Identification Of Healthcare Providers Research Articles

Health-ID: A Blockchain-Based Decentralized Identity Management for Remote Healthcare.

COVID-19 has made eHealth an imperative. The pandemic has been a true catalyst for remote eHealth solutions such as teleHealth. Telehealth facilitates care, diagnoses, and treatment remotely, making them more efficient, accessible, and economical. However, they have a centralized identity management system that restricts the interoperability of patient and healthcare provider identification. Thus, creating silos of users that are unable to authenticate themselves beyond their eHealth application’s domain. Furthermore, the consumers of remote eHealth applications are forced to trust their service providers completely. They cannot check whether their eHealth service providers adhere to the regulations to ensure the security and privacy of their identity information. Therefore, we present a blockchain-based decentralized identity management system that allows patients and healthcare providers to identify and authenticate themselves transparently and securely across different eHealth domains. Patients and healthcare providers are uniquely identified by their health identifiers (healthIDs). The identity attributes are attested by a healthcare regulator, indexed on the blockchain, and stored by the identity owner. We implemented smart contracts on an Ethereum consortium blockchain to facilities identification and authentication procedures. We further analyze the performance using different metrics, including transaction gas cost, transaction per second, number of blocks lost, and block propagation time. Parameters including block-time, gas-limit, and sealers are adjusted to achieve the optimal performance of our consortium blockchain.

Psychosocial difficulties identified by health care providers as they predict pain-related quality of life in children with cancer.

This study examined the predictive validity of the Psychosocial Care Checklist (PCCL), a psychosocial screener completed by a pediatric cancer health care provider (HCP), on child pain-related and nausea-related quality of life (QOL), and whether these associations are moderated by family psychosocial risk (Psychosocial Assessment Tool, PAT). Caregivers (N = 122) of children newly diagnosed with cancer and 62 HCPs (11 social workers, 17 nurses, 34 oncologists) at two Canadian sites participated. Near diagnosis (T1) and six months later (T2), caregivers reported on child QOL and family psychosocial risk, which was categorized as universal (typical distress), targeted (targetable distress), or clinical (severe distress). HCPs completed the PCCL at T1 and T2. HCP identification of more psychosocial problems in PCCL at T1 predicted reduced child pain-related (but not nausea-related) QOL at T2 among children with universal risk. The PCCL scores did not predict pain-related QOL in families with higher psychosocial needs (i.e., targeted and clinical). HCPs may have difficulty identifying psychosocial problems among families with high risk in a manner that predicts child's pain-related QOL. A hybrid model of psychosocial screening that includes both HCP and caregiver reports is recommended to best match family problems and interventions to improve QOL.

Evaluating quality of hospital care using time-to-event endpoints based on patient follow-up data

Revisions of hip and knee arthroplasty implants and cardiac pacemakers pose a large medical and economic burden for society. Consequently, the identification of health care providers with potential for quality improvements regarding the reduction of revision rates is a central aim of quality assurance in any healthcare system. Even though the time span between initial and possible subsequent operations is a classical time-to-event endpoint, hospital-specific quality indicators are in practice often measured as revisions within a fixed follow-up period and subsequently analyzed by traditional methods like proportions or logistic regression. Methods from survival analysis, in contrast, allow the inclusion of all observations, i.e. also those with early censoring or events, and make thus more efficient and more timely use of the available data than traditional methods. This may be obvious to a statistician but in an applied context with historic traditions, the introduction of more complicated methods needs a clear presentation of their added value. We demonstrate how standard survival methods like the Kaplan–Meier estimator and a multiplicative hazards model outperform traditional methods with regard to the identification of performance outliers. Following that, we use the proposed methods to analyze 640,000 hip and knee replacement operations with about 13,000 revisions between 2015 and 2016 in more than 1200 German hospitals in the annual evaluation of quality of care. Based on the results, performance outliers are identified which are to be further investigated qualitatively with regard to their provided quality of care and possible necessary measures for improvement. Survival analysis is a sound statistical framework for analyzing data in the context of quality assurance and survival methods outperform the statistical methods that are traditionally used in this area.

CLINICAL NURSE SPECIALIST PRACTICE INTERVENTIONS FOR SECOND VICTIMS OF ADVERSE PATIENT EVENTS

Background: Second-victim impact describes emotional suffering that occurs secondary to an adverse patient event and occurs in approximately half of all healthcare providers. Immediate intervention is needed to reduce consequences including nursing turnover, job absenteeism, repeat adverse events, professional burnout, and posttraumatic stress. Purpose: To provide clinical nurse specialists a summary of second-victim impact secondary to adverse patient events, a review of associated negative outcomes, and clinical nurse specialist practice recommendations. Recommendations: Clinical nurse specialist nursing interventions include implementation of validated screening tools, identification of healthcare providers at high risk of second-victim impact, recognition of signs of second-victim impact, facilitating supportive clinical debriefings, providing supporting dialogue, and mentorship through stages of recovery and the institutional response. Clinical nurse specialist organization/system interventions to reduce the consequences of second-victim impact include supporting a culture of safety, leading organizational improvement, as well as advocating for education and support for second victims on the national level. Conclusions: Clinical nurse specialists have the potential to mitigate the effects of second-victim impact associated with adverse patient events and secondary complications through use of evidence-based practice interventions.

A Comparative Study of Elder Abuse Reporting at Two Large Veteran?s Affairs Medical Centers

Purpose of the study: One to two million elderly Americans are injured, exploited, or otherwise mistreated by someone on whom they depend on for care or protection. Elder abuse (EA) is detrimental to the individual and has significant societal and health cost implications. Despite these profound consequences, research suggests that elder abuse is often underreported. We conducted a retrospective review of reported EA cases over a 7 year period at 2 large VA Medical Centers (VAMC) to assess the types of EA cases reported, the characteristics of those patients who were reported and the 1 year outcome. Design and methods: A retrospective review of all cases of elder abuse reported to Adult Protective Services at two large VA Medical Centers between 2006 and 2012 was conducted as part of an educational initiative to improve health care provider identification and triage of elder abuse. Results: Thirty cases of EA were reported at the Providence VAMC and 25 were reported at the Durham VAMC during the study period. A dementia diagnosis was common among EA cases, present in 50% of cases in Providence and 72% in Durham. The majority (41/55) of referrals were made by the medical team but cases were also reported by caregivers and patients themselves. In over half of the cases, the Veteran was able to remain in the home environment with support from additional community based services, such as home health aides, physical and occupational therapy. Implications: Based on the published prevalence of elder abuse in elderly populations, EA was likely underreported in the two large VAMCs. More research is necessary to help determine the prevalence of elder abuse among Veterans, to identify risk factors that might aid diagnosis, and to develop interventions that target this important problem.

Reduction and elimination solutions of informal payment in Iran's health system.

Background: Informal payments can cause delayed access to health care services, forcing people to sell their properties for cost of treatment; and as a result, they lose trust in the health system. Considering the importance of this issue, this study was conducted in 2016 to identify solutions to reduce and eliminate informal payments in Iran’s health system. Methods: Initially, solutions to reduce informal payments were extracted by reviewing resources and searching Persian and Englishlanguage databases including Science direct, PubMed, Scopus, Medline, ISC, Magiran, SID using the following keywords: informal payments, under the table payment, bribes, gratitude payment, and informal payments/fees. Then, Iranian context specific solutions were obtained by performing semi-structured interviews with 19 individuals, who were aware of the problem. Next, the identified strategies were confirmed using Delphi technique and with the participation of 50 experts. Results: Various solutions were identified and confirmed to reduce or eliminate informal payments in Iran’s health system, which are divisible in different economical fields, such as payments to providers based on performance, religious leaders’ fatwa (sociocultural), disclosing the offenders’ names (legal-political), and using family doctor system (structural). Conclusion: The proposed solutions can be used by policymakers and managers in the health sector to manage informal payments. Careful identification of health care providers and recipients’ motivations and needs can be effective in recognizing and eliminating this phenomenon.

The impact of access to immunization information on vaccine acceptance in three countries.

IntroductionVaccine acceptance is a critical component of sustainable immunization programs, yet rates of vaccine hesitancy are rising. Increased access to misinformation through media and anti-vaccine advocacy is an important contributor to hesitancy in the United States and other high-income nations with robust immunization programs. Little is known about the content and effect of information sources on attitudes toward vaccination in settings with rapidly changing or unstable immunization programs.ObjectiveThe objective of this study was to explore knowledge and attitudes regarding vaccines and vaccine-preventable diseases among caregivers and immunization providers in Botswana, the Dominican Republic, and Greece and examine how access to information impacts reported vaccine acceptance.MethodsWe conducted 37 focus groups and 14 semi-structured interviews with 96 providers and 153 caregivers in Botswana, the Dominican Republic, and Greece. Focus groups were conducted in Setswana, English, Spanish, or Greek; digitally recorded; and transcribed. Transcripts were translated into English, coded in qualitative data analysis software (NVivo 10, QSR International, Melbourne, Australia), and analyzed for common themes.ResultsDominant themes in all three countries included identification of health care providers or medical literature as the primary source of vaccine information, yet participants reported insufficient communication about vaccines was available. Comments about level of trust in the health care system and government contrasted between sites, with the highest level of trust reported in Botswana but lower levels of trust in Greece.ConclusionsIn Botswana, the Dominican Republic, and Greece, participants expressed reliance on health care providers for information and demonstrated a need for more communication about vaccines. Trust in the government and health care system influenced vaccine acceptance differently in each country, demonstrating the need for country-specific data that focus on vaccine acceptance to fully understand which drivers can be leveraged to improve implementation of immunization programs.

Abdominal Adiposity and Caregiver Recall of Healthcare Provider Identification of Child Overweight in the United States, 2001–2010

A minority of overweight or obese children are identified as such by a healthcare provider (HCP). The aim of this study was to examine characteristics of caregiver-reported HCP identification of overweight or obesity and whether it is associated with children's waist circumference (WC). This was an observational study using a nationally representative sample of 14,694 children (2-15 years of age) from the 2001-2010 National Health and Nutrition Examination Survey. Proxy respondents (i.e., caregivers) for 4906 overweight or obese (BMI≥85th percentile) children reported whether an HCP had ever told them that their child was overweight. Multi-variable logistic regression analyses were used to examine associations between reported HCP identification of overweight and child sociodemographic and anthropometric characteristics. Over 75% of caregivers of overweight or obese children did not recall being notified of their child's weight status by an HCP, though this proportion has decreased over the past decade. A significant WC by weight status interaction indicated abdominal adiposity was positively associated with reported HCP identification for obese children, but not for overweight children. Lower levels of reported HCP identification were observed for overweight children, compared to obese children; among obese children, those with lower levels of abdominal adiposity were less likely to be identified as overweight by an HCP, according to caregivers. Reasons for this finding remain unclear. Providers may be relying on a child's appearance, rather than universally screening all patients for overweight. Additionally, a variety of parent and provider characteristics may influence weight-related communications and caregiver recall of such information.

Improving Safety Through Collaboration: The Interdisciplinary Perinatal Practice Committee

<h2>Professional Issues Poster Presentation</h2><h3>Purpose for the Program</h3> Clinical care may not always be consistent with the latest evidence and scientific standards found in the peer‐reviewed scientific literature, professional organization standards, and regulatory agencies. Risk reduction strategies in perinatal practice include adopting professional organization guidelines, standardizing evaluation and monitoring processes, and communicating identifiable pregnancy risks to members of the healthcare team. Communication issues have been identified as a leading cause of sentinel events. There was not an identifiable process to review the scientific literature, compare current practice to current scientific evidence, and recommend change based on the literature review. <h3>Proposed Change</h3> We needed an opportunity to collaborate with nursing, medical providers, risk management, and administration to look at our processes and practice throughout the continuum of maternal–newborn care. The concept of the Interdisciplinary Perinatal Practice Committee (IPPC) was identified and applied to our setting. <h3>Implementation, Outcomes, and Evaluation</h3> Discussions with key leaders in nursing, obstetrics, neonatology, and risk management were held to garner support of the idea. The perinatal advanced nurse clinician attended ob‐gyn staff meetings to further promote the idea and to assist with the identification of healthcare providers who would co‐chair the IPPC with nursing. Informal nursing leaders and change agents were recruited to be part of the committee. Since its inception, the IPPC has met regularly. Topics are chosen based on staff input, policies, and procedures that are in need of being updated, and trends in evidence‐based practice in the perinatal setting. The first topic, which took three meetings to review, was the use of oxytocin. Scientific, evidence‐based articles and professional guidelines pertinent to the topic of discussion were sent to the committee members for review before each meeting. Medical education credits and nursing contact hours were obtained for each meeting. Each meeting has consisted of a lively, collaborative, and respectful discussion. Nursing and medicine came together to look at the standards and evidence, compare current practice, and make changes to policies and procedures. New electronic medical record order sets were created based on the work of the IPPC. Order sets default to an increase of the rate of oxytocin every 30 minutes. Random audits of charts have shown that the healthcare providers are consistently using the new order sets. This indicates the success of the work of the IPPC. <h3>Implications for Nursing Practice</h3> Regularly scheduled meetings will ensure the continued work of the IPPC. This will serve to enhance patient safety as all disciplines involved are communicating using the same framework, collaborating, and integrating current science into practice.

The Electronic Health Record in Austria: a strong network between health care and patients

BACKGROUND: Electronic communication between health organisations takes place within strong networks. The technical und procedural support of electronic health communication is of increasing importance for optimal treatment quality and patient safety. Due to the federal organisation of the healthcare system in Austria, the electronic health record – Elektronische Gesundheitsakte (ELGA) – is designed as a distributed system with central components for patient and healthcare provider identification and authorisation management. The network is displayed on several layers, a special legal basis is yet to be enacted and many technical components have already been tested and proved. Unambiguous identification of health service providers and patients, easier workflows and state-of-the-art document management will be among the main benefits of ELGA. METHODS: Description of the design and making of ELGA. RESULTS: The article provides information on the technical and constitutional set-up and on the IT-Architecture of ELGA. Special features as the portal, the e-medication and the nationwide harmonisation process of medical documents are discussed. The Masterplan, the cost and benefit analysis and the European health record project epSOS are also presented. CONCLUSIONS: Beyond and additionally to the upcoming ELGA law and the Data Protection Rules, ELGA has to comply with the relevant international standards. The principal challenge lies, however, in organisational and procedural questions as well as in raising confidence and acceptance for this new electronic health management tool.

Hypertension in the ED: a multifaceted intervention to change provider practice

This project measured the effect of a multifaceted intervention on health care provider identification and treatment of undiagnosed hypertensive patients. The intervention comprised provider education, audit, and feedback. The primary outcomes were pre-/postintervention differences in the proportion of patients presenting with elevated blood pressure who were (1) identified, (2) given blood pressure measurements, (3) counseled regarding behavior change, (4) prescribed medications, and (5) advised of the need for follow-up. These 5 behaviors were selected based on the recommendations in the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Rates of all 5 outcomes improved significantly after the intervention, with prevalence differences ranging from 5% to 25%. However, despite increases, rates for each behavior remained low. At no point during the study were all 5 practitioner behaviors documented for an individual patient. In conclusion, while an intervention composed of education and practitioner audit and feedback improved practitioner behaviors in treating patients with elevated blood pressure, additional interventions are needed to bring practitioner behaviors up to the level of JACHO standards.

Development of a National Standard for the Identification of Health Care Providers.

Development of a National Standard for the Identification of Health Care Providers.

Delirium in AIDS patients: discrepancy between occurrence and health care provider identification.

AIDS Patient Care and STDsVol. 10, No. 5 Delirium in AIDS Patients: Discrepancy between Occurrence and Health Care Provider IdentificationBernadette Lalonde, Karina K. Uldall, and James P. BerghuisBernadette LalondeSearch for more papers by this author, Karina K. UldallSearch for more papers by this author, and James P. BerghuisSearch for more papers by this authorPublished Online:24 Jun 2009https://doi.org/10.1089/apc.1996.10.282AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByAssociation between Delirium and Death in AIDS Patients Karina K. Uldall, Rosemary Ryan, James P. Berghuis, and Victoria L. Harris5 July 2004 | AIDS Patient Care and STDs, Vol. 14, No. 2 Volume 10Issue 5Oct 1996 To cite this article:Bernadette Lalonde, Karina K. Uldall, and James P. Berghuis.Delirium in AIDS Patients: Discrepancy between Occurrence and Health Care Provider Identification.AIDS Patient Care and STDs.Oct 1996.282-287.http://doi.org/10.1089/apc.1996.10.282Published in Volume: 10 Issue 5: June 24, 2009PDF download