Research Articles

Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers

BackgroundImplementing innovative health service models in existing service systems is complicated and context dependent. Flexible assertive community treatment (FACT) is a multidisciplinary service model aimed at providing integrated care for people with severe mental illness. The model was developed in the Netherlands and is now used in several countries, such as Norway. The Norwegian service system is complex and fragmented, with challenges in collaboration. Limited research has been performed on FACT teams and other new integrative health service models as part of such systems. However, such knowledge is important for future adjustments of innovation processes and service systems. Our aim was to explore how FACT teams are integrated into the existing formal public service system, how they function and affect the system, and describe some influencing factors to this. We sought to address how service providers in the existing service system experience the functioning of FACT teams in the system.MethodsFive focus group interviews were undertaken 3 years after the FACT teams were implemented. Forty service providers representing different services from both levels of administration (primary and specialist healthcare) from different Norwegian regions participated in this study. Team leaders of the FACT teams also participated. Service providers were recruited through purposeful sampling. Interviews were analysed using thematic text analysis.ResultsThe analysis revealed five main themes regarding FACT teams: (1) They form a bridge between different services; (2) They collaborate with other services; (3) They undertake responsibility and reassure other services; (4) They do not close all gaps in service systems; and (5) They are part of a service system that hampers their functioning.ConclusionsThe FACT teams in this study contributed to positive changes in the existing service system. They largely contributed to less complex and fragmented systems by forming a bridge and undertaking responsibility in the system and by collaborating with and reassuring other services; this has reduced some gaps in the system. The way FACT teams function and needs of the existing system appear to have contributed positively to these findings. However, complexity and fragmentation of the system partly hamper functioning of the FACT teams.

Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness (PRIMERA\u2014Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children): study protocol for a randomised controlled trial

BackgroundParental mental illness is common and can lead to dependent children incurring a high risk of developing mental disorders, physical illness, and impaired educational and occupational outcomes. Family Talk is one of the better known interventions designed to prevent the intergenerational transmission of mental illness. However, its evidence base is small, with few robust independent randomised controlled trials, and no associated process or cost evaluations. The PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children) research programme involves a mixed method evaluation of Family Talk which is being delivered in mental health settings in Ireland to improve child and family psychosocial functioning in families with parental mental illness.MethodsThe study comprises a multi-centre, randomised controlled trial (RCT), with nested economic and process evaluations, to assess the clinical and cost-effectiveness and implementation mechanisms of Family Talk compared to usual services. The study is being conducted in 15 adult and child mental health settings in Ireland. Families with a parent with mental illness, and children aged 5–18 years (n = 144 families) will be randomised to either the 7-session Family Talk programme (n = 96) or to standard care (n = 48) using a 2:1 allocation ratio. The primary outcomes are child psychosocial functioning and family functioning. Secondary outcomes are as follows: understanding and experience of parental mental illness, parental mental health, child and parental resilience, partner wellbeing and service utilisation. Blind assessments will take place at pre-intervention and at 6- and 12-month follow-up.DiscussionGiven the prevalence and burden of intergenerational mental illness, it is imperative that prevention through evidence-based interventions becomes a public health priority. The current study will provide an important contribution to the international evidence base for Family Talk whilst also helping to identify key implementation lessons in the scaling up of Family Talk, and other similar interventions, within routine mental health settings.Trial registrationISRCTN Registry, ISRCTN13365858. Registered 5th February 2019.

Internet and psychosocial interventions: What is the evidence?

Abstract BodyDigital mental health, before, during and after the COVID-19 pandemic Over the last two decades the digital landscape of mental health care research and service innovation has gained momentum. This period is characterized by many successes’ stories but brilliant failures as well. Today, e-mental health is like a two-headed Janus. One side of his face illustrates the birth of innovative technologies that entered mental health service provision. In parallel, the evidence-base for the application of these new technologies, such as internet-based treatments for depression, has been established with effect sizes comparable to those of face-to-face treatments. The other side of his face shows, however, that eMental-health has not yet lived up to its’ full potential as its actual delivery, evaluation and implementation in routine care has proven to be a much longer and bumpier road than expected. The question addressed in this presentation will be ‘what does the future hold’? Acknowledging that futures are difficult to predict Heleen Riper nevertheless provides insights into how we may overcome some of these bumps by combining the best of two worlds, i.e. blending digital and face-to-face components into one integrated treatment approach. She will illustrate these new developments by virtue of the results of the H2020 European Comparative Effectiveness Study for Major Depression and current experiences with especially videoconferencing during the Covid-19 pandemic.DisclosureNo significant relationships.

Evidence use as sociomaterial practice? A qualitative study of decision-making on introducing service innovations in health care

ABSTRACT A policy aspiration is that evidence should inform decision-making on introducing health service innovations. Internationally, innovation adoption has historically been slow and patchy. Three innovations in the English and Scottish National Health Service were analysed qualitatively: stroke service reconfiguration; revised national guidance on cancer referral; and ‘virtual’ glaucoma outpatient clinics. The authors identify three sociomaterial mechanisms through which evidence and context shape each other in decision-making: connecting, ordering, resisting. Shared preferences for research evidence enabled the medical profession to exert influence on decision-making, while other professions used alternative evidence. Implications for promoting inclusive public management around service innovations are discussed.

Implementation of the norwegian \u2018Starting right\u2019 child health service innovation: implementation adjustments, adoption, and acceptability

BackgroundAn increased and/or stable proportion of the child and adolescent population reports symptoms of impaired health, and the symptoms can be identified early. Therefore, structured child- and parent-reported outcome measures need to be implemented in child and school health services for decision support and identification of children at risk. We aimed to (a) qualitatively examine adjustments of active implementation from the pilot implementation of the Norwegian ‘Starting Right’ health service innovation including an online child health assessment tool and practical routines, and (b) measure practitioners´ adoption and parental acceptability.MethodsWe used a mixed-methods design to qualitatively examine adjustments from working notes and meeting memoranda, and quantitatively assess adoption and acceptability from user rates provided by the systems log. Twenty-one child and school health nurses (CSHNs) from two child health centers participated in the implementation pilot of online health assessments in children aged 2-, 4- and 6-year. We used a deductive and narrative analysis approach using Fixsen et al.´s core implementation components to code and sort adjustments.ResultsCore implementation components were adjusted throughout the pilot implementation. Researchers´ increased their availability in reciprocity with staff evaluation to integrate active implementation adjustments. We launched a project for improved data systems integration. The overall CSHNs adoption rate was satisfactory and higher in center A, where a medical secretary supported the nurses through the entire pilot phase, than in center B (96 vs. 55 %). Parental acceptability rate was overall high (77 %) with increased rates among parents of 6-year-old children (98 %) compared with younger ones (78–85 %), and in cases where both parents received the questionnaires.ConclusionsThe ‘Starting Right’ health service innovation implementation was actively adjusted by integration of core implementation components mainly based on staff evaluation. The CSHNs adopted the innovation which was also acceptable to parents.

Human-Technology Interaction Considerations in Hearing Health Care: An Introduction for Audiologists.

Purpose Innovations in user-driven hearing technology and services have placed greater control in the hands of the patient. While these advances could address issues of hearing health care accessibility, their success rests on the assumption that patients possess sufficient technological competence to self-manage these products and services successfully. The purpose of this tutorial is to highlight the importance of focusing on usability, rather than just performance outcomes, during the design, development, and evaluation of user-driven hearing technology and services. Method This tutorial explores human-technology interaction and usability and discusses practical methods for applying these concepts in hearing health care research and development. Two case studies illustrate how usability can inform the design and development of interactive educational materials for patients and the evaluation of a commercially available mHealth app. Conclusions In order to derive benefit from innovations in hearing health care, products and services must be intuitively usable in addition to being accessible and affordable. The discipline of human-technology interaction provides a relevant and useful framework to guide future research and development efforts in user-driven hearing health care.

Participation in adherence clubs and on-time drug pickup among HIV-infected adults in Zambia: A matched-pair cluster randomized trial.

BackgroundCurrent models of HIV service delivery, with frequent facility visits, have led to facility congestion, patient and healthcare provider dissatisfaction, and suboptimal quality of services and retention in care. The Zambian urban adherence club (AC) is a health service innovation designed to improve on-time drug pickup and retention in HIV care through off-hours facility access and pharmacist-led group drug distribution. Similar models of differentiated service delivery (DSD) have shown promise in South Africa, but observational analyses of these models are prone to bias and confounding. We sought to evaluate the effectiveness and implementation of ACs in Zambia using a more rigorous study design.Methods and findingsUsing a matched-pair cluster randomized study design (ClinicalTrials.gov: NCT02776254), 10 clinics were randomized to intervention (5 clinics) or control (5 clinics). At each clinic, between May 19 and October 27, 2016, a systematic random sample was assessed for eligibility (HIV+, age ≥ 14 years, on ART >6 months, not acutely ill, CD4 count not <200 cells/mm3) and willingness to participate in an AC. Clinical and antiretroviral drug pickup data were obtained through the existing electronic medical record. AC meeting attendance data were collected at intervention facilities prospectively through October 28, 2017. The primary outcome was time to first late drug pickup (>7 days late). Intervention effect was estimated using unadjusted Kaplan–Meier survival curves and a Cox proportional hazards model to derive an adjusted hazard ratio (aHR). Medication possession ratio (MPR) and implementation outcomes (adoption, acceptability, appropriateness, feasibility, and fidelity) were additionally evaluated as secondary outcomes. Baseline characteristics were similar between 571 intervention and 489 control participants with respect to median age (42 versus 41 years), sex (62% versus 66% female), median time since ART initiation (4.8 versus 5.0 years), median CD4 count at study enrollment (506 versus 533 cells/mm3), and baseline retention (53% versus 55% with at least 1 late drug pickup in previous 12 months). The rate of late drug pickup was lower in intervention participants compared to control participants (aHR 0.26, 95% CI 0.15–0.45, p < 0.001). Median MPR was 100% in intervention participants compared to 96% in control participants (p < 0.001). Although 18% (683/3,734) of AC group meeting visits were missed, on-time drug pickup (within 7 days) still occurred in 51% (350/683) of these missed visits through alternate means (use of buddy pickup or early return to the facility). Qualitative evaluation suggests that the intervention was acceptable to both patients and providers. While patients embraced the convenience and patient-centeredness of the model, preference for traditional adherence counseling and need for greater human resources influenced intervention appropriateness and feasibility from the provider perspective. The main limitations of this study were the small number of clusters, lack of viral load data, and relatively short follow-up period.ConclusionsACs were found to be an effective model of service delivery for reducing late ART drug pickup among HIV-infected adults in Zambia. Drug pickup outside of group meetings was relatively common and underscores the need for DSD models to be flexible and patient-centered if they are to be effective.Trial registrationClinicalTrials.gov NCT02776254.

The Effect of Partnership Strategy on Competitive Advantages through the Market Area and Health Services’ Innovation

Based on the 2014 Indonesia Republic Minister of Health Regulation on Hospital Licensing Classification, it is explained that the Hospital is one of the bodies engaged in the health sector which plays an important role for the creation of quality of life and the environment for the community, so as to create a high degree of health both for physical, spiritual health , and social. The attention of the Head of F.X Suhardjo Navy Hospital to the partnership strategy towards competitive advantage. This may improve the ability of the Head of F.X Suhardjo Navy Hospital to develop appropriate strategies to further enhance his competitive advantage. Health service innovation has an effect on competitive advantage, useful for F.X Suhardjo Navy Hospital heads in the sense that they can make efforts to improve health service innovation to improve their competitive advantage.

Strategi Inovasi Pelayanan Kesehatan Pada Rumah Sakit Umum Daerah Kota Kendari

This study aims to determine the Health Service Innovation Strategy at the Kendari City General Hospital. The method used in this research is a qualitative descriptive study by collecting data through observation, interviews, and documentation.Determination of informants in this study was conducted by purposive sampling. While the data analysis technique uses a qualitative descriptive analysis model. The results of this study indicate that the health service innovation strategy at Kendari City Hospital is a web application-based referral information system innovation regarding the availability of Inpatient Rooms or known as the Innovation System for Patient Referral Room Availability Systems (SEKAR) with this service information system for all Puskesmas in Kendari City can utilize this information to provide maximum referral services to the people of Kendari City in particular even the people of Southeast Sulawesi in general with the aim of minimizing public complaints about the uncertainty of room availability. With this information, handling is faster so that it can prevent deaths due to delayed access to services. In the application of this innovation, the management of Kendari City Hospital still faces several obstacles including the lack of socialization and publication about this health service, updating patient data in each hospital room becomes an obstacle. In addition, the budget as a fulfillment of the availability of supporting facilities such as computers is still limitedKeywords: Health, Innovation, Services, Strategies

Health service innovation in City of Makassar

This study aims to describe home care program as a health service innovation to improve quality of health service. The study employs a descriptive qualitative approach and collected data by interview and field observation. The research was conducted in two health community centers during March-May 2017. Result data is analyzed with qualitative descriptive method. The study identified home care services carried out in each community health center in Makassar City to improve the quality of public health services, especially in the community in the slum area. Nevertheless, this home care program still has obstacles, including overdependence on top leaders, limited number and capacity of health workers, and inappropriate rewards. Home care program is health service innovation, which is initiated by the Health Service Agency of City of Makassar and it contributes to quality improvement of health service, particularly to vulnerable urban communities.

Liver transplant recipients’ experiences and perspectives of a telehealth-delivered lifestyle programme: A qualitative study

Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service. Methods Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data. Results In total, 19 liver transplant recipients participated in the study (25–68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) ‘broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face care; (b) ‘impact of employment' which identified employment as a competing priority and appeared to effect involvement with the programme; (c) ‘adapting Mediterranean eating pattern to meet individual needs' which identified the adaptability of the Mediterranean diet supported by sessions with the dietitian; (d) ‘increasing exercise confidence' which recognised that a tailored approach facilitated confidence and acceptability of the exercise component of the programme. Discussion A telehealth lifestyle programme delivered by dietitians and exercise physiologists is an acceptable alternative to face-to-face care that can meet the needs of liver transplant recipients. There is a need to further innovate and broaden the scope of routine service delivery beyond face-to-face consultations.

Use of Outpatient Care Services by People with Dementia: Results of the Bavarian Dementia Survey (BayDem)

The increasing prevalence of dementia raises challenges concerning the care of people with dementia (pwd). The care of pwd is mainly conducted by informal caregivers who are faced with several burdens; however, use of care services is generally low. The aim of this study was to identify predictors of the use of outpatient care services. The Bavarian Dementia Survey (BayDem) is a multi-centre, longitudinal study that was conducted at 3 different sites in Bavaria, Germany. Participants were people with dementia (pwd) (according to ICD-10) and their informal caregivers. Data were collected by standardised face-to-face interviews using well-designed instruments in cooperation with local partners. Logistic regression analysis was carried out in order to identify predictors of the use of outpatient care services. In total, 364 pwd and 339 informal caregivers were included at the beginning of the study BayDem. The use of supportive care services was generally low. One-third of all participants used outpatient care services. In the logistic regression analysis, the following significant predictors for the use of outpatient care services 6 months after baseline were identified: severity of cognitive impairment of the pwd; use of outpatient care at the beginning of the study. The low use of outpatient care services is a well-known paradoxical phenomenon. Such services can help give relief to informal caregivers. In order to enhance the use of supportive outpatient care services, there should be more focus on innovative health service delivery models with a low access threshold barrier. Besides more public campaigns, more guidance for existing offers is needed.

The development of a regional referral pathway for locally recurrent rectal cancer: A Delphi consensus study

BackgroundThe management of patients with locally recurrent rectal cancer (LRRC) is often complex and requires multidisciplinary input whereas only few patients are referred to a specialist centre. The aim of this study was to design a regional referral pathway for LRRC, in Nouvelle Aquitaine (South-West, France). MethodsIn 2016, we conducted with a Study Steering Committee (SC) a three phase mixed-methods study including identification of key factors, identification of key stakeholders and Delphi voting consensus. During three rounds of Delphi voting, a consensus was defined as favorable, if at least 80% of participating experts rate the factor, below or equal to 3/10 using a Likert scale, or consider it as “useful” using a binary scale (third round only). Finally, the SC drafted guidelines. ResultsAmong the 423 physicians involved in 29 regional digestive Multi-Disciplinary Team (MDT) meeting, 59 participants (from 26 MDT meeting) completed all three rounds of Delphi voting. Thirteen out of twenty initially selected factors reached a favorable consensus. All patients with a LRRC need to be included into a referral pathway. Patients with a central pelvic recurrence offered curative treatment in their local hospital and patients with unresectable metastatic disease were excluded of the referral. Key performance indicators were also agreed including the time to referral and completion of pelvic MRI-, CT-, PET-scan prior to MDT referral. ConclusionThe development of this referral pathway represents an innovative health service, which will improve the management of patients with LRRC in France.

THE APPLICATION OF MASS OBSERVATION DATA IN SOCIAL RESEARCH

Responding to the opportunities and challenges of an ageing world the University of Chester established the Centre for Ageing, Mental Health and Veterans’ Studies in 2013 to provide research, consultancy and education, with the aim of promoting innovation in health and social care services for older people. This symposium brings together researchers from a wide range of disciplines and career stages, to explore the utility of Mass observation data in social research in the field of gerontology. The Mass Observation Project, established in 1937, documents the lives of ordinary people living in the UK, and explores a wide range of social issues. The symposium comprises four separate papers. The Methodological Relevance of Mass Observation Data: This preliminary overview will outline the mass observation archive, highlighting challenges and issues encountered utilising the data produced in social research. Personal Narratives of Ageing: This paper presents personal narratives reflecting on the ageing process, and growing older in the UK. The Health Impact of Scams: This presentation will offer new and alternate insights into ‘scams’ and the health effects of fraud on older people, using data from the mass observation directive commissioned by the centre. Perceptions of Dementia: This paper presents a perspective on the public knowledge and understanding about dementia not previously considered, where respondents have written openly about their own experiences, and reflected on their perception of the wider public’s knowledge and understanding about dementia.

Scaling up mental health interventions in conflict zones

Scaling up mental health interventions in conflict zones

Converging resources and co-producing for innovation: evidence from healthcare services

PurposeThe purpose of this paper is to examine healthcare organizations for the improvements in their existing services (incremental innovation) as well as for the new service developments (radical innovation) initiated through the utilization of resources and co-producing behavior.Design/methodology/approachThe paper uses an SEM approach to analyze the responses obtained from 257 medical administrators of 50 hospitals registered with National Accreditation Board for Hospitals and Healthcare Providers.FindingsThe results reflect a positive and significant impact that is more driven by internal resources and is found to be stronger for incremental innovation in healthcare. The study also posits that resource utilization in conjunction with co-production activities has greater potential to bring innovation that is likely to succeed and stay inimitable.Research limitations/implicationsThe paper outlines scope for future research and suggests inclusion of other service sectors, geographical locations and performance indicators to attain a better understanding of the constructs examined.Practical implicationsThe paper outlines implications for policy makers concerned with healthcare. Providers of health services ought to develop a proactive customer-oriented approach so as to deliver value through service innovations. Integrating customer co-production processes may further augment the overall quality of care.Originality/valueEmpirical studies integrating the resource-oriented view of innovation along with firms’ co-production and collaborative mechanisms are majorly lacking. The study bridges this gap and suggests ways to bring innovation in health services, a pivotal need for health institutions of an emerging economy like India.

Health Service Innovation in Local Government : Analyzing the effect of organizational culture and knowledge management on the Health Service Innovation and Performance

Health Service Innovation in Local Government : Analyzing the effect of organizational culture and knowledge management on the Health Service Innovation and Performance

Promoting and implementing family-focused interventions for families with parental mental illness: scoping and installation

ABSTRACT Objectives: This paper outlines the findings from the first stage of a research programme called PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and Children). This programme aims to identify, help implement and evaluate family-focused interventions for families where a parent has a mental illness, and promote a ‘think family’ service delivery agenda in the Republic of Ireland (RoI). Methods: An initial scoping study was undertaken to: (1) assess the nature and extent of family-focused practice (FFP) in adult (N = 114) and child (N = 69) mental health services in the RoI; (2) review the international literature; and (3) undertake site/service visits to assess readiness for, and inform the implementation of, FFP. Results: A national Expression of Interest (EoI) call led to 37 written submissions (20% response rate) plus six further requests for involvement from interested community services. Fifteen sites/services (35%) were included in the research following critical appraisal and consultation. FFP across services/sites was small-scale or non-existent. Following a literature review and other strategic/resource considerations, all sites were invited to deliver the Family Talk (FT) intervention; 12 agreed to do so; three sites will deliver other programmes. A series of activities was undertaken by the research team to support early implementation. Discussion: This first phase of the research provides a critical starting point for promoting, and assessing the development of, FFP in mental health services in the RoI. Some useful generalisable lessons are also identified in terms of building capacity and beginning to change practice in this field.

The Big Picture on the "AI Turn" for Digital Health: The Internet of Things and Cyber-Physical Systems.

This article offers an analysis of the ways in which digital health innovations are being coproduced by mainstreaming of artificial intelligence (AI), the Internet of Things (IoT), and cyber-physical systems (CPS) in health care. CPS blurs the boundaries between the physical and virtual worlds, and creates a dynamic digital map of all things in existence that can be analyzed in ways that are much more sophisticated than a bar code scanning system. Examples of CPS include self-driving cars, wearables for digital monitoring of heart arrhythmias, industrial AI-powered robots in smart factories and health robots delivering home care services to disabled persons and rural communities. Another interesting prospect of digital health powered by AI, IoT, and CPS is remote phenotypic data capture and characterization of pharmaceutical outcomes in clinical trials in ways that are user centric and meaningful to patients. For rural or remote communities with limited access to medical product information, the IoT could bring about pharmacy and health services innovation. There are unprecedented societal challenges at intersections of digital health with AI, IoT, and CPS as well. For example, the physical and virtual worlds markedly differ in speed, scale, and temporalities, as do our physical self and digital footprints. Our efforts to map and develop effective solutions to societal corollaries of AI, IoT, and CPS need to bear in mind such asymmetries between the physical and virtual worlds. A societal issue such as privacy may emerge in different forms and intensities in the physical and virtual contexts. Digital data are highly fluid and can rapidly move across spaces and places, whereas the physical data and humans are much slower and exist in different scales than our digital footprints. It is therefore timely for the system sciences and integrative biology communities to critically engage with digital health and the related technologies, such as AI, IoT, and CPS.

Intelligent Security and Privacy of Electronic Health Records Using Biometric Images.

In the presence of Cloud Environment and the migration of Electronic Health Systems and records to the Cloud, patient privacy has become an emergent problem for healthcare institutions. Government bylaws, electronic health documentation, and innovative internet health services generate numerous security issues for healthcare conformity and information security groups. To deal with these issues, healthcare institutes must protect essential IT infrastructure from unauthorized use by insiders and hackers. The Cloud Computing archetype allows for EHealth methods that improve the features and functionality of systems on the cloud. On the other hand, sending patients' medical information and records to the Cloud entails a number of risks in the protection and privacy of the health records during the communication process. In this paper, a solution is proposed for the security of Electronic Health Records (EHRs) in cloud environment during the process of sending the data to the cloud. In addition, the proposed method uses biometric images that allow for unified patient identification across cloud-based EHRs and across medical institutions. To protect the privacy of patients' information and streamline the migration process, a watermarking-based method is proposed for health care providers to ensure that patients' data are only accessible to authorized personnel. Patients' information, such as name, id, symptoms, diseases, and previous history, is secured in biometric images of patients as an encrypted watermark. Quality and impeccability analysis and robustness were performed to test the proposed method. The PSNR values show that the proposed method produced excellent results. The robustness and impressibility of the proposed method were tested by subjecting the watermarked images to different simulated attacks. The watermarks were largely impermeable to varied and repeated attacks.