Improve Healthcare Systems Research Articles

Service integration for improved diabetic and dental care: exploring an effective model for optimising health outcomes

PurposeThis study identifies and synthesizes existing literature on the integration of diabetic and dental services and explores a service integration model for optimising diabetic patient health outcomes and improving healthcare systems in low and middle-income countries.Design/methodology/approachPeer-reviewed literature that analysed the integration of health services regarding dental and medical services were reviewed. The articles were identified using the Academic Search Complete, Business Source Complete, CINAHL Complete, Google Scholar and MEDLINE databases and screened using the PRISMA guidelines.FindingsA total of 40 full-text articles were examined for eligibility out of which 26 were selected for analysis. Diabetes was shown to contribute significantly to the global disease burden and this is also reflected in most low and middle-income countries. It is found that the integration of medical and dental services could help alleviate this burden. Hence, locally adapted Rainbow-Modified Integrated Care model is proposed to fill this integration gap.OriginalityThe integration of dental and medical services has been proven to be useful in improving diabetic patient outcomes. Hence, the need to facilitate cross-professional collaboration between dentists and physicians cannot be overemphasised and this can be extended and locally adapted by different health systems across the world.Practice ImplicationsThe integration of dental and diabetic services using models such as the Rainbow Model of Integrated Care is recommended to optimise health outcomes of diabetic patients and enhancing service delivery, especially in resource-poor healthcare systems.

ДЕРЖАВНА МЕДИЦИНА VS ПРИВАТНА: У ПОШУКАХ ЕФЕКТИВНОГО ОРГАНІЗАЦІЙНОГО ІНСТРУМЕНТАРІЮ СИСТЕМИ ОХОРОНИ ЗДОРОВ’Я У КОНТЕКСТІ ЕКОНОМІЧНОЇ ВЗАЄМОДІЇ

Проблеми реформування вітчизняної галузі охорони здоров’я як бази формування людського потенціалу зумовили пошуки ефективного інструментарію для розбудови удосконаленої системи охорони здоров’я. Констатація незадоволеності населення поточною медичною реформою, а також визначення у роботі переваг і недоліків трансформаційної системи охорони здоров’я становлять підґрунтя аналізу сучасного стану медичної галузі, якій притаманні загальні негативні процеси. Проведений компаративний аналіз функціональних особливостей державного і приватного секторів медицини дав змогу виявити кадрову проблему в цілому по галузі, диспропорції у галузевій структурі та наявність стримуючих чинників розвитку в обох секторах. Визначено, що проблеми у державному секторі стимулюють розвиток приватної медицини, однак поруч із конкуренцією в межах приватного сектору, а також між приватною і державною медициною частково вирішення проблем оновленої системи передбачається за рахунок компенсаторних функцій приватного сектору медицини. У цих умовах значущості набуває стимулювання розвитку приватної медицини поруч із формуванням механізмів ефективної взаємодії державних, комунальних і приватних установ. У зв’язку із цим наголошується на важливості механізмів ефективної взаємодії державних, комунальних і приватних установ, в основу функціонування яких має бути покладений відповідний економічний інструментарій, який би враховував особливості розвитку кожного сектору та інтереси сторін, а також функціональні взаємозв’язки у структурах механізмів. Розглянуто загальновизнані методи та інструменти державного регулювання послуг сфери охорони здоров’я, у результаті чого з урахуванням проблем галузі, а також функціональних особливостей її секторів удосконалено організаційний інструментарій системи охорони здоров’я. Запропонований комплекс інструментів систематизовано за групами і підгрупами на основі виконуваних ними функцій і вирішуваних завдань. Базовий організаційний інструментарій застосовується в межах загальноприйнятих методів державного регулювання, складається з п’яти основних груп, які можуть розширюватися і доповнюватися.

Informing prevention of stillbirth and preterm birth in Malawi: development of a minimum dataset for health facilities participating in the DIPLOMATIC collaboration

ObjectiveThe global research group, DIPLOMATIC (Using eviDence, Implementation science, and a clinical trial PLatform to Optimise MATernal and newborn health in low Income Countries), aims to reduce stillbirths and preterm...

ID/HIV Physician Ambassadors: Advancing Policy to Improve Health.

ID/HIV physicians and other healthcare professionals advocate within the healthcare system to ensure adults and children receive effective treatment. These advocacy skills can be used to inform domestic and global infectious disease policies to improve healthcare systems and public health. ID/HIV physicians have a unique frontline perspective to share with federal policymakers regarding how programs and policies benefit patients and public health. Providing this input is critical to the enactment of legislation that will maximize the response to infectious diseases. This article discusses the advocacy of ID/HIV physicians and other healthcare professionals in federal health policy. Key issues include funding for ID/HIV programs; the protection of public health and access to health care; improving research opportunities; and advancing the field of ID/HIV, including supporting the next generation of ID/HIV clinicians. The article also describes best practices for advocacy and provides case studies illustrating the impact of ID/HIV physician advocacy.

Infectious Diseases/Human Immunodeficiency Virus Physician Ambassadors: Advancing Policy to Improve Health.

Infectious diseases/human immunodeficiency virus (ID/HIV) physicians and other healthcare professionals advocate within the healthcare system to ensure adults and children receive effective treatment. These advocacy skills can be used to inform domestic and global infectious diseases policies to improve healthcare systems and public health. ID/HIV physicians have a unique frontline perspective to share with federal policymakers regarding how programs and policies benefit patients and public health. Providing this input is critical to the enactment of legislation that will maximize the response to infectious diseases. This article discusses the advocacy of ID/HIV physicians and other healthcare professionals in federal health policy. Key issues include funding for ID/HIV programs; the protection of public health and access to healthcare; improving research opportunities; and advancing the field of ID/HIV, including supporting the next generation of ID/HIV clinicians. The article also describes best practices for advocacy and provides case studies illustrating the impact of ID/HIV physician advocacy.

Prevalence, determinants and knowledge about herbal medicine and non-hospital utilisation in southwest Nigeria: a cross-sectional study

ObjectivesTo examine the prevalence, determinants, safety perceptions, effectiveness and knowledge of herbal medicines (HMs) and reasons for non-hospital utilisation.DesignCross-sectional study.SettingEkiti state, southwest Nigeria.ParticipantsA representative sample (n=1600) of adults (18 years...

Use of digital tools by PHC professionals as instrument for health decision-making

Abstract Background Investments have been made in precision public health strategies, as a way to better assess needs and evaluate the health services. Experiences point out that the computerization of health systems reduces costs and improves the quality of information. Primary Health Care (PHC) workers are key elements of this transformation, which can be enhanced with the use of digital health strategies. This paper aims to know the perception of the use of digital tools provided by the Ministry of Health by PHC workers in municipalities in the state of Ceará/Brazil. Methods Focus groups and field monitoring were carried out with different professional profiles. The inclusion criterion was the use of digital tools in their daily work. Questionnaires were built to conduct semi-structured interviews. The analyzes were made using content analysis method. Results Among the 21 participants (32-49 years old, mostly female),3 reported not having digital knowledge prior to the use of digital tools in their daily work. Mostly associated the use of digital tools with greater agility and ease in the work routine and greater accuracy of information. The challenges were mainly related to the use of the equipment(tablet),such as fear of breakage, theft and problems in the synchronization of the information system. There was a consensus that the data collected are useful, however they are underutilized for the work process in PHC. Conclusions The use of digital tools in the health work process is able to foster the critical view of professionals for analysis and decision making, pointing out strategies to face health issues in the territories. Pointed out as a facilitator in daily work, the use of digital tools does not exclude the use of paper sheets. Despite the greater supply of data, these are not used to their full potential, mainly due to insufficient time, given the numerous tasks for professionals. Key messages Carefully planned, developed and deployed digital interventions are powerful tools to improve health care system performance. The use of digital tools in the health work process is able to foster the critical view for analysis and decision making, pointing out strategies to face health issues in the territories.

UX Research applied to digital transformation of primary care in Brazil

Abstract Background Digital are powerful tools to improve the work and quality of information of primary care teams (PHC) in Brazil has been encouraged through the institution of the e-SUS Primary Care strategy (e-SUS AB). Digital tools were developed to optimize the PHC work process in collecting data on the health of the Brazilian population. The e-SUS AB application was one of those tools developed by the Ministry of Health. This simplified collection of population data. Despite technological updates, since 2015 there were updates regarding the usability of the application. Objective Aim to report on the use of UX research tools to identify changes needed in the e-SUS AB application and to propose solutions aligned with the concepts of usability. Methods For the UX Research, we used focus groups and field monitoring. As a result, we produced personas, empathy map, user journey, and user history documents. The Heuristic User Interface Design, proposed by Nielsen, was used for the application analysis. The World Health Organization's MEDHI (Monitoring and Evaluating Digital Health Interventions) protocol was used for designing solution proposals for UX Design. Results In the design process, we produced navigation sketching's flow and high-fidelity prototypes for improvement proposals. It was necessary to correlate Nielsen's 10 heuristic principles with the needs inherent to public health applications. Problems related to the freedom of control and use by the health professional and the flexibility and efficiency of use were the most significant finds. We also identified underutilization of data collected. Conclusions Based on the results found, an aesthetic reformulation was proposed to solve the heuristic problems. It was also proposed to include a new functionality: a checklist for specific conditions, thus optimizing the use of data collected for primary health care. The proposals are currently undergoing usability testing in a municipality in northeastern Brazil. Key messages We need to plan health digital tools with UX knowledge to improve analysis and decision making capabilities to pointing out strategies to face health issues in the territories. Digital tools are powerful tools to improve health care system performance.

A GDPR-compliant information system to improve community primary care in a middle income country

Abstract Background A strong primary health care (PHC) is associated to better overall health system results. Brazil has good results in PHC in the last decades, integrating 260,000 community health workers (CHW) in 43,000 family health teams (FHT), assisting 90 million people and delivering 500 million health activities yearly, such as home visits, consultations, colposcopy, etc. We address the challenges of incorporating CHA-produced data to official electronic health records, automate its analysis and promote information use by FHT to plan activities & prioritize individuals considering social determinants of health, clinical data and treatment plans. Our study developed a general data protection regulation (GDPR) compliant information system to improve community health agents and family health teams coordination of care in order to address this challenge. Methods The intervention was developed using UX techniques and combines Apps and Web dashboards, issuing digital alerts to the FHT and municipal health manager, regarding individual health status and pending care for each covered individual. The research used the “Monitoring and Evaluating Digital Health Interventions” toolbox by World Health Organization (WHO), and GDPR compliance was attained by terms of use acceptance, pseudonymisation and anonymization procedures. Results Stage 1 and Stage 2 Maturity tests with doctors, nurses and CHA showed good feasibility, usability and user satisfaction of the solution. UX and Qualitative Assessment are reported separately. Conclusions Results so far point that the solution is viable and acknowledged as useful by health professionals. Stage 3 (Pilot) will run in September 2020 in two different cities to test efficacy and health system adherence in real world setting. Digital health interventions are powerful tool to improve health care system performance, particularly in Primary Health Care. Key messages Digital Health Intervention are viable in Primary Care as long as they reduce health profesisonal burden and increase service quality. Brazil is a promising environment for Digital Health. Careful planning, development and deployment are essential in the process.

Development of an Operative Trauma Course in Uganda—A Report of a Three-Year Experience

BackgroundTrauma is a leading cause of morbidity and mortality in low-income countries. Improved health care systems and training are potential avenues to combat this burden. We detail a collaborative and context-specific operative trauma course taught to postgraduate surgical trainees practicing in a low-resource setting and examine its effect on resident practice. MethodThree classes of second year surgical residents participated in trainings from 2017 to 2019. The course was developed and taught in conjunction with local faculty. The most recent cohort logged cases before and after the course to assess resources used during initial patient evaluation and operative techniques used if the patient was taken to theater. ResultsOver the study period, 52 residents participated in the course. Eighteen participated in the case log study and logged 117 cases. There was no statistically significant difference in patient demographics or injury severity precourse and postcourse. Postcourse, penetrating injuries were reported less frequently (40 to 21% P < 0.05) and road traffic crashes were reported more frequently (39 to 60%, P < 0.05). There was no change in the use of bedside interventions or diagnostic imaging, besides head CT. Of patients taken for a laparotomy, there was a nonstatistically significant increase in the use of four-quadrant packing 3.4 to 21.7%) and a decrease in liver repair (20.7 to 4.3%). ConclusionsThe course did not change resource utilization; however, it did influence clinical decision-making and operative techniques used during laparotomy. Additional research is indicated to evaluate sustained changes in practice patterns and clinical outcomes after operative skills training.

Exploration of advanced practice nurses' competencies necessary for achievement of universal health coverage in Jordan.

Given the global shortage of the health workforce and the nature of diseases, strengthening and improving health care systems become a necessity. One of the solutions that is recommended by the literature is to utilize advanced practice nurses (APNs) to accelerate the progress toward the Sustainable Development Goals and universal health coverage (UHC). To delineate APN practice and competencies in relation to UHC and primary care in Jordan from the perspective of nurse administrators, clinical nurse specialist, academics, and policymakers. A descriptive exploratory survey design was utilized to identify APN competencies that are important in achieving UHC. The survey developed by one of the authors (JH) at a PAHO Collaborating Center to delineate APN practice and APN competencies was adapted and utilized. A convenience sample of 94 nurse leaders was recruited from the education sector, nursing associations, councils, and hospitals. The results showed that all four competencies (clinical care; interdisciplinary and patient-centered communication; systems of care; and using evidence for best practice) were rated as agree/strongly agree across all four domains. There was a consensus of participates on dimensions of all competency domains. The current study confirms that the role of APNs is still in its infancy in Jordan. The current study provides nurse educators with baseline information that can be utilized as a framework for APN education programs. The faculty readiness to start new competency-based APN programs or revise the current graduate programs needs to be assessed.

The importance of significant event analysis

Significant event analysis (SEA) is a structured quality improvement activity that is well established in general practice. Participation in SEA prompts primary care teams to reflect on their clinical reasoning, to highlight exemplary care, and to identify any potential improvements in both practice and wider healthcare systems. This article provides an overview of the SEA process and the events surrounding a SEA meeting. Cancer care examples are used to demonstrate how SEA can be used to enhance team-based learning and improve future patient care.

Healthcare and economic burden of ANCA-associated vasculitis in Italy: an integrated analysis from clinical and administrative databases

ANCA-associated vasculitides (AAV) comprise a group of systemic vasculitides characterized by inflammation of small-sized blood vessels leading to multi-organ involvement. The worldwide annual incidence of AAV ranges from 1.2 to 3.3 cases per 100 000 individuals with a prevalence of 4.6–42.1 cases per 100 000 individuals. The prevalence of AAV is geographically heterogeneous; therefore, regional epidemiological studies can be more informative to improve health care systems. Even though clinicians are aware that the healthcare burden and the risk of hospitalization of AAV appear high, data on hospitalization and cost of illness due to AAV are still scarce or even lacking. This study aims to characterize the economic burden of AAV in Friuli Venezia Giulia (FVG), Italy. Thus, a retrospective study was conducted through the integration of many administrative health databases of the FVG as the source of information. From data integration, we estimated that more than two-thirds of AAV patients showed at least one hospitalization in their medical history, most frequently caused by the disease itself or superimposed infections. Around 10% of patients developed end-stage renal disease. In an 8-year follow-up, the overall healthcare cost was € 1,215,078, corresponding to € 6,168 patient-year. ANCA-positive patients showed much higher costs than ANCA-negative patients did. Overall, AAV are rare diseases, but imply very high healthcare costs. Early diagnosis and optimal treatment probably still remain unmet needs for AAV.

Person-Centered Care Design with Reference to Healthcare Outcomes in Saudi Arabia: An Overview

The Person-Centered Care approach improves the facility design and revolves around user preferences with the added value of superior services, respect with dignity and teamwork, infrastructure, and innovation. This study based on healthcare professionals practicing person-centered care dimensions investigates conceptualization and the process of creating high quality to examine improve healthcare systems efficiency and effectiveness. To enhance the healthcare environment, ensuring a comprehensive assessment of patient journey throughout the care process and ensure safety, timeliness, effectiveness, efficiency, and patient-centered care approach have been considered. The consideration for home-like acknowledged built environment, aesthetically delighted, space for family and friends, noise-free, rooms exposed to nature, provision to access healing gardens and promote healthcare outcomes as well as better culture and better care consequence increase patient experience and thus have positive impact on patient satisfaction. In this paper the Person-Centered Care Design facility with reference to the healthcare outcomes in Saudi Arabia has been studied.

Improving Health Care System Efficiency for Equity, Quality and Access: Does the Healthcare Decision Making Involve the Concerns of Equity? Explanatory Review

Background: Healthcare is a complex investment which requires a number of stakeholders to produce desired health outcomes. In addition to its complex nature, availability of limited resources for providing healthcare for population poses a number of questions for policy makers. Among these multitudes of questions, Efficiency, Equity and Effectiveness have complex interplay and require balanced tradeoff. Therefore, this explanatory review was conducted with intention to provide basic information on how to incorporate efficiency, equity and effectiveness in healthcare decision making. Method: We systematically searched PubMed/Medline, Scopus, and Google scholar with the following with the following queries: Effectiveness, Efficiency, Equity, Delivery of healthcare, Health care decision making. Results: Inefficiency in health systems is a global problem. About 20-40% global health expenditure is considered as w stage. Efficiency, Effectiveness and Equity are synergistic pillars of quality healthcare system. Improving efficiency in health system can reduce raising healthcare expenditure. Providing equitable care for all has national and international importance. Priority setting, multiple criteria decision making and incorporation of equity impact and trade-off analysis on costeffectiveness can be used for balancing tradeoff between efficiency, equity and effectiveness. Conclusion: Efficiency of healthcare system is important for improving, equity, effectiveness and access to healthcare. Taking efficiency into healthcare delivery with full understanding of determinants of disease in specific population can provide room for improving effectiveness and equity in healthcare as evidenced by presence of avoidable wastages and inefficiency in every healthcare system. Equity should be considered during planning process along with economic evaluations.

Built to last? The sustainability of healthcare system improvements, programmes and interventions: a systematic integrative review.

IntroductionThe sustainability of healthcare delivery systems is challenged by ageing populations, complex systems, increasing rates of chronic disease, increasing costs associated with new medical technologies and growing expectations by healthcare consumers. Healthcare programmes, innovations and interventions are increasingly implemented at the front lines of care to increase effectiveness and efficiency; however, little is known about how sustainability is conceptualised and measured in programme evaluations.ObjectivesWe aimed to describe theoretical frameworks, definitions and measures of sustainability, as applied in published evaluations of healthcare improvement programmes and interventions.DesignSystematic integrative review.MethodsWe searched six academic databases, CINAHL, Embase, Ovid MEDLINE, Emerald Management, Scopus and Web of Science, for peer-reviewed English journal articles (July 2011–March 2018). Articles were included if they assessed programme sustainability or sustained outcomes of a programme at the healthcare system level. Six reviewers conducted the abstract and full-text review. Data were extracted on study characteristics, definitions, terminology, theoretical frameworks, methods and tools. Hawker’s Quality Assessment Tool was applied to included studies.ResultsOf the 92 included studies, 75.0% were classified as high quality. Twenty-seven (29.3%) studies provided 32 different definitions of sustainability. Terms used interchangeably for sustainability included continuation, maintenance, follow-up or long term. Eighty studies (87.0%) clearly reported the timepoints at which sustainability was evaluated: 43.0% at 1–2 years and 11.3% at <12 months. Eighteen studies (19.6%) used a theoretical framework to conceptualise or assess programme sustainability, including frameworks that were not specifically designed to assess sustainability.ConclusionsThe body of literature is limited by the use of inconsistent definitions and measures of programme sustainability. Evaluations of service improvement programmes and interventions seldom used theoretical frameworks. Embedding implementation science and healthcare service researchers into the healthcare system is a promising strategy to improve the rigour of programme sustainability evaluations.

Searching for new community engagement approaches in the Netherlands: a realist qualitative study

BackgroundCommunity engagement is increasingly seen as key to improving healthcare systems and to increasing communities’ involvement in the shaping of their own communities. This paper describes how ‘community engagement’ (CE) is understood and being operationalised in the Dutch healthcare system by investigating the CE approaches being implemented in six different regions and by examining engaged citizens’ and professionals’ experiences of those CE approaches.MethodsFor this realist study, interviews and focus groups were held with citizens (16) and professionals (42) involved in CE approaches in the six regions. Additionally, CE-related activities were observed to supplement interview data.ResultsThis study shows that citizens and professionals defined and experienced CE differently and that they differed in who they felt had ownership of CE. The CE approaches implemented in community-led initiatives and organisationally-led initiatives varied accordingly. Furthermore, both citizens and professionals were searching for meaningful ways for citizens to have more control over healthcare in their own communities.ConclusionCE can be improved by, first of all, developing a shared and overarching vision of what CE should look like, establishing clear roles and remits for organisations and communities, and taking active measures to ensure CE is more inclusive and representative of harder-to-reach groups. At the same time, to help ensure such shared visions do not further entrench power imbalances between citizens and professionals, professionals require training in successful CE approaches.

Linking Hospital Consumer Assessment of Healthcare Providers and Systems to Swanson Caring Theory: A Diagnostic Model for Improvement.

Given the implications of value-based reimbursement, nurse leaders must thoughtfully assimilate an extraordinary amount of quality, safety, and patient experience data to effectively drive behavioral change. This article proposes Swanson Caring Theory (SCT) as context for Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) improvement strategies. The diagnostic model described herein is not intended to encompass the full scope of nursing care, but rather to help nurse leaders interpret HCAHPS results in terms of the SCT attributes of compassion, competence, and patient well-being.

Differences of maternal mortality rate between Shanghai and New York city from the perspective of regulatory policy.

Regulatory policy (RP) is known as a major factor to improve health care system performance. A significant difference in maternal mortality rates (MMRs) was observed between New York city (NYC) and Shanghai (SH), both first-class international metropolises. This study aims to adopt a quantitative evaluation model to analyze whether RP differences contribute to the different MMRs of the two cities. Based on collection of all publicly released policy documents regarding maternal health in the two cities, we assessed and compared the status of their maternal health care RPs from 2006 to 2017 through a series of quantitative indicators as regulatory elements coverage rate (RECR), departmental responsibility clarity rate (DRCR), and accountability mechanism clarity rate (AMCR), based on two characteristics of comprehensiveness and effectiveness of RPs. Pearson correlation analysis, principal component analysis, and linear regression analysis were used to test the relationships between the indicators and MMR in SH and NYC. By 2017, disparities of maternal health care RP are found between SH and NYC, from the indicators of RECR (100% vs. 77.0%), DRCR (38.9% vs. 45.1%), and AMCR (29.2% vs. 22.5%). From 2006 to 2017, RECR, DRCR, and AMCR in SH have shown a higher growth of 8.7%, 53.2%, and 45.2%, compared with growth of 25.0%, 12.5%, and 2.9% in NYC. The three indicators were found all negatively correlated with MMR in SH (Coefficients = -0.831, -0.833, and -0.909, and P < 0.01), while only RECR and DRCR had negative correlation with MMR in NYC (Coefficients = -0.736 and -0.683, and P < 0.05). Linear regression showed that the principal components of the three indicators were found with significant impact on MMRs both in SH (R = 0.914, R = 0.836, P < 0.001) and NYC (R = 0.854, R = 0.357, P = 0.04). Compared with NYC, the more comprehensive and effective maternal health care RPs in SH had a stronger impact on MMR control, which contributed to the differences between the two cities' MMRs to some extent. The methods and indicators we adopted for assessment are reasonable and comparable.

National monitoring and evaluation of eHealth: a scoping review.

ObjectiveThere has been substantial growth in eHealth over the past decade, driven by expectations of improved healthcare system performance. Despite substantial eHealth investment, little is known about the monitoring and evaluation strategies for gauging progress in eHealth availability and use. This scoping review aims to map the existing literature and depict the predominant approaches and methodological recommendations to national and regional monitoring and evaluation of eHealth availability and use, to advance national strategies for monitoring and evaluating eHealth.MethodsPeer-reviewed and grey literature on monitoring and evaluation of eHealth availability and use published between January 1, 2009, and March 11, 2019, were eligible for inclusion. A total of 2354 publications were identified and 36 publications were included after full-text review. Data on publication type (eg, empirical research), country, level (national or regional), publication year, method (eg, survey), and domain (eg, provider-centric electronic record) were charted.ResultsThe majority of publications monitored availability alone or applied a combination of availability and use measures. Surveys were the most common data collection method (used in 86% of the publications). Organization for Economic Co-operation and Development (OECD), European Commission, Canada Health Infoway, and World Health Organization (WHO) have developed comprehensive eHealth monitoring and evaluation methodology recommendations.DiscussionEstablishing continuous national eHealth monitoring and evaluation, based on international approaches and recommendations, could improve the ability for cross-country benchmarking and learning. This scoping review provides an overview of the predominant approaches to and recommendations for national and regional monitoring and evaluation of eHealth. It thereby provides a starting point for developing national eHealth monitoring strategies.