Model Of Care For Patients Research Articles

Mobile Monitoring-Enabled Telehealth for Patients with Complex Chronic Illnesses.

Telehealth has the potential to improve management of poorly controlled chronic diseases relative to clinic-based care alone. Mobile monitoring-enabled technologies could enhance telehealth for chronic illness care. Implementation in practice settings would rely on automated integration of data into the electronic health record (EHR). We describe the integration and visualization of data from four remote monitoring devices into the EHR that is coupled with the evaluation of an evidence-based nurse and pharmacist-led telehealth care model for patients with uncontrolled diabetes and hypertension. Using this new pragmatic infrastructure, clinicians use the EHR to prescribe for patients a suite of devices. Alerts are placed upon the data that notify a clinician when values go above or below set thresholds. These data are visualized in the clinical record and clinicians use the EHR as a tool for efficiently delivering and documenting patient telehealth encounters.

Care models for patients with heart failure at home: A systematic review.

The aim of this study is to evaluate the relative merits of various heart failure models of care with regard to a variety of outcomes. Systematic review. Five databases including PubMed, Web of Science, Medline, Embase and Science Direct were searched from the inception date of databases to August 20, 2022. This review used the Cochrane Collaboration's 'Risk of Bias' tool to assess quality. Only randomised controlled trails were included in this review that assessed all care models in the management of adults with heart failure. A categorical summary of the pattern of the papers was found, followed by extraction of outcome indicators. Twenty articles (19 studies) were included. Seven examined nurse-led care, two examined multidisciplinary specialist care, nine (10 articles) examined patient self-management, and one examined nurse and physiotherapist co-led care. Regarding outcomes, this review examined how well the four models performed with regard to quality of life, health services use, HF self-care, and anxiety and depression for heart failure patients. The model of patient self-management showed more beneficial results than nurse-led care, multidisciplinary specialist care, and nurse and physiotherapist co-led care in reducing hospital days, improving symptoms, promoting self-care behaviours of HF patients, enhancing the quality of life, and strengthening self-care ability. This systematic review synthesises the different care models and their relative effectiveness. Four different models of care were summarised. Of these models, the self-management model demonstrated better outcomes. The self-management model is more effective in increasing self-management behaviours and self-management abilities, lowering the risk of hospitalisation and death, improving quality of life, and relieving anxiety and depression than other models. There was no funding to remunerate a patient/member of the public for this review.

Limited English Proficiency and Sepsis Mortality by Race and Ethnicity

Patients with limited English proficiency (LEP) face multiple barriers and are at risk for worse health outcomes compared with patients with English proficiency (EP). In sepsis, a major cause of mortality in the US, the association of LEP with health outcomes is not widely explored. To assess the association between LEP and inpatient mortality among patients with sepsis and test the hypothesis that LEP would be associated with higher mortality rates. This retrospective cohort study of hospitalized patients with sepsis included those who met the Centers for Disease Control and Prevention's sepsis criteria, received antibiotics within 24 hours, and were admitted through the emergency department. Data were collected from the electronic medical records of a large New England tertiary care center from January 1, 2016, to December 31, 2019. Data were analyzed from January 8, 2021, to March 2, 2023. Limited English proficiency, gathered via self-reported language preference in electronic medical records. The primary outcome was inpatient mortality. The analysis used multivariable generalized estimating equation models with propensity score adjustment and analysis of covariance to analyze the association between LEP and inpatient mortality due to sepsis. A total of 2709 patients met the inclusion criteria, with a mean (SD) age of 65.0 (16.2) years; 1523 (56.2%) were men and 327 (12.1%) had LEP. Nine patients (0.3%) were American Indian or Alaska Native, 101 (3.7%) were Asian, 314 (11.6%) were Black, 226 (8.3%) were Hispanic, 38 (1.4%) were Native Hawaiian or Other Pacific Islander or of other race or ethnicity, 1968 (72.6%) were White, and 6 (0.2%) were multiracial. Unadjusted mortality included 466 of 2382 patients with EP (19.6%) and 69 of 327 with LEP (21.1%). No significant difference was found in mortality odds for the LEP compared with EP groups (odds ratio [OR], 1.12 [95% CI, 0.88-1.42]). When stratified by race and ethnicity, odds of inpatient mortality for patients with LEP were significantly higher among the non-Hispanic White subgroup (OR, 1.76 [95% CI, 1.41-2.21]). This significant difference was also present in adjusted analyses (adjusted OR, 1.56 [95% CI, 1.02-2.39]). No significant differences were found in inpatient mortality between LEP and EP in the racial and ethnic minority subgroup (OR, 0.99 [95% CI, 0.63-1.58]; adjusted OR, 0.91 [95% CI, 0.56-1.48]). In a large diverse academic medical center, LEP had no significant association overall with sepsis mortality. In a subgroup analysis, LEP was associated with increased mortality among individuals identifying as non-Hispanic White. This finding highlights a potential language-based inequity in sepsis care. Further studies are needed to understand drivers of this inequity, how it may manifest in other diverse health systems, and to inform equitable care models for patients with LEP.

Applications to augment patient care for Internal Medicine specialists: a position paper from the EFIM working group on telemedicine, innovative technologies & digital health.

Telemedicine applications present virtually limitless prospects for innovating and enhancing established and new models of patient care in the field of Internal Medicine. Although there is a wide range of innovative technological solutions in Europe, there are overarching elements associated with such technologies when applied to the practices of Internal Medicine specialists. The European Federation of Internal Medicine (EFIM) strongly advocates for active leadership and influence from the Internal Medicine societies and specialist physicians across Europe in the development and application of telemedicine and digital technologies in healthcare. This position paper's conclusions were drawn via Delphi method, which was developed collaboratively from July 2021 to December 2023. The panel, consisting of experts in clinical medicine, public health, health economics and statistics, assessed various aspects related to telemedicine. Participants assigned scores on a Likert scale reflecting perceived value and potential risks. The findings were consolidated in a comprehensive checklist aligning with relevant literature and a SWOT analysis. Specifically, key issues that need to be addressed include promoting the professional development of e-health competencies in the healthcare and medical workforce, using educational campaigns to promote digital literacy among patients and caregivers, designing and implementing telemedicine applications tailored to local conditions and needs and considering the ethical and legal contexts under which these applications are employed. Importantly, there is currently no consensus on care models or standardized protocols among European Internal Medicine specialists regarding the utilization of telemedicine. This position paper aims to outline the opportunities and challenges associated with the application of telemedicine in Internal Medical practice in Europe.

Research on the Application of Exercise-based Psychological Care Model in Patients with Gynecological Malignant Tumors

Research on the Application of Exercise-based Psychological Care Model in Patients with Gynecological Malignant Tumors

Prehabilitation and its Outcomes in Cancer Patients: A Narrative Review

Abstract Prehabilitation is a multidisciplinary health enhancement programme offered before a disease intervention, such as surgery or chemotherapy/radiotherapy. It is a holistic patient care model that focuses on providing nutritional, psychological and functional care to patients before their intervention. Researchers have found that prehabilitation can improve patient outcomes by preparing for a surgery-associated physiological challenge. While studies have been limited, prehabilitation remains a promising strategy for cancer surgery with potential benefits such as improved outcomes, early recovery and lower hospital stay. The concept of prehabilitation has been growing rapidly, and it aims to enhance a patient’s overall health and well-being before surgery or other therapeutic interventions. Prehabilitation can be a valuable tool for cancer patients, providing advantages such as improved outcomes, early recovery and reduced hospital stay after surgery. However, more evidence is needed to support the effectiveness of prehabilitation. This review paper provides an overview of current knowledge and results of studies on the role of prehabilitation in cancer surgery, highlighting the positive effects of prehabilitation on physical performance, nutritional status, quality of life and sometimes reduced morbidity. Allied interventions, such as cardiac and pulmonary rehabilitation, can also provide valuable lessons for prehabilitation in practice. This comprehensive review provides a well-structured and informative presentation, ensuring clarity and ease of understanding for a technical audience. The technical details are well-supported by appropriate references, ensuring accuracy and credibility. Overall, the paper is a thorough and informative review of prehabilitation in cancer patients, outlining key concepts and evidence and providing insights for future research and practice.

Development and evaluation of sex-specific thoracolumbar spine finite element models to study spine biomechanics.

Musculoskeletal disorders and low back pain (LBP) are common global afflictions, with a higher prevalence observed in females. However, the cause of many LBP cases continues to elude researchers. Current approaches seldom consider differences in male and female spines. Thus, this study aimed to compare the load distribution between male and female spines through finite element modeling. Two finite element models of the spine, one male and one female, were developed, inclusive of sex-specific geometry and material properties. The models consisted of the vertebrae, intervertebral discs (IVD), tendons, surrounding spinal muscles, and thoracolumbar fascia and were subjected to loading conditions simulating flexion and extension. Following extensive validation against published literature, intersegmental rotation, IVD stress, and vertebral body stress were evaluated. The female model demonstrated increased magnitudes for rotation and stresses when compared to the male model. Results suggest that the augmented stresses in the female model indicate an increased load distribution throughout the spine compared to the male model. These findings may corroborate the higher prevalence of LBP in females. This study highlights the importance of using patient- and sex-specific models for patient analyses and care.

Care Delivery Interventions for Individuals with Cancer: A Literature Review and Focus on Gastrointestinal Malignancies.

Gastrointestinal malignancies represent a particularly challenging condition, often requiring a multidisciplinary approach to management in order to meet the unique needs of these individuals and their caregivers. In this literature review, we sought to describe care delivery interventions that strive to improve the quality of life and care for patients with a focus on gastrointestinal malignancies. We highlight patient-centered care delivery interventions, including patient-reported outcomes, hospital-at-home interventions, and other models of care for individuals with cancer. By demonstrating the relevance and utility of these different care models for patients with gastrointestinal malignancies, we hope to highlight the importance of developing and testing new interventions to address the unique needs of this population.

Remission with or without comorbid substance use disorders in early psychosis: long-term outcome in integrated care (ACCESS III study).

Schizophrenia-Spectrum-Disorders are associated with poor long-term outcome as well as disability and often severely affect the lives of patients and their families often from symptom onset. Up to 70% of first episode psychosis (FEP) patients suffer from comorbid substance use disorders (SUD). We aimed at studying the course of illness in FEP patients within evidence-based care, with and without comorbid SUD, to examine how decreased, remitted or persistent substance use impacted rates of a combined symptomatic and functional long-term recovery compared with patients without SUD. ACCESS III is an integrated care model for FEP or patients in the early phase of non-affective and affective psychotic disorders. Treatment trajectories of patients, who had been in ACCESS care for 1 year, with and without SUD were compared with regard to the course of illness and quality of life using Mixed Model Repeated Measures (MMRM) and recovery rates were compared using binary logistic regression. Change in substance use was coded as either persistent, decreased/remitted or no use. ACCESS III was a prospective 1-year study (N = 120) in patients aged 12-29 years. Of these, 74 (61.6%) had a comorbid SUD at admission. There were no group differences regarding the course of illness between patients with or without comorbid SUD or between patients with a substance abuse or substance dependence. The only outcome parameter that was affected by SUD was quality of life, with larger improvement found in the group without substance use (p = 0.05) compared to persistent and remitted users. Using LOCF, 44 patients (48.9%) fulfilled recovery criteria at the endpoint; recovery did not differ based on substance use status. SUD and especially substance dependence are common in psychotic disorders even in FEP patients. Evidence-based integrated care led to long-term improvement in patients with comorbid SUD and rate of recovery did not differ for patients with substance use.

Model development of patient\'s dental and oral health care in raden mattaher hospital, Jambi Province

Dental and oral health care is the primary role and authority of the Dental and Oral Therapist. This study aims to develop a dental and oral health care model for patients in the dental polyclinic of Raden Mattaher Hospital. This quantitative study used an applied research design to develop a model of dental and oral health care. Eleven dental nurses were involved as informants, and three dentists as key informants. This research was conducted at the dental polyclinic of the Jambi Provincial Hospital from March to November 2022. The data were obtained through interviews, focus group discussions (FGD), observations, and trials of the draft model of the patient's dental health examination. Furthermore, a trial of the dental health care model was carried out on people with a mental health conditions. The total score on the questionnaire results of the HELISIDI dental and oral health care model was 546, with a presentation of 76% based on the eligibility criteria. These results mean that the HELISIDI Model is eligible but with revisions. The total score for the HELISIDI dental and oral health care status card was 546, with a presentation of 87% based on the eligibility criteria. According to the respondent, the HELISIDI Status Card is eligible but with revisions. After revision, the model and the HELISIDI status card were declared eligible without further revision. The model of dental and oral health care for patients at the dental clinic of Raden Mattaher Hospital is suitable for mental patients.

When I Don't see me, Am I seen? Race and student perception of the surgery clerkship

IntroductionIncreasing interest in general surgery from students who are Under-Represented in Medicine (URiM) is imperative to advancing diversity, equity, and inclusion efforts. We examined medical student third year surgery clerkship evaluations quantitatively and qualitatively to understand the experiences of URiM and non-URiM learners at our institution. MethodsEvaluations from 235 graduated medical students between the years of 2019 and 2021 were analyzed. T-tests were used to compare numerical data. Free-text comments were qualitatively analyzed using inductive thematic analysis by two independent reviewers with conflicts resolved by a third. ResultsEvaluations were completed by 214 non-URiM students (91.1 ​%) and 21 (8.9 ​%) URiM students. There were no significant differences between URiM and non-URiM students in ratings of faculty and resident teaching. When asked whether residents were positive role models for patient care, non-URiM students were more likely than URiM students to agree (3.284 vs. 2.864, p ​= ​0.040). When asked whether they considered faculty to be positive role models, non- URM students were also more likely to answer affirmatively than URiM students (3.394 vs. 2.909 p ​= ​0.013). Qualitative comments were similar between the two groups. When asked what the strengths of the clerkship were, the most commonly evoked theme was “interactions with team” with subthemes of “team integration” “feeling valued” and positive “faculty” or “resident” interactions. “Operative experience” was the second most commonly evoked strength of the clerkship. The most common criticisms of the clerkship involved “negative interactions with team” with subthemes of “not prioritized above other learners” and “ignored.” Negative “academic experience” was the next most commonly evoked weakness, with an affiliated theme of “lack of teaching.” ConclusionsURiM students are less likely than non-URiM students to see surgical residents and faculty as positive role models. Integrating medical students into the team, taking time to teach, and allowing students to feel valued in their roles improves the clerkship experience for trainees and can contribute to recruitment efforts.

Assessing health-related quality of life among cancer survivors during systemic and radiation therapy in Bangladesh: a cancer-specific exploration

BackgroundEvaluating the effects of cancer diagnosis and treatment on a patient’s overall well-being is crucial and health-related quality of life (HRQoL) is a reliable metric for assessing this impact. Little is known about HRQoL among cancer survivors across various stages and treatments. The study examined individual and clinical factors influencing HRQoL among cancer survivors.MethodsA cross-sectional study was conducted in two specialised cancer care hospitals in Dhaka, Bangladesh. Cancer-diagnosed adults receiving treatment at selected hospitals from January to May 2022 were enrolled. The 5-level EuroQol-5 Dimensions version (EQ-5D-5L) instrument was used to collect HRQoL data. HRQoL scores were derived using UK value sets. The investigation used a multivariable Tobit regression model to determine the association between independent variables and HRQoL scores.ResultsA total of 607 adult patients were enrolled, with 55% being females and 66% aged 36 to 64 years. Reported health problems in five EQ-5D domains include mobility (11%), self-care (11%), usual daily activities (19%), pain/discomfort (21%), and anxiety/depression (46%). Patients with throat, brain, lung, blood, and liver cancer had lower utility scores. Advanced-stage cancer survivors had lower utility scores (β = -49 units, 95% codfidence interval [CI]: -0.75 to -0.22) compared to early-stage survivors. Physically inactive survivors had lower utility scores by 0.41 units (95% CI: -0.51 to -0.30) compared to their counterparts. Private hospital patients had higher utility scores, whereas patients belonged to poor socioeconomic groups scored worse than wealthier ones.ConclusionsThis study highlights the impact of clinical and individual characteristics on HRQoL among cancer survivors. These findings advocate for an enhanced Bangladeshi cancer patient care model through timely interventions or programs, early detection or diagnosis, tailored treatments, and the promotion of physical activity to bolster HRQoL outcomes.

Innovative solutions for disease management

The increasing prevalence of chronic diseases is a driver for emerging big data technologies for healthcare including digital platforms for data collection, systems for active patient engagement and education, therapy specific predictive models, optimized patient pathway models. Powerful bioelectronic medicine tools for data collection, analysis and visualization allow for joint processing of large volumes of heterogeneous data, which in turn can produce new insights about patient outcomes and alternative interpretations of clinical patterns that can lead to implementation of optimized clinical decisions and clinical patient pathway by healthcare professionals.With this perspective, we identify innovative solutions for disease management and evaluate their impact on patients, payers and society, by analyzing their impact in terms of clinical outcomes (effectiveness, safety, and quality of life) and economic outcomes (cost-effectiveness, savings, and productivity).As a result, we propose a new approach based on the main pillars of innovation in the disease management area, i.e. progressive patient care models, patient-centric approaches, bioelectronics for precise medicine, and lean management that, combined with an increase in appropriate private-public-citizen-partnership, leads towards Patient-Centric Healthcare.

A unit’s experience with hybrid NICU design: description of care model and implications for patients, families, and professionals

A unit’s experience with hybrid NICU design: description of care model and implications for patients, families, and professionals

Panel Interview of Oncology Practices with Emergent Experience of Teclistamab in the Real World: The Tec-Pioneer Study

Background Teclistamab was recently approved as the first-in-class B-cell maturation antigen (BCMA) x CD3 bispecific therapy with personalized weight-based dosing for relapsed or refractory multiple myeloma (MM). Given its novelty, there are immediate needs for data based on real-world (RW) practices to optimize operational processes and improve experiences while ensuring patient safety in the RW. The aims of this study were to describe how US clinicians with early RW experience with teclistamab (1) manage the step-up dosing (SUD) and transition of care (ToC) to and from referring sites; (2) monitor, manage, and prevent adverse events (AEs), i.e., cytokine release syndrome (CRS), infections, and immune effector cell-associated neurotoxicity syndrome (ICANS); and (3) perceive desired future care models for optimal patient care. Methods Between April and July 2023, 60-minute, 1-on-1 in-depth structured interviews were conducted virtually with hematologists and oncologists who had treated patients with teclistamab in a RW setting. Interviews elicited clinicians' current SUD and ToC processes in their practices, AE management, and perspectives on SUD model evolution. A subsequent 90-minute roundtable discussion was held in June 2023 to discuss interview findings. Results A total of 20 clinicians representing 19 practices across 14 states completed interviews: 84% (16/19 practices) treated >50 patients with MM monthly, 69% had treated >10 patients with teclistamab, and 90% were academic medical centers. Of these interviewees, 10 participated in the roundtable discussion, joined by 3 community clinicians without teclistamab experience. Among the 19 interviewed practices, 14 (74%) were administering SUD exclusively in inpatient settings. This was being done predominantly (86%; 12/14) in 1 continuous admission with a planned length of stay of 7 days, and with 71% (10/14) following a day 1-3-5 dosing schedule. Five practices reported using outpatient models (Figure 1). The sophistication of outpatient models varied and depended on multiple factors at the practice level, including prior outpatient cellular therapy experience, staffing/facility structure, patient volume, and outpatient monitoring capability. Most (95%) of the interviewed practices initiated teclistamab for patients referred from community practices; 53% transferred at least 1 patient back to a referring practice to continue teclistamab. The time to transfer ranged from 2 weeks to 2 months to (1) ensure that patients were responding to and tolerating treatment prior to transfer and (2) recover any financial loss from inpatient SUD. Community clinicians preferred to resume care of their patients once patients were deemed clinically stable. More than half (68%) of practices reported leveraging existing CAR-T protocols for AE monitoring and management. Patients were typically monitored for CRS every 4 hours for vital signs and daily for complete blood count, comprehensive metabolic panel, C-reactive protein, and ferritin. CRS prophylaxis with tocilizumab was reported by 11% of practices. 74% (14/19) of practices used tocilizumab for treatment of grade 2 or higher CRS. 94% (17/18) of reporting practices utilized intravenous immunoglobulin for primary infection prophylaxis, typically at a dose of 0.4 g/kg every 4-8 weeks to maintain an IgG level above 400 mg/dL. ICANS risk was considered low, and corticosteroids were the preferred treatment for ICANS. Payer reimbursement, treatment availability and lack of approved indications were noted as barriers for certain prophylactic treatments. Clinicians indicated a desire to administer SUD in an outpatient setting for patient convenience and to reduce healthcare resource use. Comorbidities, tumor burden, and caregiver support were key patient-level factors to be considered for outpatient SUD. Remote patient monitoring was a potential solution to enhance the outpatient SUD administration. Conclusions The results indicated diverse RW administration and patient management strategies in practices with early familiarity with teclistamab, and consolidated practice-based experiences to help inform clinicians employing this innovative therapy. As patient care models evolve, outpatient or community-based SUD may become more common in the future. Ongoing evidence generation on RW treatment outcomes of various SUD models and AE management strategies is warranted.

OGC P13 CNS and Dietitian led clinical follow-up with support from a survivorship multi-disciplinary team meeting: A model of care for patients after oesophago-gastric (OG) cancer surgery

Abstract Background Major upper gastro-intestinal (UGI) cancer surgery in combination with chemotherapy offers the best chance of cure for patients with oesophageal and gastric cancer. However, these treatments have significant long-term side-effects resulting in a high symptom burden in this patient group. This adversely affects quality of life and places significant demands on healthcare after surgery. There is a large variation in follow-up services nationally, with little guidance on optimal practice. Methods A clinical nurse specialist (CNS) and Dietitian led clinic has been utilised in this patient group for 12 years at St Thomas’ hospital, with UGI surgeon support as required. In 2021, a survivorship multi-disciplinary team meeting (MDM) consisting of CNS, Dietitian, Gastroenterologist, UGI surgeon and psychologist was introduced. This aimed to support the clinic by discussing management of complex cases. Results Since 2011, approximately 3000 patient consults have been undertaken in the survivorship clinic. These patients benefited from specialist follow-up, expertise in symptom management, holistic needs assessments, recurrence surveillance and specialist dietetic advice. These patients were removed from surgical and oncology out-patient clinics, creating greater capacity in these services. Patient feedback has consistently supported this model of follow-up. Complex patients are discussed in the survivorship MDM which supports the clinic. Conclusions CNS and Dietitian led clinics, alongside a survivorship MDM, may provide a better model of follow-up compared to traditional surgical clinics by offering a greater breadth of expertise and consistency of follow-up. Evaluation of patient centred outcomes and economic analysis, in addition to on-going national initiatives to standardise the investigation and management of symptoms following major UGI surgery, would support replicating this model in other centres.

Has the NHS national extended access scheme delivered its policy aims? A case study of two large scale extended access providers.

In 2018, NHS England mandated that all patients in England should be able to access general practice services outside of ordinary hours. While some patients would access additional hours at their own practice, others would need supra-practice level provision - that is, they would be seen in a different location and by a different care team. The policy aim was to enhance patient access to care, with a particular focus on those who work during the day. This study examines (a) how supra-practice level provision of extended access appointments for general medical problems are operationalised and (b) whether the aims of the policy are being met. This study presents qualitative comparative case studies of two contrasting service providers offering extended access. The data collected included 30hours of clinician-patient observations, 25 interviews with staff, managers, and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data. Thematic analysis ran concurrently with data gathering and facilitated the iterative adaptation of data collection. Three cross-cutting themes were identified: extended access is being used to bolster a struggling primary care system, extended access provides a different service to in-hours general practice, and it is difficult for extended access to provide seamless care. Supra-practice access models can provide effective care for most patients with straightforward issues. When ongoing management of complex problems is required, this model of patient care can be problematic.

Examining the Feasibility of Implementing Digital Mental Health Innovations Into Hospitals to Support Youth in Suicide Crisis: Interview Study With Young People and Health Professionals.

Hospitals are insufficiently resourced to appropriately support young people who present with suicidal crises. Digital mental health innovations have the potential to provide cost-effective models of care to address this service gap and improve care experiences for young people. However, little is currently known about whether digital innovations are feasible to integrate into complex hospital settings or how they should be introduced for sustainability. This qualitative study explored the potential benefits, barriers, and collective action required for integrating digital therapeutics for the management of suicidal distress in youth into routine hospital practice. Addressing these knowledge gaps is a critical first step in designing digital innovations and implementation strategies that enable uptake and integration. We conducted a series of semistructured interviews with young people who had presented to an Australian hospital for a suicide crisis in the previous 12 months and hospital staff who interacted with these young people. Participants were recruited from the community nationally via social media advertisements on the web. Interviews were conducted individually, and participants were reimbursed for their time. Using the Normalization Process Theory framework, we developed an interview guide to clarify the processes and conditions that influence whether and how an innovation becomes part of routine practice in complex health systems. Analysis of 29 interviews (n=17, 59% young people and n=12, 41% hospital staff) yielded 4 themes that were mapped onto 3 Normalization Process Theory constructs related to coherence building, cognitive participation, and collective action. Overall, digital innovations were seen as a beneficial complement to but not a substitute for in-person clinical services. The timing of delivery was important, with the agreement that digital therapeutics could be provided to patients while they were waiting to be assessed or shortly before discharge. Staff training to increase digital literacy was considered key to implementation, but there were mixed views on the level of staff assistance needed to support young people in engaging with digital innovations. Improving access to technological devices and internet connectivity, increasing staff motivation to facilitate the use of the digital therapeutic, and allowing patients autonomy over the use of the digital therapeutic were identified as other factors critical to integration. Integrating digital innovations into current models of patient care for young people presenting to hospital in acute suicide crises is challenging because of several existing resource, logistical, and technical barriers. Scoping the appropriateness of new innovations with relevant key stakeholders as early as possible in the development process should be prioritized as the best opportunity to preemptively identify and address barriers to implementation.

NIMG-86. ESTIMATING BRAIN TUMOR RELATED EDEMA FROM NON-INVASIVE IMAGING IN A CLINICALLY RELEVANT TIMELINE

Abstract Image-based mathematical modeling is emerging as an advantageous tool to integrate into the care routine for patients with brain tumors. These tools can be used for a variety of tasks including predicting tumor growth, indicating spatial genomic alterations, and guiding radiation therapy. Often, the methods to produce these maps are developed in silos, using cohorts of retrospective patients and switching to a per patient map calculation can be an afterthought. Automatic pipelines are needed to enable creating mathematical maps in a clinically-relevant workflow. To this end, we developed a pipeline to create an image-based mathematical map of edema abundance based on T2-weighted (T2W) magnetic resonance imaging that includes preprocessing steps, abnormality and tissue type segmentation, brain extraction, map generation, and conversion between image file formats. The python-based pipeline was designed to take in T1-weighted (T1W), T1W with gadolinium contrast (T1Gd), T2W, and fluid attenuated inversion recovery (FLAIR) DICOM images for a single patient as input and convert them to NIfTIs for downstream steps. The pipeline preprocessed images by correcting bias field fluctuations using the N4 algorithm and normalizing intensities. The T1W, T1Gd, and FLAIR are then registered to the T2W. T1Gd and FLAIR are used in a deep learning algorithm to delineate the brain and abnormality including enhancing tumor, necrosis, and peripheral edema. Normal tissue segmentations are performed using the statistical parametric mapping (SPM) segmentation routine. The segmentations and preprocessed images are all utilized in the edema mathematical model. The resulting edema map is then reformatted as a DICOM and output for further use by clinicians and clinical imaging systems. Our future goals include integrating our pipeline in a clinical workstation and sending final maps to our hospital’s picture archiving and communication system (PACS) to allow for deployment of these models for patient care in a clinically efficient timeline.

Co-production of a structured integrated post pulmonary embolism care model (Attend-PE)

Abstract Background More than half of patients with pulmonary embolism (PE) develop persistent functional limitation and experience lower quality of life (1). To mitigate long-term complications, the European Society of Cardiology clinical guidelines on PE management recommends an integrated model for patient care after PE. However, there is currently no consensus on what such an optimal follow-up strategy should include, and high-quality evidence to provide guidance is lacking (1,2). Purpose To describe the co-production of a structured model for PE follow-up. Methods This study is part of the project - A structured Integrated post PE care model (Attend-PE) aimed at developing and testing the effectiveness of a structured, integrated and patient-centred follow-up care model for patients with PE in Denmark. The co-production of the Attend-PE model was conducted from October 2021 till June 2022, featuring user-centred and participatory design techniques. This methodology was combined with a structural stepwise approach based on Intervention Mapping, to ensure the developed model was founded on evidence and theory (3). Results In accordance with the Intervention Mapping protocol, a national panel of stakeholders was formed, and a needs assessment was conducted. The needs assessment comprised a mapping of PE follow-up at all main sites treating PE in Denmark (18 hospitals), based on a co-design process with patients and health care professionals inspired by the patient journey method. To supplement this, a literature search was conducted to identify further knowledge concerning the follow-up care needs and preferences of patients with PE, as well as the optimal clinical management of PE follow-up. Based on this, the overall goal and performance objectives of a structured follow-up care model were formulated, laying the foundation for co-production workshops. In two full-day workshops, patient representatives and healthcare professionals, as well as experts in the field of PE, developed the components, scope, and sequence of the Attend-PE model. Subsequently, the structure and organization of the follow-up model were refined during online workshops, and a working group produced patient education material. The Attend-PE model (Figure 1), outlines a systematic strategy for post-PE in-hospital follow-up, involving patient education, the content and frequency of individual follow-up consultations, and the application of patient reported outcome measures to actively assess physical and psychological well-being. This model supports an individualized post-hospitalization follow-up care plan tailored to the patient's specific needs. Conclusion(s) The co-production process was successful in developing a structured follow-up model for patients with PE which was based on patients’ needs and preferences, as well as the clinical experience and perspectives of healthcare providers, and was in line with current clinical guidelines.Attend-PE model