Health Service Team Research Articles

Barriers and facilitators to implementation of a home-based cardiac rehabilitation programme for patients with heart failure in the NHS: a mixed-methods study

ObjectivesThis study aimed to identify barriers to, and facilitators of, implementation of the Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) programme within existing cardiac rehabilitation services, and develop and refine...

Effect of an intervention for patients 65 years and older with blunt chest injury: Patient and health service outcomes

IntroductionBlunt chest injury in older adults, aged 65 years and older, leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes in older adults with blunt chest injury. MethodsChIP comprised multidimensional implementation guidance in three key pillars of care for blunt chest injury: respiratory support, analgesia, and complication prevention. Implementation was guided using the Behaviour Change Wheel. This proof-of-concept controlled pre- and post-test study with two intervention and two control sites in Australia was conducted from July 2015 to June 2019. The primary outcomes were non-invasive ventilation (NIV) use, unplanned Intensive Care Unit (ICU) admissions, and in-hospital mortality. Secondary outcomes were health service and costing outcomes. ResultsThere were 1122 patients included in the analysis, with 673 at intervention sites (331 pre-test and 342 post-test) and 449 at control sites (256 pre-test and 193 post-test). ChIP was associated with unplanned ICU admissions and in NIV use with a reduction of the odds in the post vs the pre periods in the intervention sites when compared to the controls (ratio of OR=0.13, 95%CI=0.03-0.55) and (ratio of OR=0.14, 95%CI=0.02-0.98) respectively. There was no significant change in mortality. Implementing ChIP was also associated with health service team reviews with an increased odds in the post vs pre periods in the intervention sites in comparison to the controls for surgical review (ratio of OR =6.93, 95%CI=4.70-10.28), ICU doctor (ratio of OR =5.06, 95%CI=2.26-9.25), ICU liaison (ratio of OR =14.14, 95%CI=3.15-63.31), and pain (ratio of OR =5.59, 95%CI=3.25-9.29). ChIP was also related to incentive spirometry (ratio of OR=6.35, 95%CI= 3.15-12.82) and overall costs (ratio of mean ratio=1.34, 95%CI=1.09-1.66) with a higher ratio for intervention sites. ConclusionImplementation of ChIP using the Behaviour Change Wheel was associated with reduced unplanned ICU admissions and NIV use and improved health care delivery. Trial registrationANZCTR: ACTRN12618001548224, approved 17/09/2018

Young people’s views on specialist mental healthcare and remote delivery during the COVID-19 pandemic

This article reports findings from a service evaluation involving interviews with 16 young people under the care of a single specialist child and adolescent mental health service team. The team serves various ‘vulnerable’ population groups, including children and young people living in residential and foster care, those who are adopted and those who are involved with youth justice services. The evaluation was concerned with how the shift from face-to-face to remote methods of care delivery and new ways of working during the coronavirus disease 2019 pandemic has been experienced by service users. The young people’s accounts highlight how differences in provision were mostly anticipated, which interlinked with a high level of satisfaction with the service overall. Therapeutic relationships with clinicians also appeared to hold a renewed significance when care was delivered remotely or through a combination of remote and face-to-face delivery. The article concludes by considering the implications of the findings for practice and care pathway planning and commenting on the value of service evaluations for illuminating issues that transcend local care.

Establishing a novel community-focussed lactation support service: a descriptive case series

BackgroundAlthough breastfeeding is widely acknowledged as protecting both infant and maternal health postnatally, a partial or complete shortfall of maternal milk can occur for a range of reasons. In this eventuality, the currently available options for feeding infants are screened donor human milk (DHM), infant formula or unscreened shared human milk. In the UK, DHM has only been widely available in specific clinical contexts for the last 40 years, mainly to reduce the risk of necrotising enterocolitis in extremely preterm infants alongside optimal support for maternal lactation and breastfeeding. The Hearts Milk Bank (HMB) was established in 2017 as an independent, non-profit human milk bank that aimed to ensure equitable, assured access to screened DHM for neonatal units. As a result of the generosity of mothers, a surplus of DHM rapidly became available and together with lactation support, has since been provided to families with a healthcare referral. This programme has now been formalised for families facing lactational challenges, and DHM stocks are permanently maintained to meet their needs.Case seriesThis case series describes the clinical paths of four families who accessed lactation support and DHM from the HMB, along with a description of the process for community provision. To date, the HMB has supported over 300 families. Working collaboratively with key stakeholders, the HMB team has developed a prioritisation strategy based on utilitarian ethical models, protocols that ensure safe handling and appropriateness of use, broader donor recruitment parameters that maintain safety with a pragmatic approach for full term healthy infants, and a process to ensure parents or carers have access to the knowledge needed to give informed consent and use DHM appropriately.ConclusionsStakeholders, including parents, healthcare professionals, and milk banks, will need to discuss priorities for both DHM use and research gaps that can underpin the equitable expansion of services, in partnership with National Health Service (NHS) teams and third-sector organisations that support breastfeeding and maternal mental health.

Monitorização da Temperatura à entrada das Empresas: vale a opinião ou a evidência?

Introduction / background / objectives Temperature screening (with infrared thermometers) in workplaces has proven to be controversial, creating discussions between Occupational health services teams, assuming as a "requirement" from workers and/ or Employers. This article intends to analyze the evidence of such as strategy. Methodology This is a descriptive literature review. The search for scientific sources was carried out using the PUBMED (Medline) databases during the month of July 2021, without time limitation, in Portuguese or English, with keywords “temperature screening” and “Covid-19”. Content Skin temperature, rather than core temperature, can be influenced by several factors; infrared thermometers does not appear to be reliable enough to detect or exclude fever, and fever is not a characteristic symptom of all infected from Covid-19. Thus, this unreliable proxy does not provide evidence to support its implementation in workplaces as an evidence-based measure. This strategy appears to lend more accountability to marketing and placebo than to evidence, helping workers and Employers feel better, but not doing much and potentially getting worse, by conveying a false sense of security. Conclusions Each workplace can determine its own preferences, depending on its particular epidemiological context, and for this reason there is no “right answer” on how Companies should approach this matter - the evidence on this topic is incomplete and the challenges posed by the pandemic are changing; however, in order to delineate more informed decisions, if we are to achieve, as a country, a fast economic recovery, employers will have to stop betting on measures that require resources, but which are placebos. Keywords: temperature screening; Covid-19; Ocupacional Health.

The consistency of visual acuity measurement using PEEK acuity and Snellen-E performed by trained teachers in elementary school students

Background: Visual impairment in children affects growth and development, psychological, social, daily activities, which reduce the quality of life. Children often don't realize that they see "lack of" and do not complain of any difficulty in seeing. Collaboration between medical and non-medical personnel could be developed as a tiered health service team. Teachers as educators could help the health service team through health education and eye screening. The purpose of this study was to find out the consistency of visual acuity measurements by trained teachers using PPEK acuity and Snellen-E.Methods: This study is an analytic cross sectional study conducted on 178 samples in elementary school. Visual acuity was measured by trained teachers using PEEK Acuity and Snellen-E cards and ETDRS by an ophthalmologist. Data analysis using Bland Altman and Rank-Spearman correlation test.Results : Mean difference in visual acuity measurement with PEEK Acuity by trained teacher and ETDRS by ophthalmologist are 0,0028 logMAR (p = 0,543; 95% CI -0,0063 – 0,0119; 95% limit of agreement -0,11766 - 0,12326). Mean difference in visual acuity measurement with Snellen-E by trained teacher and ETDRS by ophthalmologist shows 0,0090 logMAR (p = 0,103; 95% CI -0.0018 – 0.0198; 95% limit of agreement -0.13426 – 0.15225). Mean difference in visual acuity measurement with PEEK Acuity and Snellen-E by trained teacher shows -0,0062 logMAR (p = 0.248; 95% CI -0,0175– 0,0052; 95% limit of agreement -0,15667 – 0,144269).Conclusion: Visual acuity measurement using PEEK Acuity and Snellen-E by trained teachers and ETDRS by an ophthalmologist are consistent and could replace each other.

Coronavirus disease 2019 (COVID-19) screening system utilizing daily symptom attestation helps identify hospital employees who should be tested to protect patients and coworkers.

To investigate the effectiveness of a daily attestation system used by employees of a multi-institutional academic medical center, which comprised of symptom-screening, self-referrals to the Occupational Health Services team, and/or a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) test. We conducted a retrospective cohort study of all employee attestations and SARS-CoV-2 tests performed between March and June 2020. A large multi-institutional academic medical center, including both inpatient and ambulatory settings. All employees who worked at the study site. Data were combined from the attestation system (COVIDPass), the employee database, and the electronic health records and were analyzed using descriptive statistics including χ2, Wilcoxon, and Kruskal-Wallis tests. We investigated whether an association existed between symptomatic attestations by the employees and the employee testing positive for SARS-CoV-2. After data linkage and cleaning, there were 2,117,298 attestations submitted by 65,422 employees between March and June 2020. Most attestations were asymptomatic (99.9%). The most commonly reported symptoms were sore throat (n = 910), runny nose (n = 637), and cough (n = 570). Among the 2,026 employees who ever attested that they were symptomatic, 905 employees were tested within 14 days of a symptomatic attestation, and 114 (13%) of these tests were positive. The most common symptoms associated with a positive SARS-CoV-2 test were anosmia (23% vs 4%) and fever (46% vs 19%). Daily symptom attestations among healthcare workers identified a handful of employees with COVID-19. Although the number of positive tests was low, attestations may help keep unwell employees off campus to prevent transmissions.

Participants' Perspective of Engaging in a Gym-Based Health Service Delivered Secondary Stroke Prevention Program after TIA or Mild Stroke.

People who have had a transient ischemic attack (TIA) or mild stroke have a high risk of recurrent stroke. Secondary prevention programs providing support for meeting physical activity recommendations may reduce this risk. Most evidence for the feasibility and effectiveness of secondary stroke prevention arises from programs developed and tested in research institute settings with limited evidence for the acceptability of programs in ‘real world’ community settings. This qualitative descriptive study explored perceptions of participation in a secondary stroke prevention program (delivered by a community-based multidisciplinary health service team within a community gym) by adults with TIA or mild stroke. Data gathered via phone-based semi-structured interviews midway through the program, and at the end of the program, were analyzed using constructivist grounded theory methods. A total of 51 interviews from 30 participants produced two concepts. The first concept, “What it offered me”, describes critical elements that shape participants’ experience of the program. The second concept, “What I got out of it” describes perceived benefits of program participation. Participants perceived that experiences with peers in a health professional-led group program, held within a community-based gym, supported their goal of changing behaviour. Including these elements during the development of health service strategies to reduce recurrent stroke risk may strengthen program acceptability and subsequent effectiveness.

Developing digital approaches for adolescents and young adults with autism and learning disabilities: Tools to facilitate access and shared decision-making

Aims:Digital living is now an integral part of many children and young people’s (CYP) everyday experience. Practitioners who work with them are increasingly focused on effectively deploying technology to help those with social, emotional and mental health (SEMH) needs. Throughout all aspects and phases of work, practitioners must adhere to legal and professional best practice standards in involving service users, person-centred working and in enhancing accessibility for all.Methods:Measures introduced to reduce the spread of Covid-19 triggered significant service delivery change in a specialist multi-disciplinary child and adolescent mental health service (CAMHS) team. The majority of assessment and intervention work moved to an online audio and web conferencing platform. A shared decision-making approach was developed to support service user understanding of online appointments and to giving informed consent, in line with the i-THRIVE Framework for system change (Wolpert et al., 2019). Three Guides were developed and distributed ahead of online appointments: written, easy-read and video.Findings:Data collected within a Quality Improvement (QI) framework indicated that the Guides supported practitioners to prepare service users, as well as themselves, for digital working. The Guides supported service access, collaborative decision-making and increased CYP autonomy. Their introduction also led to conversations about equity and cultural responsiveness, as well as serving as a model for the development of aids to support shared decision-making for autism diagnostic assessments.Limitations:This paper outlines the first phase of the QI project with a small participant sample and requires further engagement with service users to review the use of Guides and shared decision-making decision aids.Conclusions:Digital approaches present new possibilities and are rapidly changing service delivery across CAMHS. The importance of involving service users in shared decision-making when developing digital practices must be held in mind as part of this change process.

First response of emergency health care system and logistics support in an earthquake

BACKGROUND: An earthquake is an event that differs from any other disaster because it requires a multidisciplinary approach and affects all the people in the region where it occurs. The presented research aims to present healthcare, search and rescue, logistics and support to the magnitude 6.6 Elazığ earthquake by literaturę sight. This research also provides analysis of local and nearby support provided by Disaster and Emergency Management Authority (DEMA) (AFAD), 112 Emergency Health Services and National Medical Rescue Team (NMRT) (UMKE), equipment, timely manner and staff in the earthquake of Elazıg on 24.01.2020. MATERIAL AND METHODS: A total of 1942 people, including 120 NMRT Teams (821 NMRT staff) and 276 staff 112 Ambulance teams, were assigned for medical rescue. RESULTS: Victims: 12 injured and 5 exitus, who were triaged by 112 and NMRT teams, were pulled from the wreckage and transported to the hospitals within the first 30 minutes. CONCLUSION: As in the Elazığ earthquake, the coordinated and cooperative work of all search and rescue and first aid teams of the region appeared to be one of the most important factors in reducing the mortality and morbidity of earthquake victims and maintaining life comfort.

Effect of an online psychological support group on patients with COVID-19 in a Thai field hospital: a real world study

PurposeThe purpose of this study is to evaluate the effectiveness of an online psychological support group on patients with coronavirus disease 2019 (COVID-19) in a Thai field hospital.Design/methodology/approachA prospective controlled trial was conducted at a Thai field hospital and included patients with confirmed COVID-19 who were over the age of 18 and able to use an online communication application. Patients were free to decide whether to participate in the online group. The group provided a space for participants to communicate with each other and a mental health service team. The everyday activities were designed to enable group support via texting or livestreaming through the LINE application. Psychoeducation via video clips or articles regarding stress management were provided. Outcomes were measured by an online self-reported questionnaire based on the twenty-one-item Depression, Anxiety and Stress Scale (DASS-21) on the first and fourteenth day of admission to the field hospital.FindingsForty-six patients participated in this study. Forty participants completed the secondary assessment, with 21 in the intervention group and 19 in the control group. From multilevel mixed-effects regression analysis, adjusted for gender, age and education, participation in the intervention group significantly decreased total DASS scores and anxiety subdomain scores compared to those in the control group (p = 0.038 and 0.008).Originality/valueThe online psychological support group offered benefits for patients with COVID-19 who were isolated in the field hospital. It could be an effective alternative measure to distribute psychological care during a pandemic situation. However, a small sample size was a limitation of this study.

Assessing the compliance of accurately documenting medication history in CAMHS – completion of the audit cycle

AimsTo assess the documentation of medication across all Child and Adolescent Mental Health Service (CAMHS) teams in the south region of Derbyshire Healthcare NHS Foundation Trust against a locally agreed protocol. The aim is to ensure accurate and timely documentation of medication history in a standardised way to reduce the risk of medication errors.MethodWe randomly selected 78 patients across seven teams within CAMHS that were currently prescribed medication as of November 2020. We reviewed each patient to see if medication history had been recorded in the specified section of the trust's patient database PARIS. We then cross referenced this information with the patient notes, clinic letters and prescriptions to review accuracy of information in terms of recording of drug name, dose, frequency, and whether the medication was regular or as required. We compared the data to the results of a previous audit in 2017 which used the same methods.ResultOf the 78 patients, 74% (n = 58) had medication recorded in the correct section of PARIS compared to 13% in the 2017 audit. We found that compliance varied between different CAMHS teams ranging from 0% to 100%. Of those with medication history recorded, 86% had all drug names listed correctly, 79% had all drugs listed at the correct dose, 71% had the correct frequency recorded and 81% had whether the medication was regular, or PRN recorded.ConclusionAlthough we have seen improvement in standardised documentation of medication history since 2017, it remains difficult to rely on this information being up to date and reliable. There was a wide range of compliance in documentation of medication history across different teams, possibly reflecting how effectively the teaching following the previous 2017 audit had been delivered to each team. We have completed more teaching for medical and non-medical prescribers across all localities to highlight the importance of timely and standardised documentation. This is particularly important in CAMHS where the prescribing of medication often remains the responsibility of secondary care, with clinicians regularly prescribing on behalf of colleagues from other teams. Our findings support the move within the Trust towards a system where medication can be both documented and electronically prescribed in the same place (System One).

Predicting the cumulative number of disaster deaths during the early stage of earthquakes.

BackgroundThe quantitative measurement of the anticipated number of disaster deaths is very important shortly after the mainshock because the forecasted fatalities could help determine the size of the health and medical services team to be deployed. This study aimed to devise a simple method to predict the cumulative number of deaths during the immediate or early stage of a large earthquake.MethodsWe analyzed six earthquakes in Japan that involved at least 20 deaths, 1990–2018. Analyzing statistical patterns in the cumulative number of deaths, we used three models—the exponential model, the Weibull model, and the percentile-based model—to predict the likely number of deaths during the early stage of earthquakes.ResultsThe median time required to reach the median number of deaths was 2.2 (interquartile range: 1.5, 3.8) days from the mainshock. By only multiplying the cumulative number of deaths as on day 2 by a factor of two, the likely number of deaths was calculated using the percentile-based method. The validity of this simple method was better than the results from day 4 using the parametric models. The Great East Japan earthquake was exceptionally large and difficult to predict in real time, and it involved a large number of fatalities following a tsunami.ConclusionsFor all other earthquakes, the median number of deaths was reached on day 2. Even in a setting with poor technical resources, the predicted number of deaths can be obtained by multiplying the reported cumulative number on day 2 by a factor of two.

Parents\u2019 and medical staff\u2019s experience of adolescents with suicide-related behaviors admitted to a general hospital in China: qualitative study

BackgroundCurrently, there is increasing awareness of suicide-related behaviors. Mental health services are a key location for assisting people with suicide-related behaviors. However, few studies focused on the evaluation and experience of the mental health care system from families and the medical staff’s perspective in China. The study aims to explore parents’ and the front-line medical staff’s experience of an adolescent with suicide-related behaviors admitted to the psychiatry department of a general hospital in China.DesignQualitative study was employed in the study. Participants were recruited from a general hospital in China characterized by high levels in the Chinese mental health system.MethodsSemi-structured in-depth interviews were conducted exploring their experience and perceptions when an adolescent was admitted to the hospital. The theme analysis method is used for data analysis.ResultsParticipants expressed dissatisfaction in the psychiatric department. Other barriers in their work were identified, such as the shortage of staff and difficulties in caring or communicating with patients. Besides, the imperfect treatment system also contributes to the low satisfaction of patients and their families. Two themes and six subthemes were identified: 1) staff perceive patients with SRBs as difficult to engage (feelings of helplessness, the need for compassion, challenges of professional self-efficacy, the recommendations to the health care service); 2) parents not satisfied with the existing hospital services (doubt the hospitalization treatment and the advice to the health care service).ConclusionThis study found that insufficient staffing and lacking of systematic professional treatment models are the major challenges. We suggest increasing the input of mental health resources to expand and train the mental health service team and establish a complete set of a treatment model for SRBs.

Perancangan Sistem Informasi dan Sarana Pelaporan Kasus Bullying Berbasis Web Menggunakan Teknologi Pemograman PHP dengan Framework Laravel

Bullying is still a troubling social problem. Bullying cases that occur in high school students have caused many problems both physically and psychologically. Bullying is a phenomenon that is very much, rooted, passed down from generation to generation. The seriousness of bullying is a big problem for all of us. The level of knowledge and concern for teachers, parents, health service teams, and the Indonesian people towards bullying is still low. Information systems are needed for management in making decisions to overcome bullying problems. Researchers in this study created a system that can be used as a means of delivering information from students to schools. The creation of this system is based on a system that is easily accessible, secure, and guarantees the confidentiality of the complainants. So that this product can help schools identify cases of bullying in schools, who are the perpetrators of bullying, and victims of bullying, with the hope that schools can stop the chain of bullying events and prevent bullying at schools. The scheme in this study is to design a website that reports bullying and provides information. The system design model used in this study is a prototype model and data was collected through observation, interviews and literature study. The programming language used is PHP and software for designing interfaces using the laravel framework. Making a database using MySQL with the XAMMP application.

"Just see the person who is still a person (…) they still have feelings": Qualitative description of the skills required to establish therapeutic alliance with patients with a diagnosis of dementia.

Establishing a relationship is considered the foundation of providing person-centred care (PCC) when working with a person who has a diagnosis of dementia. Currently, there is a lack of consensus about the how to develop this relationship. This aim of this study was to explore the key skills adopted by clinicians to establish an effective care relationship, referred to as therapeutic alliance, specific to working with patients who have dementia. Participants were clinicians (nursing and allied health professionals) from two older person's mental health service teams (inpatient and community) who routinely provided clinical care to patients with a diagnosis of dementia. Participants self-selected from a purposive sample to complete a semi-structured interview about their provision of care to, and strategies used to engage with, people with a diagnosis of dementia. Exploratory qualitative thematic analysis was conducted using mixed inductive and deductive procedures. Five themes were identified as the interpersonal skills used to develop relationships with patients including the following: empathy, unconditional positive regard, congruence, psychological flexibility, and communication. Findings from this study provide direction for training of clinicians employed in a dementia setting and can also be generalized to other non-specific clinical settings where clinicians may incidentally provide treatment to patients with a diagnosis of dementia.

Implementation of individual placement and support in a first‐episode psychosis unit: A new way of working

AbstractThe aim of this study is to explore the IPS implementation process in a first‐episode psychosis (FEP) mental health service team in Sweden. More specifically, the study explores how integration processes and critical situations are perceived over time by team members who originated from two diverse welfare organizations. A serial interview design was used (initially, at 6 and 12 months) to describe experiences of 16 team members. Material was analyzed using a constant comparison grounded theory approach. Team members dealt with the ambivalence of sharing mental health information, and whether the new way of working was a risk or benefit for users. They gradually learned new perspectives and knowledge, built trust and shared common views. After a year, the team workload perceived reduced and became person‐centred. Some members described remaining unclear roles and requested further support. Negotiated goals for integration and early knowledge transfer are critical. Organizational change and trusting team relationships have to be facilitated. Anticipated gains of integration should be clearly described and discussed early on, and continuous support for sustainability should be considered. This study confirmed the importance and potential of integrating IPS into FEP teams.

Review Sistematik: Model Pemulihan Penderita Gangguan Jiwa Berat Berbasis Komunitas

People with severe mental illness have complex disabilities affecting mental functions, daily activities, and social life, thus they need help from others in carrying out daily functional activities. Optimizing the recovery of severe mental illness requires a holistic approach and integration between mental health services and supportive communities so that sufferers can interact with others, have a positive self-concept, and improve their well-being. This study aims to describe a community-based model of recovery for people with severe mental illness. Several literature studies were obtained from 50 reference sources through Science Direct, Google Scholar, Proquest Health and Medical Complete, Proquest Nursing, and Allied Health Sources from 2009 to 2019. Results explain that the community provides an adequate support system in improving the care of people with severe mental illness. Support systems in the community involve social and physical aspects as well as the economic infrastructure through employment opportunities or financial support and a decent living. The interaction between community members and people with severe mental illness could be a positive thing in strengthening the motivation of people with severe mental illness to recover and be able to do their activities independently. The recovery process of severe mental illness requires strong motivation and commitment from the sufferer, the family, all society members, community mental health service team, and related policymakers. It can be concluded that people with severe mental illness need support from various parties in terms of future life planning, identifying strengths and weaknesses that they have, and recognizing multiple obstacles and support so that they recover and live independently.

Abstract NS3: A Comprehensive Post-Acute Stroke Services (COMPASS) Website for Public Use

Background: Stroke patients, caregivers, and health and human services are in need of organized, evidence-based resources to improve post-acute care and outcomes. Educational materials vetted by stakeholders are scarce and difficult to develop. The COMprehensive Post-Acute Stroke Services (COMPASS) Study developed online resources by discipline for clinical providers, patients, caregivers, and health and human services teams. Purpose: This presentation introduces the COMPASS website content available and ready for immediate use to support post-acute stroke care quality improvement. Methods: Materials were developed as a component of the PCORI-funded COMPASS Study designed to implement and evaluate comprehensive transitional care (TC) for stroke survivors. Patients discharged home from 41 NC hospitals after a stroke or TIA received COMPASS TC which incorporated Centers for Medicare and Medicaid (CMS) recommendations: a follow-up phone call within two days of discharge; a comprehensive follow-up clinic visit; and delivery of a patient care plan. An interdisciplinary team of health care providers, stakeholders, and researchers developed patient and caregiver educational materials tested for sixth grade literacy, a community resource directory, and training materials for implementation of COMPASS TC that are available on the COMPASS website at www.nccompass-study.org/. Results: Educational products, including a directory of resources, training manuals, recorded webinars, instructional handouts, animated videos, and patient/caregiver materials are on the COMPASS website. An electronic application called COMPASS-Care Plan (CP) also developed can be readily integrated into Epic and Cerner electronic health records. COMPASS-CP was developed to streamline the delivery of the TC model. Since the website was made public July 1, 2019, there have been 616 views from 15 countries with the majority reviewing patient/caregiver resources. Conclusions: The COMPASS website provides health and human services teams with organized, evidence-based resources to support delivery and management of post-acute transitional care for patients and caregivers.

Making Health Services Adolescent-Friendly in Northeastern Peninsular Malaysia: A Mixed-Methods Study.

A mixed-methods study was conducted in a Malaysian state beginning with a cross-sectional quantitative study to determine the relationship between clinic characteristics and clinic score of adolescent-friendliness. Subsequently, perceptions of healthcare providers on the facilitating factors for the provision of adolescent-friendly health services were explored qualitatively to support the quantitative findings. Availability of trained healthcare providers, adequate privacy, dedicated adolescent health services team, and adolescent health promotional activities were the clinic characteristics that significantly (p < 0.05) related with clinics’ scores of adolescent-friendliness. The facilitating factors required for adolescent-friendly health services were (1) healthcare providers’ commitment and prioritization towards adolescent-friendly health services; (2) organizational supports; (3) appropriate clinic settings; and (4) external supports for adolescent health promotional activities. The qualitative findings reaffirmed those of the quantitative study on the significant clinic characteristics required for adolescent-friendly health services. This study provides valuable insight for the Ministry of Health to elicit the required facilitating factors to further improve the quality of adolescent health services in Malaysia.