Engagement Of Key Stakeholders Research Articles

Digital health integration for noncommunicable diseases: Comprehensive process mapping for full-life-cycle management.

To create a systematic digital health process mapping framework for full-life-cycle noncommunicable disease management grounded in key stakeholder engagement. A triphasic, qualitative methodology was employed to construct a process mapping framework for digital noncommunicable disease management in Shanghai, China. The first phase involved desk research to examine current guidance and practices. In the second phase, pivotal stakeholders participated in focus group discussions to identify prevalent digital touchpoints across lifetime noncommunicable disease management. In the final phase, the Delphi technique was used to refine the framework based on expert insights and obtain consensus. We identified 60 digital touchpoints across five essential stages of full-life-cycle noncommunicable disease management. Most experts acknowledged the rationality and feasibility of these touchpoints. This study led to the creation of a comprehensive digital health process mapping framework that encompasses the entire life cycle of noncommunicable disease management. The insights gained emphasize the importance of a systemic strategic, person-centered approach over a fragmented, purely technocentric approach. We recommend that healthcare professionals use this framework as a linchpin for efficient disease management and seamless technology incorporation in clinical practice.

Key stakeholder perceived value’s influence on autonomous vehicles’ privacy and security governance – an evolutionary analysis based on the prospect theory

Purpose The promotion of autonomous vehicles introduces privacy and security risks, underscoring the pressing need for responsible innovation implementation. To more effectively address the societal risks posed by autonomous vehicles, considering collaborative engagement of key stakeholders is essential. This study aims to provide insights into the governance of potential privacy and security issues in the innovation of autonomous driving technology by analyzing the micro-level decision-making processes of various stakeholders. Design/methodology/approach For this study, the authors use a nuanced approach, integrating key stakeholder theory, perceived value theory and prospect theory. The study constructs a model based on evolutionary game for the privacy and security governance mechanism of autonomous vehicles, involving enterprises, governments and consumers. Findings The governance of privacy and security in autonomous driving technology is influenced by key stakeholders’ decision-making behaviors and pivotal factors such as perceived value factors. The study finds that the governmental is influenced to a lesser extent by the decisions of other stakeholders, and factors such as risk preference coefficient, which contribute to perceived value, have a more significant influence than appearance factors like participation costs. Research limitations/implications This study lacks an investigation into the risk sensitivity of various stakeholders in different scenarios. Originality/value The study delineates the roles and behaviors of key stakeholders and contributes valuable insights toward addressing pertinent risk concerns within the governance of autonomous vehicles. Through the study, the practical application of Responsible Innovation theory has been enriched, addressing the shortcomings in the analysis of micro-level processes within the framework of evolutionary game.

AI implementation in the UK landscape: Knowledge of AI governance, perceived challenges and opportunities, and ways forward for radiographers

IntroductionDespite the rapid increase of AI-enabled applications deployed in clinical practice, many challenges exist around AI implementation, including the clarity of governance frameworks, usability of validation of AI models, and customisation of training for radiographers. This study aimed to explore the perceptions of diagnostic and therapeutic radiographers, with existing theoretical and/or practical knowledge of AI, on issues of relevance to the field, such as AI implementation, including knowledge of AI governance and procurement, perceptions about enablers and challenges and future priorities for AI adoption. MethodsAn online survey was designed and distributed to UK-based qualified radiographers who work in medical imaging and/or radiotherapy and have some previous theoretical and/or practical knowledge of working with AI. Participants were recruited through the researchers’ professional networks on social media with support from the AI advisory group of the Society and College of Radiographers. Survey questions related to AI training/education, knowledge of AI governance frameworks, data privacy procedures, AI implementation considerations, and priorities for AI adoption. Descriptive statistics were employed to analyse the data, and chi-square tests were used to explore significant relationships between variables. ResultsIn total, 88 valid responses were received. Most radiographers (56.6 %) had not received any AI-related training. Also, although approximately 63 % of them used an evaluation framework to assess AI models’ performance before implementation, many (36.9 %) were still unsure about suitable evaluation methods. Radiographers requested clearer guidance on AI governance, ample time to implement AI in their practice safely, adequate funding, effective leadership, and targeted support from AI champions. AI training, robust governance frameworks, and patient and public involvement were seen as priorities for the successful implementation of AI by radiographers. ConclusionAI implementation is progressing within radiography, but without customised training, clearer governance, key stakeholder engagement and suitable new roles created, it will be hard to harness its benefits and minimise related risks. Implications for practiceThe results of this study highlight some of the priorities and challenges for radiographers in relation to AI adoption, namely the need for developing robust AI governance frameworks and providing optimal AI training.

Strategic Human Resource Planning in the Era of Digital Transformation

Digital transformation has had a significant impact on business and human resource management (HR). This research explores "Strategic Human Resource Planning in the Era of Digital Transformation" through a systematic literature review. Key findings include deep technology integration, key stakeholder engagement, and an emphasis on developing employee skills and leadership as crucial elements in responsive HR planning. Organizations that successfully align HR planning with sustainable development goals also create broader positive impacts. Nonetheless, implementation challenges such as change resistance, technological uncertainty, and difficulty in predicting skills needs are a major focus. In conclusion, this research provides in-depth insights, highlights knowledge gaps, and details future research opportunities to help organizations navigate the changing dynamics of the digital era.

1953 Improving access to community palliative care by raising awareness of services, indications for referral and referral pathways

Abstract Introduction 40% of 1056 patients discharged from our acute geriatrics ward met Gold Standards Framework (GSF) Prognostic Indicator Guidance for Recognition of Patients approaching End of Life (EOL). 92% were not referred to Community Palliative Care (CPC) services, meaning patients’ needs were not fully met and other services over-stretched. This project aimed to achieve a 10% reduction in missed referrals. Methods Highlighting the missed referral rate enabled engagement of key stakeholders including ward and palliative care multidisciplinary teams. This 12-month project comprised four PDSA Cycles: 1. Raising awareness of GSF and CPC through ward-based teaching; 2. Development of posters outlining referral criteria and pathways; 3. Hospital-wide survey of doctors’ understanding of treating patients approaching EOL, with real-time feedback on GSF and CPC; 4. Formal departmental and year-group teaching sessions. The outcome measure was the percentage of patients meeting GSF criteria who were not referred to CPC, as determined by retrospective analysis of discharge letters. Readmission rate was calculated as a marker of quality of life (QoL) and to assess the impact of missed referrals on the Trust. Results Interventions led to a sustained reduction in missed referrals (72% from 92%). Certain diagnoses are more readily referred, metastatic malignancy for example, 9x more frequently than advanced Parkinson’s. Patients meeting criteria averaged 3 admissions in the preceding year (compared to 1.7). Of those meeting criteria and still alive, patients not referred averaged 1 re-admission within 6 months compared to 0.3 when referred. Conclusions Missed CPC referrals impact patient QoL and increase the burden on acute inpatient services. Significant benefits could be seen if these findings are extended to other inpatient wards. There is also a need for education about the palliative stage of non-malignant diseases such as Dementia and Parkinson’s. Future steps include technology-based active screening of inpatients to facilitate referrals.

"We're all truly pulling in the exact same direction": A qualitative study of attending and resident physician impressions of structured bedside interdisciplinary rounds.

Physicians often hold leadership roles in implementing interdisciplinary rounds (IDR) in clinical settings, thus understanding physician perspectives of bedside IDR is crucial. To understand physicians' perspectives of structured bedside IDR. Qualitative descriptive study. Medical and transitional year resident and hospitalist physicians participating in structured bedside IDR in a community teaching hospital affiliated with a large academic center. We conducted semi-structured interviews and focus groups with study participants about their experiences with participating in structured bedside IDR between July 2017 and April 2018. All interviews were recorded and professionally transcribed. We used thematic analysis to identify key themes. We interviewed 41 resident physicians and 10 hospitalist physicians and discovered five key themes that highlight physician impressions of bedside IDR. Bedside IDR decreased unnecessary care, screened for risks/errors, created a shared mental model of care, and increased physician empathy for the patient and the interprofessional care team. Physicians felt patients valued the streamlined communication they experienced but questioned the intrusiveness of large healthcare teams. Challenges to bedside IDR included the meaningful engagement of key stakeholders and, particularly for resident physicians, the difficultly of managing unstandardized communication in a standardized time-sensitive setting. Structured bedside IDR have the capacity to improve patient care, interprofessional teamwork, and physician empathy for patients and the interprofessional team. However, sustained leadership support and clearly defined rounds goals and objectives are necessary ingredients to maximize the benefits and address the challenges of bedside IDR.

Key interoperability Factors for patient portals and Electronic health Records: A scoping review

AimTo identify the key requirements and challenges to interoperability between patient portals and electronic health records (EHRs). IntroductionPatient portals provide patients with access to their health information directly from EHRs within hospitals, primary care centres and general practices (GPs). Patient portals offer many benefits to patients including improved communication with healthcare providers and care coordination. However, many challenges exist with the integration and automatic and secure sharing of information between EHRs and patient portals. It is critical that countries learn from international experiences to successfully develop interoperable national patient portals. MethodsA scoping review methodology was undertaken. A search strategy using index terms and keywords was applied across four key databases, an additional grey literature search was also run. The identified studies were screened by two reviewers to determine eligibility against defined inclusion criteria. Data were abstracted from the eligible studies and reviewed to identify the key requirements and challenges to interoperability of patient portals with EHRs. ResultsAfter screening 3,462 studies, 34 were included across 11 countries. Of the 29 unique patient portals studied, few offered patients access to their entire healthcare record across multiple sites and a number of different functionalities were available. Key interoperability requirements and challenges identified were: Data Sharing Incentives & Supports; Heterogenous Organisations & Information Systems; Data Storage & Management; Available Information & Functionalities; Data Formats & Standards; Identification of Individuals; User Access, Control & Consent; and Security & Privacy. ConclusionSeamless exchange of health information across patient portals and EHRs required organisational and individual factors, as well as technical considerations. Interorganisational collaboration and engagement of key stakeholders to determine standards and guidelines for consent and sharing of information, as well as technical standards and security measures were recommended.

Miras Destekli Yenileme Sürecinde Temel Paydaşların ve Fon Sağlayan Kurumların Katkıları: Lefkoşa Surlar İçi Örneği

The availability of and eligibility for funding, and the engagement of key stakeholders are important factors in the progress and outcomes of the heritage-led regeneration of cultural heritage. In Cyprus, in the Walled City of Nicosia, there has been an ongoing process of heritage-led regeneration since two decades. The island’s political issues have affected the regeneration process in different ways, especially as regards funding the conservation of cultural heritage. The main aim of this paper is to identify key funding bodies and resources in the conservation of cultural heritage, and to investigate their contributions through selected key stakeholders during the heritage-led regeneration process in the Walled City of Nicosia (northern part). The research adopts a case study approach and investigates these issues through 15 projects in the Selimiye Quarter because public space projects are dense in this area. The research reveals that implementation and management are two important factors in the success of the regeneration process and its outcomes.

Strategies for recruiting African Americans into aging research: The Health and Aging Brain Health Disparities (HABS‐HD) Study.

AbstractBackgroundDespite the increase in Alzheimer’s disease (AD) research among ethnic and racial minority populations, they are underrepresented in research and successful recruitment of diverse cohorts remains challenging. Culturally specific recruitment strategies and community engagement are needed to increase diverse participant enrollment in aging research. In 2020, we designed and implemented a strategy to recruit 1,000 African Americans (AA), 50 years and older into the Health & Aging Brain Study‐ Health Disparities (HABS‐HD) project. In this study, we examined the effectiveness of recruitment strategies among this group.MethodHABS‐HD is an epidemiological study of cognitive aging among diverse communities. The team recruited an initial cohort of 1,000 non‐Hispanic whites and 1,000 Mexican Americans using a community‐based approach. This foundation was expanded to reach the AA community through the engagement of key stakeholders and the use of an integrated marketing and outreach strategy. Recruitment methods included an integrated approach combining traditional marketing (print, radio); social media (influencers and online ads), and in person community recruitment and education events at local churches, barbershops, health fairs, etc. The reach and enrollment data were collected and analyzed.ResultOut of 4066 participants that were interested in HABS‐HD, 1362 (33.5%) identified as AA. While recruiting the AA cohort outreach team participated in over 140 community events, ranging from state fairs, barbershops, and church events. Enrollment data indicated participants heard of us through word of mouth (35%); community events (21.6%); news (12.7%); refer a friend program (6.8%); print media (6.4%) radio (4%); and social media (3.6%). In terms of traditional marketing and overall general study awareness, the social media approach reached 179,200 individuals. Of this number12.1% of people interacted with the landing site and then a further 747 clicked to sign up. The reach of our radio advertising was 2,200,000 listeners.ConclusionRecruiting diverse communities into research involves targeting the recruitment techniques and materials to the target population. The creation of a culturally appropriate media campaign and utilizing community based methods such as outreach, engagement, and collaboration between the research team and key stakeholders in the community led to the successful recruitment of AA into our study.

How to Successfully Engage a Community in Road Safety

Lack of community engagement in road safety issues has been a difficult barrier to achieving greater road safety outcomes. In this project, our aim was to develop a road safety campaign that humanises cyclists. We devised a four-step approach to develop and implement the campaign to engage the community and achieve positive outcomes. The four steps were: 1) key stakeholder engagement, 2) community consultation, 3) campaign creation and delivery and, 4) evaluation. As this project was conducted in 2020/2021, we address how we managed disruptions caused by COVID-19. Key findings show the campaign was successful and increased understanding of safe behaviours and positive influence on attitudes about cyclists. The frameworks used for this project are provided and while the insights from this project apply to cyclist safety, the steps can be applied to improve collaborative projects to include community engagement in any area of road safety.

Pathways to community living in practice: Local development and adaptation within an older peoples mental health service

Objective To describe the local adaptation of the Pathways to Community Living (PCLI) program in an Older Peoples Mental Health (OPMH) service to guide other services. Method A retrospective observational study was conducted. Data were obtained from service planning meetings and newly developed documents, Clinical Advisory Committee meetings, and OPMH PCLI database. Results The PCLI program was adapted for the local OPMH service through development of an assessment template, creating a Memorandum of Understanding with a partner Residential Aged Care Facility (RACF) and establishing processes for collaboration and regular review. Between 2019 and March 2023, 20 mental health consumers were referred to the OPMH PCLI program. Their demographic and clinical characteristics are described. Conclusions Adaptation of the PCLI program for OPMH consumers required consideration of specific older adult needs to develop a bespoke plan for assessment and partnership with the PCLI-funded RACF. The development phase and ongoing processes for review facilitated engagement of key stakeholders across health and RACF sectors, highlighting issues with consumer engagement. Similar models could be used by other health services to implement the PCLI in their local context.

Stakeholder perspectives on the Kisoboka intervention: A behavioral and structural intervention to reduce hazardous alcohol use and improve HIV care engagement among men living with HIV in Ugandan fishing communities

BackgroundEast Africa’s fishing communities experience a high burden of two interrelated and frequently co-occurring health issues: HIV and hazardous alcohol use. Nearly two-thirds of Ugandan fisherfolk men meet the criteria for harmful alcohol use. We developed a multilevel intervention to reduce hazardous alcohol use and improve HIV care engagement among fisherfolk men living with HIV (LWHIV) in Wakiso district, Uganda. MethodsThis is a qualitative study of stakeholder perspectives on the appropriateness, acceptability, and feasibility of a multilevel intervention for fisherfolk men LWHIV. The proposed intervention, Kisoboka (“It is possible!”), combines a structural component [changing the mode of work payments from cash to mobile money] with a behavioral component [motivational interviewing-based counseling combined with content using behavioral economic principles to promote behavior change]. We conducted one focus group (n=7) and eight in-depth interviews with fisherfolk men LWHIV and 19 key informant (KI) interviews with health workers, employers, and community leaders. These explored the appropriateness, acceptability, and feasibility of specific key intervention components. ResultsOverall, stakeholders' perspectives supported high intervention acceptability and perceived appropriateness of the proposed intervention. It was perceived to be feasible with some caveats of recommendations for overcoming potential implementation challenges identified (e.g., having a friend assist with documenting savings and alcohol use if an individual was unable to write themselves) which are discussed. ConclusionThis work highlights the potential of the Kisoboka intervention and the importance of early engagement of key stakeholders in the intervention development process to ensure appropriateness, acceptability, feasibility, and socio-cultural fit.

Virtual Multidisciplinary Rounds to Reduce Length of Stay, Decrease Variation, and Promote Accountability.

Evidence suggests in-person multidisciplinary rounds can help reduce length of stay (LOS) and improve throughput, but there are limited studies about the effectiveness of virtual multidisciplinary rounds on these measures. The authors hypothesized that virtual multidisciplinary rounds could help reduce LOS, improve throughput, promote accountability, and reduce provider variation. The research team designed and implemented virtual multidisciplinary rounds by a phone conference call with key stakeholders, including hospitalists, case managers, the clinical documentation improvement team, physical and occupational therapy, and nursing leaders. To track progress in real time, dashboards were created using data from electronic medical records. After several months, unit-based discharge huddles were also implemented to supplement the process and sustain the improvement. The interventions led to more than 60% of discharges below geometric mean LOS after starting the initiative, compared to approximately 52% before the initiative. Mean observation hours went from around 44 hours to 31.9 hours, and the change was sustained for more than a year. In fiscal year 2021, 3,813 excess days were reduced in 10 months, resulting in combined savings of $6.7 million. A decrease in hospitalist provider variation is noted with the initiative, which is a crucial contributor to the results. Virtual multidisciplinary rounds combined with other interventions can effectively reduce LOS and observation hours. Decreasing variation among hospitalists and improved key stakeholder engagement can be achieved with virtual multidisciplinary rounds. More studies to test the effectiveness of virtual multidisciplinary rounds in various patient care settings would provide more insights.

Development and piloting of a primary school-based salt reduction programme: Formative work and a process evaluation in rural and urban Malawi.

Excess salt intake is a major modifiable risk factor for cardiovascular disease. Promoting salt reduction as part of routine school-health programming may be a pragmatic way to address this risk factor early in the life course but has not been tested in sub-Saharan Africa (SSA). Here we describe the formative work with stakeholders and process evaluation of pilot work to develop a school-based salt reduction programme for children aged 11-14 years, in preparation for a cluster-randomised trial in rural/urban Malawi. Collection of observational data and documentary evidence (meeting minutes/field notes) from the earliest key stakeholder engagement with Malawi Ministries of Health, Education, Local Government and Rural Development and Malawi Institute of Education, and non-governmental stakeholders; and a series of semi-structured interviews and focus groups (with head teachers (n = 2); teachers (n = 4); parents (n = 30); and learners (n = 40)). Data was analysed thematically and conceptualised through a Normalization Process Theory lens. Formative work illustrated a range of administrative, technical, and practical issues faced during development of the programme; including allocation of stakeholder roles and responsibilities, harmonisation with pre-existing strategies and competing priorities, resources required for programme development, and design of effective teaching materials. While participants were positive about the programme, the process evaluation identified features to be refined including perceived challenges to participation, recommended adaptations to the content and delivery of lessons, and concerns related to quantity/quality of learning resources provided. This study demonstrates the importance of comprehensive, sustained, and participatory stakeholder engagement in the development of a novel school health programme in SSA; and highlights the factors that were critical to successfully achieving this. We also demonstrate the value of detailed process evaluation in informing development of the programme to ensure that it was feasible and relevant to the context prior to evaluation through a cluster-randomised trial.

Extending the vision of adaptive point-of-care platform trials to improve targeted use of drug therapy regimens: An agile approach in the learning healthcare system toolkit

ObjectivesImproving the targeted use of drug regimens requires robust real-world evidence (RWE) to address the uncertainties that remain regarding their real-world performance following market entry. However, challenges in the current state of RWE production limit its impact on clinical decisions, as well as its operational scalability and sustainability. We propose an adaptive point-of-care (APoC) platform trial as an approach to RWE production that improves both clinical and operational efficiencies. Methods and findingsWe explored design innovations, operational challenges, and infrastructure needs within a multi-stakeholder consortium to evaluate the potential of an APoC platform trial for studying chronic disease treatment regimens using rheumatoid arthritis as a case study. The concept integrates elements from adaptive clinical trials (dynamic treatment regimen strategies) and point-of-care trials (research embedded into routine clinical care) under a perpetual platform infrastructure. The necessary components to implement an APoC platform trial within outpatient settings exist, and present an opportunity for a cross-disciplinary, multi-stakeholder approach. Effective engagement of key stakeholders involved in and impacted by the platform is critical to success. Our collaborative design process identified three high-impact stakeholder-engagement areas: (1) focus on research question(s), (2) design and implementation planning such that it is feasible and fit-for-purpose, and (3) measurement, or meaningful metrics for both clinical (patient outcomes) and system (operational efficiencies) impact. ConclusionsAn APoC platform trial for rheumatoid arthritis integrating innovative design elements in a scalable infrastructure has the potential to reduce important uncertainties about the real-world performance of biomedical innovations and improve clinical decisions.

Preventing Medical Device-Related Pressure Injuries

Pressure injuries (PIs) are a common, yet preventable complication of patient care. 1 Dang W Liu Y Zhou Q et al. Risk factors of medical device-related pressure injury in intensive care units. J Clin Nurs. 2022; 31: 1174-1183https://doi.org/10.1111/jocn.15974 Crossref Scopus (14) Google Scholar ,2 Hajhosseini B Longaker MT Gurtner GC Pressure injury. Ann Surg. 2020; 271: 671-679https://doi.org/10.1097/sla.0000000000003567 Crossref PubMed Scopus (0) Google Scholar Regulatory, quality, and health care bodies view the frequency of hospital-acquired pressure injuries (HAPIs) as indicative of the quality of nursing care and take the issue of HAPIs very seriously in terms of patient safety. 3 Pittman J Otts JA Riley B Mulekar MS Pressure injury prevention and management: a gap analysis using key stakeholder engagement. J Wound Ostomy Continence Nurs. 2022; 49: 416-427https://doi.org/10.1097/WON.0000000000000906 Crossref Scopus (0) Google Scholar Every year, approximately 2.5 million people develop HAPIs, and approximately 60,000 people die as a result of these injuries. 3 Pittman J Otts JA Riley B Mulekar MS Pressure injury prevention and management: a gap analysis using key stakeholder engagement. J Wound Ostomy Continence Nurs. 2022; 49: 416-427https://doi.org/10.1097/WON.0000000000000906 Crossref Scopus (0) Google Scholar ,4 Padula WV Delarmente BA The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019; 16: 634-640https://doi.org/10.1111/iwj.13071 Crossref PubMed Scopus (207) Google Scholar The total cost of HAPI care per patient ranges from $29,900 to $151,700, resulting in an estimated annual cost of $26.8 billion. 3 Pittman J Otts JA Riley B Mulekar MS Pressure injury prevention and management: a gap analysis using key stakeholder engagement. J Wound Ostomy Continence Nurs. 2022; 49: 416-427https://doi.org/10.1097/WON.0000000000000906 Crossref Scopus (0) Google Scholar ,5 Tschannen D Anderson C The pressure injury predictive model: a framework for hospital-acquired pressure injuries. J Clin Nurs. 2020; 29: 1398-1421https://doi.org/10.1111/jocn.15171 Crossref Scopus (14) Google Scholar Despite the introduction of new technology and HAPI prevention strategies, the occurrence of HAPI is still on the rise. 2 Hajhosseini B Longaker MT Gurtner GC Pressure injury. Ann Surg. 2020; 271: 671-679https://doi.org/10.1097/sla.0000000000003567 Crossref PubMed Scopus (0) Google Scholar ,3 Pittman J Otts JA Riley B Mulekar MS Pressure injury prevention and management: a gap analysis using key stakeholder engagement. J Wound Ostomy Continence Nurs. 2022; 49: 416-427https://doi.org/10.1097/WON.0000000000000906 Crossref Scopus (0) Google Scholar People suffering from this injury can experience severe discomfort, a decrease in their overall quality of life, reduced activity, decreased productivity, social alienation, depression, and increased length of stay. 2 Hajhosseini B Longaker MT Gurtner GC Pressure injury. Ann Surg. 2020; 271: 671-679https://doi.org/10.1097/sla.0000000000003567 Crossref PubMed Scopus (0) Google Scholar

Early Feasibility Lessons: A Pilot Randomized Trial of Amnioinfusion as a Novel Indication for Intrapartum Neuroprotection [ID: 1374128

INTRODUCTION: Developing evidence-based management strategies to decrease maternal/neonatal morbidity in labor is essential. However, the barriers/facilitators to executing these trials are underreported. Our objective is to present early feasibility lessons learned after the rollout of a pilot randomized control trial examining amnioinfusion as a novel indication for intrapartum neuroprotection. METHODS: Our pilot randomized control trial began recruiting patients in July of 2022. In the first 3 months of our pilot, we followed the Plan, Do, Check, Act (PDCA) cycle to identify barriers and facilitators as a part of our feasibility aim. The PDCA cycle was executed by the primary research team and began with the first patient to be successfully consented and randomized. The barriers and facilitator were tracked by key study personnel and addressed at the weekly research meetings. Using this cycle, we developed the study protocol before widespread recruitment was initiated. RESULTS: We identified several barriers including 1) challenging acute and emergent clinical situations inherent to intrapartum care; 2) lack of provider/patient acceptability for novel indication of amnioinfusion; 3) monitoring for the development of intrapartum risk factors, and 4) unanticipated hospital system processes. We implemented several facilitators in direct response to these barriers for the pilot feasibility trial including 1) identification and presence of a research champion on labor and delivery to build rapport with staff and participants; 2) continuous education of the novel therapy; 3) incentivization of care team and participants; and 4) engagement of key stakeholders. CONCLUSION: Using a PDCA was invaluable. We identified several barriers and facilitators to be considered when designing/implementing future randomized trials intrapartum, particularly when studying novel indications of therapy.

Measuring the Effectiveness of Food Policy Councils in Major Cities in the United States.

The United States food system is comprised of a diversity of stakeholders representing a range of sectors including agriculture, health, hospitality, and other sectors of the economy. Coordinating these wide-ranging aspects of the food system is a challenging responsibility of the United States Department of Agriculture (USDA) and its counterparts at the state and county level. While the USDA acknowledges the institutional importance of diversity, it has only recently begun to meaningfully consider the agricultural needs of urban environments, the unique experiences from communities of color, and opportunities for urban agriculture in its purview. This study provides a framework for food systems leaders, specifically in food policy councils (FPCs) in large urban communities, to assess the visibility and effectiveness of their diversity and inclusion initiatives represented across three key domains: (1) leadership and governance structures, (2) key stakeholder engagement strategies, and (3) advance food justice. A cluster analysis of the study results for FPCs in 19 U.S. cities and metropolitan areas across these three domains revealed four distinct groups of food policy councils. Results from the assessment of the urban FPCs reveal that they succeed in embedding diversity and inclusion in all three diversity measures, with key stakeholder engagement receiving the highest score at 73%. On average, FPCs received a score of 54% when assessing diversity and inclusion in their leadership and governance and a score of 49% in their activities to advance food justice. Results of the analysis also highlights opportunities to improve individual, thematic, and cumulative scores. Participation from food systems leadership groups such as food policy councils will be vital in advocating for equitable food systems through urban producer and consumer programs in the upcoming reauthorization of the U.S. farm bill in 2024.

Protocol for a realist and social return on investment evaluation of the use of patient-reported outcomes in four value-based healthcare programmes

IntroductionThere is growing recognition that in order to remain sustainable, the UK’s National Health Service must deliver the best patient outcomes within available resources. This focus on outcomes relative to...

Designing and evaluating a smartphone app to increase underserved communities’ data representation in transportation policy and planning

The current global focus on transportation equity, as well as a move towards smart mobility, highlights the need for more representative transportation data to inform transportation planning. In this case study, an interdisciplinary research team describes the process of refining and evaluating the utility of a transportation daily diary mobile-phone-based app. The process is framed through transportation equity and diverse key stakeholder engagement. The team custom-designed the app, MyAmble, to capture successful transportation behaviors, as well as latent demand, defined as travel not taken but desired, among underserved populations. Stakeholder focus groups with subject matter expert (n = 30) and end users (n = 19) were conducted prior to pilot testing the app, and post-pilot test focus groups (n = 18) and usability surveys (n = 76) were conducted to evaluate the app’s usability. Pre-pilot focus groups indicated that transportation planners desired more questions about safety and other transit modes. End users identified missing destinations, such as temporary housing locations. Post-pilot focus group members reported that using MyAmble required minimal training or technological assistance and that they had sustained confidence throughout usage. Further refinements include reducing length of daily use and resolving Broadband or data plan obstacles for end users. Designing transportation apps to collect data about transportation behaviors among underserved population members is critical to equitable transportation planning. Moreover, key stakeholder involvement in the design may produce more successful apps and those which include more relevant information for planners, as well as more inclusive travel behaviors.