Implementation Of Health System Research Articles

1.X.1. Achieving universal health coverage: international lessons from Irish policy implementation

Abstract Health systems all over the world are struggling to meet population health needs and provide timely access to universal healthcare in the context of the COVID-19 pandemic. COVID-19 occurred in Ireland in the early years of implementation of a national plan for universal healthcare, called Sláintecare. While many health systems are experiencing a retrenchment on universalism in the context of COVID-19, in Ireland despite tediously slow Sláintecare implementation, the pandemic provided a boost to reform implementation and universalism. The reason for this workshop is to draw on a publicly funded Health Research Board Applied Partnership Award, entitled ‘Foundations’, harnessing lessons from the Irish COVID-19 health system response to inform Sláintecare’s implementation https://hrbopenresearch.org/articles/3-70/v1 The objectives of the workshop are to 1) provide academic research evidence from the Irish experience of universal health system reform during and since COVID-19; 2) to give participants space to reflect on the implications of the Irish universal health system reform on international health systems and policy; 3) to actively involve workshop participants in an engaged discussion on implementing universal health coverage in the context of COVID-19. The added value of the workshop is to share learnings from an academic research programme, which is coproducing evidence in partnership with the Irish health system, in a worldwide context, providing relevant and thought-provoking discussion and analysis for an international audience. Four separate inter-related presentations will draw on aspects of the Foundations’ research project. Presentation 1, Prof Sara Burke will outline recent academic literature on universalism and the politics of reform implementation in the context of COVID-19 and present a timeline of universal healthcare reform implementation since 2018 when Sláintecare was adopted by the Irish government (14 mins). Presentation 2, Dr Sarah Parker will detail a specific study which set out to advance understanding of how and to what extent COVID-19 has highlighted opportunities for change that enabled better access to universal, integrated care in Ireland, with a view to informing universal health system reform and implementation (10 mins). Presentation 3, Dr Katharine Schulmann and Carlos Bruen will present findings on the governance of reform implementation and implications for all health systems (10 mins). Presentation 4, Dr Philip Crowley, Health Service Executive (HSE) National Director of Strategy and Research and Chair of the Foundations’ research steering group will reflect how research findings can inform implementing reform and their implications for all health systems (6 mins). There will be four presentations totalling 40 mins, followed by questions and discussion chaired by an international expert/academic on universal health systems. Key messages • COVID-10 has highlighted how universal health coverage is more important than ever, however the pandemic has resulted in some retrenchment on universalism. • While data and research drove health system decision making during the pandemic, embedding research evidence into health system and policy reform remains challenging and can be politically opposed.

How to not revert to type: learnings from the pandemic response for universal health system reform

Abstract Background Understanding of the opportunities and learnings for health system change that have arisen during the pandemic is still emerging. Situated in the Irish health reform context of Sláintecare, the programme which aims to deliver universal, integrated healthcare, this study set out to generate evidence on the processes that impacted access to universal, integrated care during COVID-19, with a view to informing universal health system reform and implementation. Methods The study, which is qualitative, was underpinned by a co-production approach with Irish health system leadership. Semi-structured interviews were conducted with 16 health system professionals (including managers and frontline workers) from a range of responses to explore their experiences during the pandemic. Following thematic analysis, a complexity-informed approach guided the interpretation of the findings. Results A range of factors facilitated better access to integrated care during the crisis, falling under three key themes (1) nurturing whole-system thinking through a clear, common goal and shared information base; (2) harnessing, sharing and supporting innovation; and (3) prioritizing trust and relationship-building in a human-centred health system. Conclusions Alongside establishing health system structures, we must also incorporate alternative approaches to reform that recognise the value of shared sense-making in an interdependent system, while also allowing for innovation, exploration and learning; and acknowledging the role of social dynamics in driving change.

Evaluation and Comparison of Airborne Concentrations of Crystalline Silica and Total Respirable Dust in Refractory Brick Industries in Isfahan

Background and Objective: Inhalation of crystalline silica particles in the workplace can lead to occupational diseases, such as silicosis. This study aims to evaluate and compare airborne concentrations of crystalline silica and respirable dust in the refractory brick industries in Isfahan province. Materials and Methods: In this cross-sectional study, the airborne concentrations of crystalline silica and respirable dust were measured among 79 workers from large industries and 30 workers from small refractory brick industries over a three-year period. Personal sampling was conducted using individual sampling pumps and cyclones. Data analysis was performed in SPSS 24 software using the Mann-Whitney U and Kruskal-Wallis tests. Results: The results indicated that 65.1% of the samples exceeded the occupational exposure limits, while 34.9% were below the limits. There was no significant difference in the mean three-year airborne crystalline silica concentration between the two occupational groups (P=0.791). However, a significant difference was observed in the mean airborne respirable dust concentrations between the groups (P=0.002). Conclusion: The findings of this study suggest that the implementation of safety, health, and environmental management systems has effectively reduced airborne crystalline silica and respirable dust concentrations, creating a safer work environment for employees.

Progress Toward Meaning-as-Goal and Its Association with Pain, Functioning, and Global Meaning and Purpose Among Veterans with Co-occurring Chronic Pain and PTSD.

Co-occurring chronic pain and posttraumatic stress disorder (PTSD) is associated with poorer physical and mental functioning and well-being. Treatments often incorporate goal-setting around personally meaningful behaviors; however, it is unclear whether intentionally focusing on improving meaning and purpose in life (i.e., meaning-as-goal) may also serve as a helpful treatment target. The objective of the current study is to determine whether reported progress toward meaning-as-goal at 6months is associated with pain severity and interference, physical and mental health functioning, and global meaning and purpose at 6- and 12-months. Data were collected as part of an evaluation effort focused on VA's Whole Health System implementation efforts. VA electronic health records were linked to survey data across three time points (baseline, 6months, and 12months) from Veterans with both chronic pain and PTSD across 18 VA sites. A total of 1341 Veterans met inclusion criteria (mean age = 62, SD = 11.7). Regression analyses showed that progress toward meaning-as-goal was significantly associated with all 6-month variables, with standardized coefficients ranging from - 0.14 (pain severity and interference) to .37 (global meaning and purpose), in addition to all 12-month variables, with standardized coefficients ranging from - .13 (pain severity and interference) to .31 (global meaning and purpose). Efforts to intentionally promote meaning and purpose as part of evidence-based treatment for chronic pain and PTSD may lead to decreased pain and improved physical and mental health functioning and global meaning and purpose. With coefficients ranging from small to moderate effect sizes, more work is needed to better understand how best to maximize meaning-related goals.

Enfermería en práctica avanzada a la vanguardia de la atención sanitaria

Advanced practice nursing (APN) is a category of nursing characterized by advanced training and autonomous clinical practice. Advanced practice nurses have a wide range of competencies, including diagnosing and treating diseases, prescribing medications, and case management. The objective: Analyze Advanced Practice Nursing at the forefront of health care. Material and method: A documentary investigation was carried out, through a systematic review in a first phase, analysis of the state of the art and then systematization according to descriptors, leaving a total of 35 articles for analysis, of which 6 come from Scopus and web of Science. Conclusions As a result of the review and analysis, three thematic areas emerged, which allowed the development of the work: Thematic area 1 (AT1): Nursing: Thematic area 2 (AT2): Advanced Practice Nursing and evolution. Thematic area 3 (AT3): Well-being and the health system. The research allowed the appreciation of the progress of Advanced Practice Nursing, as well as its challenges for its implementation in health systems, with the purpose of providing quality services to users of the health system.

Patient Perspectives on Adapting Collaborative Care for Opioid Use Disorder With Depression and/or Post-traumatic Stress Disorder

Abstract: Background: Individuals with opioid use disorder and cooccurring mental health concerns experience heightened consequences and lower rates of treatment access. Engaging patients as research partners alongside health systems is critical for tailoring care for this population. Collaborative care is promising for the treatment of co-occurring disorders Objectives: We used a community-participatory partnered research1 approach to partner with patients, providers, and clinic administrators to adapt and implement a collaborative care intervention for co-occurring disorders in primary care. Methods: We conducted qualitative interviews with patients to assess their feedback on the proposed collaborative care model before intervention implementation. A first round of interviews was conducted to obtain patient feedback on our adaptation ideas ( n = 11). The team then incorporated these suggestions, beta-tested the intervention with participants ( n = 9), and assessed participant feedback. Data were analyzed using rapid content analysis and then implemented by health systems. Results: Patient feedback underscored the need for the care coordinator (CC) to be trained in patient engagement and stigma reduction and to provide assistance around socioeconomic barriers and relapse. Patients shared that it was helpful to have the CC address co-occurring disorders, emphasized the need for the CC to be flexible, and expressed that tele-health was acceptable. Patient feedback was integrated in subsequent CC training with health systems. Conclusions: The present research demonstrates the feasibility and usefulness of incorporating patient perspectives into treatment design and implementation in health systems using community-participatory partnered research .

Feasibility and acceptability of implementing an evidence-based ESCALATION system for paediatric clinical deterioration.

The ESCALATION system is a novel paediatric Early Warning System that incorporates family involvement and sepsis recognition. This study aimed to assess the feasibility and iteratively refine the ESCALATION system in a variety of hospital settings in preparation for full-service implementation. A series of four multi-methods studies using an Implementation Science and co-design approach were conducted. We examined concepts of implementation, context, and mechanisms of action across a variety of hospitals. Data collected included practice and chart audits, surveys (health professionals), interviews (families) and focus groups (health professionals). Quantitative data were analysed descriptively with qualitative findings assessed by content analysis or thematic analysis. There were 650 audits (Study I-IV), 205 health professional survey responses (Study I), 154 health professionals participated in focus groups (Study II-IV), 13 parents of hospitalised children interviewed (Study I), and 107 parents reported their involvement in the ESCALATION system (Study III-IV). Each of the studies further refined and confirmed the feasibility, specifically the components of family involvement and the sepsis recognition pathway. The Implementation Science evaluation of the ESCALATION system resulted in a uniform approach that was feasible and acceptable to users and appropriate for full-service implementation. This series of four studies used a co-production approach built on the Medical Research Council framework to understand feasibility and acceptability of an intervention to improve recognition and response to clinical deterioration in children to the point of full-service implementation. We have reported a detailed, systematic approach to assessing feasibility and acceptability of a complex intervention using established methodologies for whole of health system implementation. The ESCALATION System is an evidence based paediatric early warning system that is a highly refined, well accepted and accommodates a health system that has substantial contextual variation.

Maturity Assessment of District Health Information System Version 2 Implementation in Ethiopia: Current Status and Improvement Pathways.

Although Ethiopia has made remarkable progress in the uptake of the District Health Information System version 2 (DHIS2) for national aggregate data reporting, there has been no comprehensive assessment of the maturity level of the system. This study aims to assess the maturity level of DHIS2 implementation in Ethiopia and propose a road map that could guide the progress toward a higher level of maturity. We also aim to assess the current maturity status, implementation gaps, and future directions of DHIS2 implementation in Ethiopia. The assessment focused on digital health system governance, skilled human resources, information and communication technology (ICT) infrastructure, interoperability, and data quality and use. A collaborative assessment was conducted with the engagement of key stakeholders through consultative workshops using the Stages of Continuous Improvement tool to measure maturity levels in 5 core domains, 13 components, and 39 subcomponents. A 5-point scale (1=emerging, 2=repeatable, 3=defined, 4=managed, and 5=optimized) was used to measure the DHIS2 implementation maturity level. The national DHIS2 implementation's maturity level is currently at the defined stage (score=2.81) and planned to move to the manageable stage (score=4.09) by 2025. The domain-wise maturity score indicated that except for ICT infrastructure, which is at the repeatable stage (score=2.14), the remaining 4 domains are at the defined stage (score=3). The development of a standardized and basic DHIS2 process at the national level, the development of a 10-year strategic plan to guide the implementation of digital health systems including DHIS2, and the presence of the required competencies at the facility level to accomplish specific DHIS2-related tasks are the major strength of the Ministry of Health of Ethiopia so far. The lack of workforce competency guidelines to support the implementation of DHIS2; the unavailability of core competencies (knowledge, skills, and abilities) required to accomplish DHIS2 tasks at all levels of the health system; and ICT infrastructures such as communication network and internet connectivity at the district, zonal, and regional levels are the major hindrances to effective DHIS2 implementation in the country. On the basis of the Stages of Continuous Improvement maturity model toolkit, the implementation status of DHIS2 in Ethiopia is at the defined stage, with the ICT infrastructure domain being at the lowest stage as compared to the other 4 domains. By 2025, the maturity status is planned to move from the defined stage to the managed stage by improving the identified gaps. Various action points are suggested to address the identified gaps and reach the stated maturity level. The responsible body, necessary resources, and methods of verification required to reach the specified maturity level are also listed.

Timeliness and quality of peripartum care provision during a health system strengthening initiative in rural Guinea-Bissau: a qualitative situation analysis

Guinea-Bissau has among the world’s highest maternal and perinatal mortality rates. To improve access to quality maternal and child health (MCH) services and thereby reduce mortality, a national health system strengthening initiative has been implemented. However, despite improved coverage of MCH services, perinatal mortality remained high. Using a systems-thinking lens, we conducted a situation analysis to explore factors shaping timeliness and quality of facility-based care during labour, childbirth, and the immediate postpartum period in rural Guinea-Bissau. We implemented in-depth interviews with eight peripartum care providers and participant observations at two health facilities (192 h) in 2021-22, and analysed interview transcripts and field notes using thematic network analysis. While providers considered health facilities as the only reasonable place of birth and promoted facility birth uptake, timeliness and quality of care were severely compromised by geographical, material and human-resource constraints. Providers especially experienced a lack of human resources and materials (e.g., essential medicines, consumables, appropriate equipment), and explained material constraints by discontinued donor supplies. In response, providers applied several adaptation strategies including prescribing materials for private purchase, omitting tests, and delegating tasks to birth companions. Consequences included financial barriers to care, compromised patient and occupational safety, delays, and diffusion of health worker responsibilities. Further, providers explained that in response to persisting access barriers, women conditioned care seeking on their perceived risk of developing birthing complications. Our findings highlight the need for continuous monitoring of factors constraining timeliness and quality of essential MCH services during the implementation of health system strengthening initiatives.

Assessment of Occupational Health and Safety Management System Implementation in General Hospital

Objective: This study aims to assess the application of Occupational Health and Safety Management System (OHSMS) in Kertosono Regional General Hospital by identifying the obstacles and strategies that exist, as well as successful system implementation for health sector.Methods: This study utilized a mixed-methods design to assess OHSMS effectiveness and employee perceptions before and after implementation.Findings: Results show a statistically significant decrease in incidents at work after implementation of an OHSMS, which confirms that the global safety performance of this plant is affected by the OHSMS. By contrast, though inadequate instruction, lack of continuous leadership dedication and investment were some major obstacles to successful operation of OHSMS.Novelty: The findings from this study suggest the importance of structured safety management systems designed for public healthcare workers, and provide practical suggestions to bolster the effectiveness of OHSMS in Indonesia.Research Implications: The results also emphasize the importance of ongoing education and training, strong leadership support, as well as providing sufficient resources to promote a culture of safety in healthcare settings. Future research might instead seek upper bounds benefit of an OHSMS for safety or examine how technology can be integrated to provide monitoring, training function on a continuous basis.

Relevance of learning health systems to physiatrists and its synergy with implementation science: A commentary.

As health care attempts to bridge the gap between evidence and practice, the concept of the learning health system (LHS) is becoming increasingly relevant. LHS integrates evidence with health systems data, driving health care quality and outcomes through updates in policy, practice, and care delivery. In addition, LHS research is becoming critically important as there are several initiatives underway to increase research capacity, expertise, and implementation, including attempts to stimulate increasing numbers of LHS researchers. Physical Medicine & Rehabilitation (PM&R) physicians (physiatrists), nurses, therapists (physical therapists, occupational therapists, speech therapists, clinical psychologists), and scientists are affiliated with LHSs. As LHS research expands in health care systems, better awareness and understanding of LHSs and LHS research competencies are key for rehabilitation professionals including physiatrists. To address this need, the Agency of Healthcare Research and Quality (AHRQ) identified 33 core competencies, grouped into eight domains, for training LHS researchers. The domains are: (1) Systems Science; (2) Research Questions and Standards of Scientific Evidence; (3) Research Methods; (4) Informatics; (5) Ethics of Research and Implementation in Health Systems; (6) Improvement and Implementation Science; (7) Engagement, Leadership, and Research Management; and the recently added (8) Health and Healthcare Equity and Justice. The purpose of this commentary is to define LHS and its relevance to physiatrists, present the role of implementation science (IS) in LHSs and application of IS principles to design LHSs, illustrate current LHS research in rehabilitation, and discuss potential solutions to improve awareness and to stimulate interest in LHS research and IS among physiatrists in LHSs.

Evaluation of the impact of the single contract and the provincial approach in the implementation of health system reform at intermediate level in Maniema, DR Congo

Evaluation of the impact of the single contract and the provincial approach in the implementation of health system reform at intermediate level in Maniema, DR Congo

Neuropsychological Assessment for Early Detection and Diagnosis of Dementia: Current Knowledge and New Insights.

Dementia remains an underdiagnosed syndrome, and there is a need to improve the early detection of cognitive decline. This narrative review examines the role of neuropsychological assessment in the characterization of cognitive changes associated with dementia syndrome at different states. The first section describes the early indicators of cognitive decline and the major barriers to their identification. Further, the optimal cognitive screening conditions and the most widely accepted tests are described. The second section analyzes the main differences in cognitive performance between Alzheimer's disease and other subtypes of dementia. Finally, the current challenges of neuropsychological assessment in aging/dementia and future approaches are discussed. Essentially, we find that current research is beginning to uncover early cognitive changes that precede dementia, while continuing to improve and refine the differential diagnosis of neurodegenerative disorders that cause dementia. However, neuropsychology faces several barriers, including the cultural diversity of the populations, a limited implementation in public health systems, and the adaptation to technological advances. Nowadays, neuropsychological assessment plays a fundamental role in characterizing cognitive decline in the different stages of dementia, but more efforts are needed to develop harmonized procedures that facilitate its use in different clinical contexts and research protocols.

Analysis of Factors Affecting Hospital Risk Management in Indonesia: The SEM-PLS Approach

Healthcare workers, especially those in hospitals, face a variety of complex hazards and exposures. One of the essential aspects of reducing risks and dangers is effective risk management. This study used a cross-sectional approach to survey the implementation of occupational health and safety management systems in Indonesian hospitals and to identify factors predisposing hospital risk management in Indonesia. A purposive sampling method was employed to select 90 hospitals distributed across 10 provinces in Indonesia. Data were analyzed using descriptive analysis, correlation, and SEM-PLS. A total of 44 hospitals (48.9%) had complete status plenary, and the majority were type C hospitals (43.3%). The results of SEM-PLS analysis showed that the hazard and risk identification analysis and Standard Operating Procedures (SOPs) factor-variables significantly predisposed the high quality of hospital risk management in Indonesia, with path values of 0.282 and 0.469, respectively. Enhancing hospital risk management in Indonesia could be achieved by increasing the use of appropriate SOPs and conducting a thorough analysis of hazards and risk identification.

A narrative review of e-health systems' evolution - evidence from a regional study.

The growing implementation of electronic health (e-health) systems has raised the importance of analyzing how these systems have been implemented in diverse regions. By employing a contextual sensitive approach and social mechanism theory, this study aims to better understand the reasons for the success and failure of e-health initiatives in the ex-Yugoslav region and derive useful insights for policymakers. We employ a narrative review process grounded in the social mechanism theory, extended with field experts' review, to acquire state-of-the-art information. Findings indicate that different e-health systems coexist and evolve in different contexts in different countries, with varying levels of success. The contextual differences shape the broader environment, affecting the level of preparedness and capability for e-health implementation. Top-down approaches dominate e-health implementation in most countries when it comes to design process features, and more developed countries do not rely on strong social mechanisms for implementing e-health due to the openness of their culture towards e-health innovations. Analyzing the milestones, challenges and functionalities of e-health systems in the region of interest can assist policymakers, academics and practitioners in making informed decisions and recommendations to enhance future e-health implementation. No known studies evaluated e-health initiatives in the former ex-Yugoslav countries holistically and evolutionarily in the form of a comprehensive regional study. Further, our research endeavor is contextually specific since the health systems of these countries in the past were tied together under the federative umbrella health system and then diverged in terms of e-health development.

#1377 Evaluation of state-wide health system implementation of renal supportive care shows substantial net benefits

Abstract Background and Aims In 2016, the New South Wales (NSW) Health system implemented a service to make the principles and practice of palliative medicine comprehensively available to patients receiving chronic kidney disease (CKD) care across NSW. Summative evaluation of the economic value that this multi-disciplinary State-wide RSC service provided following implementation was prospectively planned in the domains of patient experience and economic value. This abstract reports the first cost-benefit analysis of a RSC service. Method De-identified patient-level data was extracted from the NSW Renal Supportive Care Register (a linked dataset comprising admitted patient, non-admitted patient, emergency department episodes and death registrations). Data was compared between 2015/16, prior to implementation of the State-wide RSC service; and 2018/19, following settled operation of the service. A cost-benefit analysis model was constructed to estimate the economic value of the RSC service between 2015/16 and 2018/19; and the projected value to 2029/30 under different scenarios. Multivariate Cox regressions were estimated to measure survival benefits, and a polynomial regression model was employed to estimate the impact of RSC on the share of patients receiving dialysis. Results Considering the actual impact of the NSW RSC service; in 2015/16, 5% (n = 443) of all ESKD patients, (defined as receiving dialysis >3 months, non-dialysis conservative care or in receipt of a functioning transplant) received any RSC service. By 2018/19, 16% (n = 1460) of all ESKD patients had received RSC within NSW. The proportion of patients receiving RSC from a non-dialysis conservative care or dialysis context remained stable between 2015/16 and 2018/19 at 41% and 29% respectively. Patients receiving RSC were estimated to have increased survival by 3-21 weeks, depending on patient characteristics, compared to the scenario of no RSC service. Considering the projected value of ongoing RSC services; scenarios with different assumptions were modelled. Assuming that the proportion of patients receiving different ESKD modalities and the costs of care remained stable, the RSC service would deliver a net financial benefit to the commissioning health system (avoided costs of service minus RSC costs) of ${\$}$109 million Australian Dollars (AUD), with a return on investment of 212%, compared to the scenario of no RSC service. When the economic value for the whole NSW community from increased survival benefit was included, the projected value was ${\$}$275 million AUD, with return on investment of 535%. The projected economic value of RSC was modelled under scenarios of increasing access to the service by ESKD patients (Figure). Increasing RSC access from the achieved 16% to 20% of ESKD patients was projected to deliver maximal economic value, with a 3% fall in ESKD patients receiving dialysis, increasing survival benefit (${\$}$221 million AUD) and economic value ${\$}$94 million AUD. As access to RSC expands further, modelling indicates that additional dialysis substitution becomes less likely but benefits still accrue from survival up to a maximum viable rollout of 50% of the ESKD population receiving RSC, when survival benefits plateau. Conclusion Economic evaluation of this implementation of the Statewide RSC service across NSW Health shows it has been associated with both a net economic benefit and survival benefits four years after implementation. It is projected to provide an economic value of ${\$}$275 million AUD over ten years, which would increase with greater participation of ESKD patients suitable for RSC.

Implementing the Serious Illness Care Program in Safety Net Health Systems: A Qualitative Study

ContextInterventions to improve the quality of care for people affected by serious illness commonly fail to reach patients from marginalized and underserved communities, which include those characterized by racialized or indigenous identity, sexual and gender minority status, and rural living. Interventions to improve care through serious illness conversations have demonstrated benefit, but little is known about their implementation in health systems that predominantly serve these patient groups. ObjectivesThe study aimed to understand factors influencing implementation of a serious illness communication-focused intervention—the Serious Illness Care Program in health systems who primarily provide care to marginalized and underserved communities. MethodsQualitative interviews (16) and focus groups (3) were conducted with 19 interdisciplinary team members from six geographically diverse U.S. healthcare systems. Using a template analysis approach, investigators coded data inductively and deductively to identify themes. ResultsThree themes emerged: patient factors, intervention elements, and health system contextual factors. Participants highlighted mission-driven efforts, creativity, interprofessional practice, and trainees as enablers of success. They identified weaknesses in the intervention's communication tool—the Serious Illness Conversation Guide as barriers to implementation of conversations. Resource constraints, socio-economic vulnerability, and mistrust in the health system were seen as additional barriers. ConclusionsHealth systems that provide care to underserved and marginalized communities face unique challenges implementing the Serious Illness Care Program. They also possess assets, some unique to these settings, that support program adoption. Findings suggest that implementation of similar programs in low-resource healthcare settings may help address unmet needs among marginalized populations.

Priority setting: Development of the South Australian Aboriginal Chronic Disease Consortium RoadMap for Action.

Aboriginal and Torres Strait Islander (Aboriginal) people in South Australia are overburdened by cardiovascular disease, diabetes and cancer. The South Australian Aboriginal Chronic Disease Consortium (Consortium) was established in June 2017 as a collaborative partnership to lead the implementation of three state-wide chronic disease plans using a strategic approach to identifying key priority areas for action. In 2017-2018, the Consortium Coordinating Centre facilitated a priority setting process, which involved extensive consultation, including a prioritisation survey and stakeholder workshops. The Consortium's Aboriginal Community Reference Group was instrumental in leading the identification of priorities for action. The Consortium RoadMap for Action identified seven across-plan priorities and six condition-specific priorities. It acknowledged that: strengthening social and emotional well-being is central to improving health outcomes; prevention and early detection, acute management and ongoing management are all components of the continuum of care; and improving access to services, strengthening the workforce, and monitoring and evaluation are required across the continuum of care. Widespread implementation failure in the past across the health system and health services implementation and research translation highlights the value of the Consortium approach and its commitment to implementing the state-wide chronic disease plans in a collaborative manner. The Consortium relies on and fosters cross-sectoral alignment, with all key players including all public, private and Aboriginal Community Controlled health services, to progress its priorities and aspirations to improve health outcomes for Aboriginal people using evidence-based strategies. SO WHAT?: Rigorous and transparent priority setting processes that bring together research, clinical practice, health services operations, policy and community perspectives can foster intersectoral collaboration and partnership and support the implementation of shared priorities.

Health system implementation of the PROMIS Cognitive Function Screener in the Medicare Annual Wellness Visit: framing as abilities versus concerns

BackgroundCognitive assessment is a required component of the Medicare Annual Wellness Visit (AWV). In this prospective study, we evaluated acceptability and usefulness of a patient-reported outcome measure (the PROMIS® Cognitive Function Screener, or PRO-CS) to screen for cognitive impairment during the AWV. We compared two versions of the PRO-CS: Abilities and Concerns.MethodsWe developed PRO-CS Abilities and PRO-CS Concerns using items from the PROMIS Cognitive Function item banks. We partnered with a large health system in Pennsylvania to implement an electronic health record (EHR)-integrated version of the 4-item PRO-CS into their AWV workflow. PRO-CS Abilities was implemented in June 2022 and then replaced with PRO-CS Concerns in October 2022. We used EHR data to evaluate scores on Abilities versus Concerns and their association with patient characteristics. We gathered feedback from providers on experiences with the PRO-CS and conducted cognitive interviews with patients to evaluate their preferences for Abilities versus Concerns.ResultsBetween June 2022 and January 2023, 3,088 patients completed PRO-CS Abilities and 2,614 patients completed PRO-CS Concerns. Mean T-scores for Abilities (54.8) were slightly higher (indicating better cognition) than for Concerns (52.6). 10% of scores on Abilities and 13% of scores on Concerns indicated concern for cognitive impairment (T-score < 45). Both Abilities and Concerns were associated with clinical characteristics as hypothesized, with lower scores for patients with cognitive impairment diagnoses and those requiring assistance with instrumental activities of daily living. Abilities and Concerns had similar negative correlations with depression (r= -0.31 versus r= -0.33) and anxiety (r= -0.28 for both), while Abilities had a slightly stronger positive correlation with self-rated health (r = 0.34 versus r = 0.28). In interviews, providers commented that the PRO-CS could be useful to facilitate conversations about cognition, though several providers noted potential limitations of patient self-report. Feedback from patients indicated a preference for PRO-CS Concerns.ConclusionsOur findings suggest potential utility of the PRO-CS for cognitive screening in the Medicare AWV. PRO-CS Abilities and Concerns had similar associations with patient clinical characteristics, but the Concerns version was more acceptable to patients.

Occupational safety & health risk analysis in formwork in high-rise building projects

The implementation of Occupational Health and Safety Management systems remains a significant concern, particularly in the context of multi-storey building construction projects. Within the realm of these complex endeavors, the management of work-related accidents during formwork operations is of paramount importance. This research employs a rigorous methodology involving questionnaire distribution and interviews, complemented by advanced analytical tools such as the Frequency Adjusted Importance Index (FAII) and Bow Tie Analysis. The study focuses on the Indonesian Development University’s high-rise building project, systematically assessing potential hazards associated with formwork activities. Furthermore, this research evaluates the inherent risk levels and proposes comprehensive control measures to mitigate these hazards effectively. By shedding light on the intricate interplay between safety management and high-rise construction, this study contributes to the enhancement of occupational safety and health practices in the construction industry, ultimately promoting safer and more efficient work environments.