Health Care Movement Research Articles

Integrating Maternity Care Through Bundled Payments In The Netherlands: Early Results And Policy Lessons.

Bundled payments are increasingly used globally to move health care delivery in a value-based direction. However, evidence remains scant in key clinical areas. We evaluated bundled payments for maternity care in the Netherlands during the period 2016-18. We used a quasi-experimental difference-in-differences design to measure the association between the bundled payment model and changes in key clinical and economic outcomes. Bundled payments were associated with an increase in outpatient, midwife-led births and a reduction in in-hospital, obstetrician-led births, along with changes in the use of labor inductions and planned versus emergency cesarean deliveries. Total spending on maternity care decreased by US$328 (5percent) per pregnancy. No changes in maternal or neonatal health outcomes were observed. Several policy lessons emerged. First, bundled payments appeared to help affect providers' behavior in the maternity care setting. Second, bundled payments seemed to exert heterogeneous effects across participating maternity care networks, as the same financial incentive translated into different changes in clinical practices and outcomes. Third, alternative payment models should be designed with clear goals and definitions of success to guide evaluation and implementation.

Carrot Health: digitizing health care through consumer analytics

Theoretical basis The case is designed to be used with the digital business model framework developed by Peter Weill and Stephanie Woerner of Massachusetts Institute of Technology (MIT) (Weill and Woerner, 2015) and is referred to as the W & W framework. This approach provides a useful structure for thinking through the strategic options facing environments ripe for digital transformation. Research methodology Research for this case was conducted through face-to-face interviews with the protagonist, as well as through a review of their business planning documents and other data and documentation provided by the founder. Some of the market and industry data were obtained using secondary research and industry reports. Interviews were digitally recorded and transcribed to ensure accuracy. Case overview/synopsis The case follows the story of Kurt Waltenbaugh, a Minnesota entrepreneur who shared the dream of using data analytics to reduce costs within the US health-care system. In early 2014, Waltenbaugh and a physician colleague founded Carrot Health to bring together their personal experience and expertise in both consumer data analytics and health care. From the beginning, they focused on how to use data analytics to help identify high-risk/high-cost patients who had not yet sought medical treatment. They believed that they could use these insights to encourage early medical interventions and, as a result, lower the long-term cost of care. Carrot’s initial success found them in a consultative role, working on behalf of insurance companies. Through this work, they honed their capabilities by helping their clients combine existing claims data with external consumer behavioral data to identify new potential customers. These initial consulting contracts gave Carrot the opportunity to develop its analytic tools, business model and, importantly, to earn some much-needed cash flow during the start-up phase. However, they also learned that, while insurance companies were willing to purchase data insights for one-off market expansion projects, it was much more difficult to motivate them to use data proactively to eliminate costs on an ongoing basis. Waltenbaugh believed that Carrot’s greatest potential lay in their ability to develop predictive models of health outcomes, and this case explores Carrot’s journey through strategic decisions and company transformation. Complexity academic level This case is intended for either an undergraduate or graduate course on entrepreneurial strategy. It provides an effective introduction to the unique structure and constraints which apply to an innovative start-up within the health-care industry. The case also serves as a platform to explore the critical criteria to be considered when developing a digital transformation strategy and exposing students to the digital business model developed by Weill and Woerner (2015) at MIT (referred to in this instructor’s manual as the W&W framework). The case was written to be used in an advanced strategy Master of Business Administration (MBA) class, an undergraduate specialty health-care course or as part of a health-care concentration in a regular MBA, Master of Health Care Administration (MHA) or Master of Public Health (MPH). It may be taught toward the end of a course on business strategy when students are building on generic strategy frameworks and adapting their strategic thinking to the characteristics of specific industries or sectors. However, the case can also be taught as part of a course on health-care innovation in which case it also serves well as an introduction to the health-care payments and insurance system in the USA. Finally, the case can be used in a specialized course on digital transformation strategy in which case it serves as an introduction to the MIT W&W framework. The case is particularly well-suited to students who are familiar with traditional frameworks for business strategy and business models. The analysis builds on this knowledge and introduces students interested in learning about the opportunities and challenges of digital strategy. Equally, the case works well for students with clinical backgrounds, who are interested in how business strategy can influence changes within the health-care sphere. Finally, an important aspect of the case design was to develop students’ analytical confidence by encouraging them to “get their hands dirty” and to carry out some basic exploratory data analytics themselves. As such, the case requires students to combine and correlate data and to experience the potentially powerful combination of clinical and consumer data. Instructors should find that the insights from these activities give students unique insights into the potential for of data analytics to move health care from a reactive/treatment ethos to a proactive/intervention ethos. This experience can be particularly revealing for students with clinical backgrounds who may initially be resistant to the use of clinical data by commercial organizations.

What Do Students' Questionnaire Responses Tell Us about Their Language around Person-Centred Care? An Exploratory Sentiment Analysis.

There is a global movement for health and social care to be person-centred: supporting people's active participation when making health decisions and considering their opinions, beliefs, and needs. The World Health Organization recommend the inclusion of person-centred care in health and social care provision. This research aimed to explore Australian health and social care profession students' language around person-centred care. Final-year health and social care professions students, attending one of two Australian universities, participated in an online questionnaire. Responses were analysed and themed to an existing person-centred care framework, then a sentiment analysis was applied to each response. Of the responses collected from 90 students, 235 statements were linked to the four core values of the person-centred care framework: cultivating communication (44%); respectful and compassionate care (35%); engaging patients in managing their care (20%); and integration of care (<1%). Within these, 24 statements were positively aligned (10%); 100 statements were neutral (43%); and 111 statements contained negative sentiments (47%). Almost half of the responses were not aligned with the core values of person-centred care. This suggests that many of the final-year students are not yet conceptualizing care using a person-centred approach.

Going Beyond Management and Maintenance: Occupational Therapy's Role in Primary Prevention for Adults at Risk of Obesity.

There is a critical need to address the escalating obesity epidemic by examining new methods of care. Adult obesity has historically been addressed through management and maintenance once an individual is clinically diagnosed as obese. Research and practice demonstrate that significant weight loss can be difficult to achieve and even harder to maintain. Despite this, preventive interventions targeted toward adult obesity have been limited in many health care professions, including occupational therapy. As professionals who are skilled in supporting clients' holistic development of healthy habits and routines, occupational therapists are equipped to play a key role in moving health care practices away from a reactive model of care to a proactive one that emphasizes primary prevention. This column identifies how this issue is aligned with occupational therapy's domain and presents potential examples of interventions to support adult obesity prevention.

Patient-Reported Outcomes Measures in Rhinoplasty: Need for Use and Implementation.

Patient-reported outcome metrics (PROMs) are increasingly utilized to capture data about patients' quality of life. PROMs play an important role in the value-based health care movement by providing a patient-centered metric of quality. There are many barriers to the implementation of PROMs, and widespread adoption requires buy-in from numerous stakeholders including patients, clinicians, institutions, and payers. Several validated PROMs have been utilized by facial plastic surgeons to measure both functional and aesthetic outcomes among rhinoplasty patients. These PROMs can help clinicians and rhinoplasty patients participate in shared decision making (SDM), a process via which clinicians and patients arrive at treatment decisions together through a patient-centered approach. However, widespread adoption of PROMs and SDM has not yet been achieved. Further work should focus on overcoming barriers to implementation and engaging key stakeholders to increase the utilization of PROMs in rhinoplasty.

A STUDY TO ASSESS THE EFFECTIVENESS OF FOOT REFLEXOLOGY ON REDUCING PAIN AMONG POST CAESAREAN MOTHER IN SMI HOSPITAL, DEHRADUN

Reflexology is unique and simple method becoming increasingly popular as part of the alternative health care movement. It is one of the non-pharmacological methods of pain management. The research approach used for this study was quantitative research approach. A pre-experimental design was used for the study. By using purposive sampling technique 40 samples was selected. Findings of the study, majority of women mild pain 20 (50%), 15(38%) had moderate pain and 5(12%) had severe pain in pretest level of scores.

Editorial introductions.

Editorial introductions.

Definition and Contextual Factors of Nursing Home Residents' Mobility in a Holistic View: A Delphi Study.

Current definitions of older adults' mobility do not cover the full range of influencing factors and do not consider nursing home residents. The present study reports expert ratings from a Delphi study regarding factors influencing the mobility of long-term nursing home residents. We invited 129 professionals with expertise in a field relevant to research on mobility in older adults such as health care, medicine, or human movement science to participate in a Delphi study comprising 3 rounds of online questionnaires. Up to 40 experts participated in each round. In the first round, we used open-ended questions to solicit possible definitions, contextual factors, and assessment tools. In the second round, the participants used Likert scales (1-10) to rate their suitability. In the final round, we presented a definition based on consensus as well as the top-rated contextual factors and assessment tools from the first 2 rounds for a final rating of agreement. The experts showed broad agreement on the final version of the mobility definition, with 8.9 ± 1.4 (mean ± standard deviation) out of 10 points. The experts also showed broad consensus on the selected contextual factors, with 8.4 ± 1.8 points to 8.9 ± 1.2 points (out of 10 points). This was also the case for the top 3 assessment tools selected from results of previous rounds, which showed an agreement of 7 or more points (out of 10 points) by 81.6% to 100% of all experts in the different categories. Given that an interdisciplinary group of experts considered various hitherto neglected contextual factors as relevant, the Delphi survey and its results imply the need for an updated interdisciplinary and holistic understanding of mobility in nursing home residents and can provide a basis for putting it into practice.

A philosophical exploration of experience-based expertise in mental health care

ABSTRACT The idea that (former) patients are experts who could contribute to mental health care practices is gaining traction. Experts-by-Experience are increasingly employed by institutions to contribute to various levels of care, organization and policy-making. However, the success of this movement is hindered by conceptual and epistemological ambiguities. Our goal in this paper is to turn to the rich philosophical literature to start addressing such ambiguities. We first summarize the advantages of and challenges for Experience-based Expertise movement in mental health care. Next, we explicate the theoretical assumptions of this movement by outlining its salient tenets, with a focus on the Dutch mental care system. We point out three challenges of the movement that could be addressed using the insights by recent work in philosophy of mind and philosophy of science, i.e., (i) conceptual problems, (ii) worries about the subjectivity of the contributions of Experts-by-Experience, and (iii) addressing of the conflicts between the Experts-by-Experience and other experts. We conclude by proposing an enactive affordance-based framework as a candidate for clarifying the goals of the Experience-based Expertise movement in a way that avoids the current conceptual and epistemological problems and opens up venues for its growth.

Impact and Adaptation of Reproductive Training During COVID-19 Pandemic in Malaysia.

The novel coronavirus (COVID-19) pandemic has affected the community at large. It has affected almost everyone and every aspect of social, economic and educational activities. Training in reproductive medicine has not been spared, as training in this field requires a combination of clinical interaction with patients, procedural experience, constant discussions and the element of research. The changes to numbers of new infections or active cases dictate the restrictions placed on the community and health care services alike. At the beginning of the pandemic, both the patients’ fear of going to a health care facility and movement restrictions had caused a significant reduction in the number of COVID-19 cases. Furthermore, the Ministry of Health (MOH) Malaysia’s recommendation to withhold all non-essential medical services, including those related to reproductive medicine, falls under this category. Therefore, it could negatively impact the quality of training and lead to an extension of training duration in reproductive medicine. Thus, the procedural experience could be supplemented with simulator training, teleconsultation could replace standard clinic sessions and online meeting platforms could replace routine academic meetings. Any modifications must be adaptable or flexible, as similar infectious pandemics and restrictions could recur from time to time.

Family medicine: An evolving field around the world.

It is 2021. The imperative to move health care services outside of hospitals is evident. Before the coronavirus disease 2019 (COVID-19) pandemic, Canadian media had switched its tune from “shorter surgical times” to demanding the end of “hallway medicine.” During the COVID-19 pandemic, the

Localization of Praziquantel Production and Clonorchiasis Control Program in Korea, 1970s~1980s.

The Korean parasite control program is regarded as one of the most successful examples of health care movement in Korea. This 'Parasite Eradication Program' which was conducted from 1969 to 1995, involved testing and treating of 300 million people. In cooperation with Japan, parasitologists and activists who participated in the parasite control program formed a common system called the 'Mass Testing, Mass Treatment.' This study focuses on the localization process of Praziquantel, Clonorchiasis treatment production and its application in Clonorchiasis control program. Parasitologists rapidly introduced newly developed Praziquantel, and Korean chemists quickly reverse engineered the compound to evade patent issues. This allowed for the mass production of Praziquantel at a lower price, which in turn enabled a nationwide Clonorchiasis control program. At the same time, low price and stable supply opened the private market for Praziquantel. However, acceptance and understanding of the Praziquantel differed significantly among the stakeholders. For the government, it was a means for policy propaganda, and for the health agencies, it was a means for mass scale control program, while for the public, it was a means for maintaining conventional eating habits without risk of infection. This study reveals how the material end of a disease control policy is accepted and interpreted by different actors.

COVID-19 Pandemic: An Opportunity for Universal Health Coverage.

Universal Health Coverage (UHC) is an ambitious goal in health service with sustainable development goal (SDG). Likewise this goal is a mean and end as well in comparison with other goals. The lessons that countries are currently learning from the COVID-19 pandemic all underscore that investing in health for all is not optional. Stable, equitable, prosperous and peaceful society and economy is only possible when no one is left behind. This global crisis created from COVID-19 pandemic could be an opportunity to seize the moment to make changes that benefit both UHC and health security. Foundations of Universal Health Coverage Philosophical Foundation The philosophical foundation of UHC is based with health care as fundamental human right and it is not limited with certain group or class of people (1). In the spirit of previous unifying concepts such as Health for All, basic health needs, and the Alma-Ata declaration, it presents a vision in which all citizens will enjoy a strong and efficient health system that spans preventive and curative medicine, affordable access to that health system, access to relevant medicines, and sufficient human resources. Current sustainable development goal (goal 3) universal health care has been modified and revised form of previous approach of primary health care, Millennium Development Goal (MDG) and other related movement in health care for justice. Previous developing countries health needs has been extended for all countries and accepted on the ground of justice and equity in SDG goal 3.

The Health and Adolescents’ Potential Community Movement

Community nurses have an important role in the current society. A number of roles are inherent in community nurses, among them, prevention, maintenance, health promotion and recovery of community diseases. The teenagers become one of the target of community nurses, in case of health care development. Among of them, the Narcotics, Psychotropics, and Addictive Substances (NAPZA) abuse and sex are things that need to be followed up. This can be agreed upon the case studies on Kalipucang Village, Tamantirto, Kasihan, Bantul, which show that some adolescents are involved in deviant behavior, such as drinking alcohol, drug abuse, and unexpected pregnancy –as the result of a lack of understanding of these two things. For this reason, the Youth Health Care and Potential Community Movement (GEMA PESTA REMAJA) activity be held. These activities include health screening, health education, formation and training of Youth Healthcare Services or Posyandu Remaja cadres, as well as optimizing the role of these cadres in managing the Posyandu Remaja that formed. The results of this activity showed a significant changes for the teenagers of Kalipucang Village. This can be seen from the increase in the knowledge of adolescents, which is measured through a post-test, about drug and reproductive health that they get from a series of GEMA PESTA REMAJA activities.

Health and Sustainability: New Gender Perspectives

European health systems face important challenges related to the sustainability of health care, both from an economic point of view and in relation to the quality of health services provided in terms of continuous improvement of effectiveness, safety, clinical and organisational appropriateness. The ability of EU Member States to continue to provide high quality care to all, whatever their biological and socio-cultural characteristics, depends on their health systems becoming more sustainable. Therefore, there is a need to strengthen health promotion and disease prevention, to invest in primary care systems, to move health care out of the hospital and into more accessible ambulatory and domestic care, and to develop integrated care practices. Starting from these premises, the aim of this paper is to present a narrative overview of the main aspects related to Gender Medicine and its evolution over time. Our critical overview is, therefore, aimed at providing a general picture of what has been developed by health systems on Gender Medicine, with a particular focus on the relationship between social sustainability and Gender Medicine. To achieve our goal, we carry out a systematic literature review in order to understand what has been developed so far in the area and to highlight the possible evolution of studies in the field and to strengthen the awareness of the importance of encouraging prevention, training and information programs shared with hospitals, institutions, health professionals and patient associations. To the best of the authors' knowledge, this is among the first studies that investigate through a systematic literature review the phenomenon of gender medicine, especially with reference to the sustainability of the health care system. Although our analysis needs further investigation, due to the fact that the topic is not yet fully mature, our initial and preliminary results underline the importance of further investigating gender diversity and assessing the possibility of promoting a clinical pathway to personalised treatment. In fact, only through a “gender medicine” approach it is possible to guarantee a real right to health and an effective personalisation of treatments, thus reinforcing the concept of patient focussed care and contributing to the sustainability of the whole health system.

Digitalizing Community Health Work: A Struggle over the Values of Global Health Policy

The introduction of digital technology has sparked new debates about the value of community health workers in low-and-middle-income countries. This debate offers important insights into the conventions that are relevant in global public health. Community health workers, a workforce that was already celebrated during the 1970s Primary Health Care movement, are having a remarkable revival in recent years, and myriad actors seek to boost their impact through mobile devices. Our content analysis of the public health literature evaluating this impact reveals the centrality of attempts at reconciling equity and cost effectiveness concerns, and thus considerable normative tensions. Additionally, we find that discussions about “domestic” values such as privacy and gender roles come with a paternalistic undertone, calling for feminist and postcolonial engagement with the digitalization of community health work.

Addressing Positionality Within Case-Based Learning to Mitigate Systemic Racism in Health Care.

Case-based learning has historically focused on the individual patient; however, there is often little consideration within this teaching method of how social determinants of health, such as structural racism and its adverse health effects, bear upon patients' health status and consequent patient outcomes. Implementing case studies necessitates taking into account the positionality of patients, as well as health care providers, to counter the racial oppression and discrimination embedded in existing health care and educational systems. We describe a process for creating an inclusive, antiracist environment for case-based learning within nursing education, outlining steps for preparing students to more effectively examine case studies through social determinants of health framing and lens to mitigate harmful impacts from systemic racism and racial discrimination in clinical care. Addressing positionality in case-based learning is one antiracist strategy to begin rectifying health disparities and moving health care toward equity.

Defining the experience: How do you know you are practicing Whole Person Care?

Introduction: Whole Person Care (WPC) is a growing movement in health care recognized as an important tool for both practitioners and patient outcomes. What remains unclear is what WPC looks like in practice and how providers know they are practicing it successfully. Methods: Researchers conducted in-depth interviews with 30 healthcare providers during the WPC congress in 2017. An iterative qualitative process was used to code and analyze the data using qualitative research software.The primary research question explored how practitioners know that they are practicing WPC. Results: Our analysis revealed that the practice of WPC is an individual experiential process appreciated through self-awareness and connection. Most practitioners reported the importance of i) their ability to be present in an interaction and to acknowledge their own emotions, ii) the relationship between practitioner and patient, characterized by a feeling of trust and of mutual impact, and iii) relying on external cues, such as explicit patient feedback and body language. In this workshop, attendees will be prompted to reflect on their experiences of providing WPC through individual and group exercises. Attendees will be invited to reflect on the above results and discuss emerging themes. This participatory research model creates an interactive space for workshop attendees to build on our data and guide further analysis. Conclusion: Cues to whether you are practicing WPC rely on practitioner self-awareness and perceptions of how interactions transpire. This workshop offers an opportunity to create an experiential map of the elements contributing to the growing practice of WPC.

Leveraging Interdisciplinary Education Toward Securing the Future of Connected Health Research in Europe: Qualitative Study.

BackgroundConnected health (CH) technologies have resulted in a paradigm shift, moving health care steadily toward a more patient-centered delivery approach. CH requires a broad range of disciplinary expertise from across the spectrum to work in a cohesive and productive way. Building this interdisciplinary relationship at an earlier stage of career development may nurture and accelerate the CH developments and innovations required for future health care.ObjectiveThis study aimed to explore the perceptions of interdisciplinary CH researchers regarding the design and delivery of an interdisciplinary education (IDE) module for disciplines currently engaged in CH research (engineers, computer scientists, health care practitioners, and policy makers). This study also investigated whether this module should be delivered as a taught component of an undergraduate, master’s, or doctoral program to facilitate the development of interdisciplinary learning.MethodsA qualitative, cross-institutional, multistage research approach was adopted, which involved a background study of fundamental concepts, individual interviews with CH researchers in Greece (n=9), and two structured group feedback sessions with CH researchers in Ireland (n=10/16). Thematic analysis was used to identify the themes emerging from the interviews and structured group feedback sessions.ResultsA total of two sets of findings emerged from the data. In the first instance, challenges to interdisciplinary work were identified, including communication challenges, divergent awareness of state-of-the-art CH technologies across disciplines, and cultural resistance to interdisciplinarity. The second set of findings were related to the design for interdisciplinarity. In this regard, the need to link research and education with real-world practice emerged as a key design concern. Positioning within the program context was also considered to be important with a need to balance early intervention to embed integration with later repeat interventions that maximize opportunities to share skills and experiences.ConclusionsThe authors raise and address challenges to interdisciplinary program design for CH based on an abductive approach combining interdisciplinary and interprofessional education literature and the collection of qualitative data. This recipe approach for interdisciplinary design offers guidelines for policy makers, educators, and innovators in the CH space. Gaining insight from CH researchers regarding the development of an IDE module has offered the designers a novel insight regarding the curriculum, timing, delivery, and potential challenges that may be encountered.

A Survey of Patient and Partner Outcome and Treatment Preferences in Mild Cognitive Impairment.

Background:The patient-centered movement in health care is increasing efforts to design studies and interventions that address the outcomes that matter most to patients and their families. Research has not adequately addressed Alzheimer’s disease patient and caregiver preferences.Objective:To survey the outcome and treatment preferences of patients and caregivers who had completed a multicomponent behavioral intervention for mild cognitive impairment (MCI).Methods:Extending prior work, we conducted an online survey regarding outcome and intervention preferences. Participants were patients with MCI and partners who completed the HABIT Healthy Action to Benefit Independence & Thinking ® program.Results:Both patient and partner respondents ranked patient quality of life as the highest priority, followed by patient self-efficacy, functional status, patient mood, and patient memory performance. Distressing behaviors and caregiver outcomes (burden, mood, and self-efficacy) had low rankings. Regarding the importance of HABIT ® program components, memory compensation training was ranked highest and wellness education lowest by all groups.Conclusion:Additional research should compare patient preference for patient reported outcomes, traditional neuropsychological and clinician outcomes, and modern biomarker outcomes.