Patient-centric Healthcare Services Research Articles

Block Medcare: Advancing Healthcare Through Blockchain Integration

In an era driven by information exchange, transparency and security hold crucial importance, particularly within the healthcare industry, where data integrity and confidentiality are paramount. This paper investigates the integration of blockchain technology in healthcare, focusing on its potential to revolutionize Electronic Health Records (EHR) management and data sharing. By leveraging Ethereum-based blockchain implementations and smart contracts, we propose a novel system that empowers patients to securely store and manage their medical data. Our research addresses critical challenges in implementing blockchain in healthcare, including scalability, user privacy, and regulatory compliance. We propose a solution that combines digital signatures, Role-Based Access Control, and a multi-layered architecture to enhance security and ensure controlled access. The system's key functions, including user registration, data append, and data retrieval, are facilitated through smart contracts, providing a secure and efficient mechanism for managing health information. To validate our approach, we developed a decentralized application (dApp) that demonstrates the practical implementation of our blockchain-based healthcare solution. The dApp incorporates user-friendly interfaces for patients, doctors, and administrators, showcasing the system's potential to streamline healthcare processes while maintaining data security and integrity. Additionally, we conducted a survey to gain insights into the perceived benefits and challenges of blockchain adoption in healthcare. The results indicate strong interest among healthcare professionals and IT experts, while also highlighting concerns about integration costs and technological complexity. Our findings underscore the transformative potential of blockchain technology in healthcare, pointing towards a new era of patient-centric and secure healthcare services. By addressing current limitations and exploring future enhancements, such as integration with IoT devices and AI-driven analytics, this research contributes to the ongoing evolution of secure, efficient, and interoperable healthcare systems.

A-178 Reduced Hemolysis with a Novel Capillary Collection System as Compared With Conventional Capillary Collection Devices

Abstract Background Capillary blood collection is often cumbersome and lacks consistency in the applied pressure during squeezing of the finger. This may result in poor sample quality (i.e., hemolysis and dilution of the sample with interstitial fluid). Standardizing the capillary collection process and thereby making it less technique dependent can enable diagnostic blood testing to be performed in non-traditional settings (e.g., retail pharmacy). A novel capillary blood collection system has been developed to help standardize the process and may enable blood sampling by non-traditional healthcare workers (e.g., pharmacists, pharmacy technicians). Multiple studies were performed to evaluate the performance of this capillary blood collection system on sample quality in comparison with currently marketed capillary and venous blood collection devices. Sample quality was assessed by visual observation of hemolysis and by quantitative assessment of Plasma Free Hemoglobin (PFH). Methods Participants were enrolled at three sites representative of the intended use environment (i.e., retail pharmacy site or patient service center). Phlebotomists performed venipuncture using a currently marketed venous comparator and conventional capillary collection using a capillary comparator. Capillary collection was also performed using the novel capillary device in the same subjects by targeted trained healthcare workers (e.g., retail pharmacists, pharmacy technicians). Blood was collected using each method (venous and two capillary–conventional and novel capillary devices) into serum separator tubes from the same subject within the same timeframe. Data from the studies were pooled in a meta-analysis to assess device performance across multiple studies. Visual assessment of hemolysis was performed post centrifugation using a rating scale (0 = None, 1 = Trace, 2 = Moderate, 3 = Gross). For PFH measurement, a cut-off of >50 mg/dL was selected, as hemolysis interference may be observed at these levels in highly sensitive analytes. Results When compared with the venous comparator, the incidences of hemolysis, as assessed by visual hemolysis and PFH measurements, were higher with capillary collections. However, the incidences were significantly lower with the novel capillary collection system than with the capillary comparator. The overall incidence of visual hemolysis was significantly lower for the new capillary device when compared to the capillary comparator (“None” rating of 94% vs 64.5%). The frequency of trace, moderate and gross hemolysis was also less in the new capillary device when compared to the capillary comparator (4.4% vs 23.2%, 1.2% vs 9.8%, 0.4% vs 2.5%, respectively). For the quantitative measurement of PFH as an indicator of hemolysis, a similar trend was observed. The mean PFH value in the new capillary device was significantly lower than in the capillary comparator (29.87 vs 55.18), and the frequency of PFH >50 mg/dL was also significantly lower in the new capillary device than in the capillary comparator (11.7% vs 42.0%). Conclusions Improved sample quality was demonstrated with a novel capillary blood collection system, as the incidences of hemolysis, as measured visually and quantitatively as PFH measurement, were significantly lower than in conventional capillary blood collection devices. Consequently, this may result in fewer rejected samples in the lab than conventional capillary methods and help meet the demands for more convenient, patient-centric healthcare services.

Crime Prevention through Environmental Design in Healthcare Facilities: A study of Sehat Al Sharq at Al Khobar, KSA

This paper shall cover the existing theories and practices in the field of Crime Prevention through Environmental Design with a special focus on Healthcare Projects. The intention is to address the gap between theory and practices. Safety & Security is one of the basic human needs for peaceful existence. Patient safety and security have always been concerns in the successful operation of a healthcare setup. Nowadays, patient-centric healthcare service has given a competitive edge to the hospital; therefore, safety against crime has become very crucial for the hospitals. Other than the patients, safety and security for staff and visitors are equally important. Safety from data theft and breaches of privacy are other concerns in the healthcare setup. The design approach of best practices, like Crime Prevention through Environmental Design, seeks to create safer spaces through detailed design principles and strategies, and guidelines issued by the International Association for Healthcare Security and Safety. The majority of evidence suggests that designing the physical environment while considering safety features like Access Control, CCTV, Ultrasonic Occupancy Sensor, Public Addressable System & Duress Alarm for healthcare setup, duress alarms have proved to be life-saving measures that are used to alert hospital staff and security personnel when an individual is in need of emergency. In this paper, qualitative research methodology is used as a case study and physical observations to collect qualitative data and analysis of Sehat Al Sharq Hospital, Al Khobar, KSA, shall be included to identify and propose solution factors affecting the design challenges related to CPTED. Furthermore, it aims to recommend a roadmap to address design constraints, optimize efficiency, and improve safety and patient care in the healthcare facility.

Crime Prevention through Environmental Design in Healthcare Facility: A Study of Sehat Al Sharq at Al Khobar, KSA

This paper shall cover the existing theories and practices in the field of Crime Prevention through Environmental Design with a special focus on Healthcare Projects. The intention is to address the gap between theory and practices. Safety & Security is one of the basic human needs for peaceful existence. Patient safety and security have always been concerns in the successful operation of a healthcare setup. Nowadays, patient-centric healthcare service has given a competitive edge to the hospital; therefore, safety against crime has become very crucial for the hospitals. Other than the patients, safety and security for staff and visitors are equally important. Safety from data theft and breaches of privacy are other concerns in the healthcare setup. The design approach of best practices, like Crime Prevention through Environmental Design, seeks to create safer spaces through detailed design principles and strategies, and guidelines issued by the International Association for Healthcare Security and Safety. The majority of evidence suggests that designing the physical environment while considering safety features like Access Control, CCTV, Ultrasonic Occupancy Sensor, Public Addressable System & Duress Alarm for healthcare setup, duress alarms have proved to be life-saving measures that are used to alert hospital staff and security personnel when an individual is in need of emergency. In this paper, qualitative research methodology is used as a case study and physical observations to collect qualitative data and analysis of Sehat Al Sharq Hospital, Al Khobar, KSA, shall be included to identify and propose solution factors affecting the design challenges related to CPTED. Furthermore, it aims to recommend a roadmap to address design constraints, optimize efficiency, and improve safety and patient care in the healthcare facility.

Crime Prevention through Environmental Design in Healthcare Facility: A Case Study of Sehat Al Sharq at Al Khobar, KSA

This paper shall cover the existing theories and practices in the field of Crime Prevention through Environmental Design with a special focus on Healthcare Projects. The intention is to address the gap between theory and practices. Safety & Security is one of the basic human needs for peaceful existence. Patient safety and security have always been concerns in the successful operation of a healthcare setup. Nowadays, patient-centric healthcare service has given a competitive edge to the hospital; therefore, safety against crime has become very crucial for the hospitals. Other than the patients, safety and security for staff and visitors are equally important. Safety from data theft and breaches of privacy are other concerns in the healthcare setup. The design approach of best practices, like Crime Prevention through Environmental Design, seeks to create safer spaces through detailed design principles and strategies, and guidelines issued by the International Association for Healthcare Security and Safety. The majority of evidence suggests that designing the physical environment while considering safety features like Access Control, CCTV, Ultrasonic Occupancy Sensor, Public Addressable System & Duress Alarm for healthcare setup, duress alarms have proved to be life-saving measures that are used to alert hospital staff and security personnel when an individual is in need of emergency. In this paper, qualitative research methodology is used as a case study and physical observations to collect qualitative data and analysis of Sehat Al Sharq Hospital, Al Khobar, KSA, shall be included to identify and propose solution factors affecting the design challenges related to CPTED. Furthermore, it aims to recommend a roadmap to address design constraints, optimize efficiency, and improve safety and patient care in the healthcare facility.

Exploring enablers of modularity in healthcare service delivery

PurposeThis paper explores the enablers of modular healthcare services.Design/methodology/approachA survey-based approach was adopted with specialised hospitals as the unit of analysis. A structural model was developed based on a literature review and assessed using a cross-sectional research design. A 23-indicator questionnaire was circulated among service providers in the healthcare system across India, and 286 valid responses were received. The data were analysed using partial least squares-structural equation modeling (PLS-SEM).FindingsThe results reveal that professional competence, technological versatility, clear division of tasks, channelised flow of information and professional autonomy act as enablers that may drive modular service delivery.Research limitations/implicationsBy examining service providers' perspectives, this paper highlights the influence of the identified enablers on modular service delivery in healthcare organisations.Practical implicationsFor practitioners, the study provides suggestions for designing patient-centric healthcare services via modular healthcare delivery. The identified structural relationships can facilitate immediate corrective actions and the formulation of future policies. The findings will help practitioners foresee opportunities for patient participation in value co-creation, meet patients' varying needs, decompose service offerings, mix and match components develop sets of rules as interfaces between service modules and design service packages on an ongoing basis.Social implicationsThis study underscores the emergence of patient-centric care and may aid the design of processes that deliver health to the patient as a person.Originality/valueThis paper identifies and empirically validates relationships between healthcare service delivery processes and modular service delivery.

ICT Framework to Support a Patient-Centric approach in Public Healthcare

Although Information and Communication Technologies (ICTs) in the healthcare sector are extensively deployed globally, they are not used effectively in developing countries. Many resource poor countries face numerous challenges in implementing the ICT interventions. For instance, many health applications that have been deployed are not user-centric. As a result, such ICT interventions do not benefit many health consumers. The lack of an ICT framework to support patient-centric healthcare services in Malawi renders the e-health and mhealth interventions less sustainable and less cost effective. The aim of the study was therefore to develop an ICT Framework that could support patient-centric healthcare services in the public health sector in Malawi. The comprehensive literature review and semi-structured interviews highlighted many challenges underlying ICT development in Malawi. An ICT framework for patient-centric healthcare services is therefore proposed to ensure that eHealth and mobile health interventions are more sustainable and cost effective. The framework was validated by five experts selected from different areas of expertise including mhealth application developers, ICT policy makers and public health practitioners. Results show that the framework is relevant, useful and applicable within the setting of Malawi. The framework can also be implemented in various countries with similar settings.

The world through their eyes: The perceptions and lived experience among Capetonian young adults with hereditary visual impairment

Background: More than one-third of genetic conditions involve the eye. Young adults with visual impairments experience psychosocial implications throughout their lives. The transition from adolescence to adulthood is a critical period during which young adults with hereditary visual impairment make choices regarding relationships, procreation and independence, setting the foundation for their future. Aim: This study explored the perceptions and lived experiences of visually impaired young adults. Setting: The study was conducted at three institutions for the blind in Cape Town. Methods: Using purposive sampling, in-depth qualitative interviews were conducted using a phenomenological approach with 15 young adults aged 18–23 years with genetic-based visual conditions. The data were analysed using thematic analysis. Results: Eleven participants had minimal knowledge and understanding of their condition, which also created uncertainty about their future health. Making decisions about procreation was the main implication of having a genetic-based visual impairment. Mixed feelings were reported regarding bearing offspring. Social alienation was experienced in some instances; many participants felt misunderstood by society, and intimate relationships were thought to be harder to obtain. Challenges with mobility, such as the inability to drive and the need to use public transportation, significantly impacted them, and various psychosocial aspects influenced how they perceived their lives and future. Conclusion: This research indicates that improved patient-centred healthcare services and support systems would be beneficial in aiding visually impaired individuals successfully transition into adulthood. The findings of this study serve as a useful guide for those who need to provide healthcare services, genetic services and support for visually impaired young adults.

Exploring value-dense environment in the healthcare service delivery

Purpose The purpose of this paper is to explore the antecedents and consequences of a value-dense environment in healthcare service delivery. Design/methodology/approach A structural model was developed based on a literature review. Circulation of a 31-indicator questionnaire among service receivers in the healthcare system across India generated 279 valid responses. The research model was assessed using a cross-sectional research design, and the data were analyzed by partial least squares-structural equation modeling. Findings Integrated supply chain performance (ISCP), internal service quality (ISQ) and coordinated care are antecedents of a value-dense environment, which drives patient-centricity. The leagile supply chain strategy strengthens the relationship between ISCP and coordinated care. Employee trust and commitment acts as a moderator between coordinated care and ISQ. Research limitations/implications By adopting the perspective of service receivers, this paper highlights the influence of value-density on patient-centricity in healthcare organizations. Future research should include healthcare professionals’ perceptions of value-dense environment creation. Practical implications The study provides suggestions to practitioners for designing patient-centric healthcare services by leveraging ISCP, coordinated care and ISQ in the value-creation process. Recognizing the relationships among these constructs can aid the timely formulation of corrective actions and future policies. Social implications This study underscores patient-centric care as a basis for effectively delivering healthcare as a social good. Originality/value This paper contributes to the body of knowledge by identifying and empirically validating the relationships between patient-centricity and value co-creation.

From ‘fixed dose combinations’ to ‘a dynamic dose combiner’: 3D printed bi-layer antihypertensive tablets

There is an increased evidence for treating hypertension by a combination of two or more drugs. Increasing the number of daily intake of tablets has been reported to negatively affect the compliance of patients. Therefore, numerous fixed dose combinations (FDCs) have been introduced to the market. However, the inherent rigid nature of FDCs does not allow the titration of the dose of each single component for an individual patient's needs. In this work, flexible dose combinations of two anti-hypertensive drugs in a single bilayer tablet with a range of doses were fabricated using dual fused deposition modelling (FDM) 3D printer. Enalapril maleate (EM) and hydrochlorothiazide (HCT) loaded filaments were produced via hot-melt extrusion (HME). Computer software was utilised to design sets of oval bi-layer tablets of individualised doses. Thermal analysis and x-ray diffractometer (XRD) indicated that HCT remained crystalline in the polymeric matrix whilst EM appeared to be in an amorphous form. The interaction between anionic EM and cationic methacrylate polymer may have contributed to a drop in the glass transition temperature (Tg) of the filament and obviated the need for a plasticiser. Across all tablet sets, the methacrylate polymeric matrix provided immediate drug release profiles. This dynamic dosing system maintained the advantages of FDCs while providing a superior flexibility of dosing range, hence offering an optimal clinical solution to hypertension therapy in a patient-centric healthcare service.

Privacy-preserving data integrity verification by using lightweight streaming authenticated data structures for healthcare cyber–physical system

Nowadays the healthcare system is undergoing a paradigm shift to integrate cloud computing and Internet-of-Things with physical medical equipments into a distributed network ensuring real-time and near real-time data transfer from the physical world to the cyber space for computation, storage and analysis. Namely, the healthcare system can be seen as a cyber–physical system (CPS) for patient-centric healthcare applications and services, called Health-CPS, based on cloud computing, Wireless Body Area Networks (WBANs) and big data analytics technologies. Health-CPS has played an important role in healthcare for improving treatment quality and patients’ assistance speed. However, despite these advantages, the development of Health-CPS will be restricted by serious security threats, especially the security threats to the healthcare-related data. Because Health-CPS forward Electronic health records (EHRs), biomedical signals of patients and public health to the cloud which may operate in distributed and hostile environments, novel security mechanisms are required to prevent malicious interactions to the storage infrastructure. Therefore, the cloud providers must take strong security measures to protect the integrity and privacy of the healthcare related data. But most of the researchers do not simultaneously pay attention to both integrity and privacy for Health-CPS. Therefore, we proposed a privacy-preserving data integrity verification model by using lightweight streaming authenticated data structures for Health-CPS. We have given the design idea, architecture, formal definition, security definition, communication protocols of our model in detail. The key construction processes of our model which include initialization, data appending, scale expansion, data query and verification, are also given in this paper. Finally, the security and performance analysis show that our scheme is not only secure but also efficient.

Health-CPS: Healthcare Cyber-Physical System Assisted by Cloud and Big Data

The advances in information technology have witnessed great progress on healthcare technologies in various domains nowadays. However, these new technologies have also made healthcare data not only much bigger but also much more difficult to handle and process. Moreover, because the data are created from a variety of devices within a short time span, the characteristics of these data are that they are stored in different formats and created quickly, which can, to a large extent, be regarded as a big data problem. To provide a more convenient service and environment of healthcare, this paper proposes a cyber-physical system for patient-centric healthcare applications and services, called Health-CPS, built on cloud and big data analytics technologies. This system consists of a data collection layer with a unified standard, a data management layer for distributed storage and parallel computing, and a data-oriented service layer. The results of this study show that the technologies of cloud and big data can be used to enhance the performance of the healthcare system so that humans can then enjoy various smart healthcare applications and services.

Health Care Virtual Environment System Reinforced by Hadoop and Cloud

The advances in information technology have wit- nessed great progress on healthcare technologies in various do- mains nowadays. However, these new technologies have also made healthcare data not only much bigger but also much more difficult to handle and process. Moreover, because the data are created from a variety of devices within a short time span, the character- istics of these data are that they are stored in different formats and created quickly, which can, to a large extent, be regarded as a big data problem. To provide a more convenient service and environment of healthcare, this paper proposes a cyber-physical system for patient-centric healthcare applications and services, called Health-CPS, built on cloud and big data analytics technolo- gies. This system consists of a data collection layer with a unified standard, a data management layer for distributed storage and parallel computing, and a data-oriented service layer. The results of this study show that the technologies of cloud and big data can be used to enhance the performance of the healthcare system so that humans can then enjoy various smart healthcare applications and services.

Using participatory methods to enhance patient-centred mental health care in a federally qualified community health center serving a Mexican American farmworker community.

Mexican American farmworkers experience high rates of mental health conditions; however, it is difficult for them to access care. Patient-centred care is a systems-wide approach to improving the delivery of services for diverse populations in the primary care setting. We describe the application of community-based participatory research methods to assess and address gaps in perceptions of mental health care between providers and migrant workers living in a US-Mexico Border community. A federally qualified health centre (FQHC) serving a community of approximately 60 000 agricultural workers who live in Yuma County and harvest vegetables during the winter season. We conducted patient focus groups (n = 64) and FQHC staff interviews (n = 16) to explore attributes and dimensions of patient-centred mental health care. Patients and staff both prioritized increased access to mental health care and patient-centred care, while patients were more concerned with interpersonal care and providers with coordination of care. All participants stressed the relationship between life events and mental health and the centrality of family in care. Patients also emphasized the importance of a good attitude, the ability to solve problems, positive family relationships and reliance on faith. Patients suggested that the FQHC inform patients about mental health resources, provide community informational talks to address stigma, and offer support groups. The participatory approach of this qualitative study resulted in a wealth of data regarding patient preferences that will enable the FQHC to develop protocols and training to provide patient-centred mental health-care services for their community.

Information Integration Platform for Patient-Centric Healthcare Services: Design, Prototype and Dependability Aspects

Technology innovations have pushed today’s healthcare sector to an unprecedented new level. Various portable and wearable medical and fitness devices are being sold in the consumer market to provide the self-empowerment of a healthier lifestyle to society. Many vendors provide additional cloud-based services for devices they manufacture, enabling the users to visualize, store and share the gathered information through the Internet. However, most of these services are integrated with the devices in a closed “silo” manner, where the devices can only be used with the provided services. To tackle this issue, an information integration platform (IIP) has been developed to support communications between devices and Internet-based services in an event-driven fashion by adopting service-oriented architecture (SOA) principles and a publish/subscribe messaging pattern. It follows the “Internet of Things” (IoT) idea of connecting everyday objects to various networks and to enable the dissemination of the gathered information to the global information space through the Internet. A patient-centric healthcare service environment is chosen as the target scenario for the deployment of the platform, as this is a domain where IoT can have a direct positive impact on quality of life enhancement. This paper describes the developed platform, with emphasis on dependability aspects, including availability, scalability and security.

Healthcare in Singapore: the present and future

Singapore’s rapidly evolving economy and social progress has helped accelerate the milestones of healthcare development in the country.(1) In 1970, a committee on specialisation was commissioned by the Singapore government to look into the development of specialised medical services and postgraduate specialty training. Since then, there has been a steady focus on the development of our healthcare sector and the advancement of medical specialties. This has catapulted Singapore’s health system to a level on par with other advanced nations.(2) Today, healthcare systems around the world spend trillions of dollars annually to tackle the growing challenges in healthcare.(2-6) These challenges include epidemiological transitions of death rates (from maternal, perinatal and infectious diseases to cardiovascular diseases and cancers) and an ageing population with improved life expectancies.(2,7) Current lifestyle trends, which are by and large the result of technological advancements, have led to individuals having an increased number of risk factors, leading to the increased prevalence of multiple chronic diseases.(2,6) These chronic diseases are also increasingly being diagnosed in the younger adult population in the recent years.(2,4-6,8) Such trends will result in greater financial costs for the nation and the individual, and our current healthcare system may not remain sustainable if we continue to invest in and develop what had served us well in the past five decades.(1) It is intuitive that the answer does not lie in ‘more of the same’. An increase in healthcare spending does not always translate to better outcomes due to the complexity of the healthcare situation. The fundamental question that should be asked is what will likely deliver better value or outcome per unit cost in the coming years. The new funding model for healthcare should be one that moves away from the episodic, fee-for-service model to one that is outcome- or value-based for a population. The targeted outcome or value should be patient-centred, with each member of the healthcare system providing for all the needs of a patient as a whole.(9) Members of the healthcare system should no longer be called healthcare ‘stakeholders’. This term is passe, and was used when we built and developed our healthcare system in parts.(1) As we move toward a more patient-centric healthcare system, healthcare institutions and services would be more correctly termed ‘providers’ because they serve as providers for the healthcare needs of a patient. The term ‘stakeholders’ should be reserved for the public, patients, payers (the government, employers or other third-party payers), policy-makers and the healthcare system (the regional health system and their partners). There are three main areas that we can focus on in order to deliver better value – healthcare integration, strengthening of primary healthcare, and collaboration for health in the community. These are further elaborated in the following text.

Abstract FO02-03: Breast cancer control in federally qualified health centers.

Abstract Patient Navigation is a patient-centric health care service delivery intervention, with the goal of eliminating barriers, which may occur across the health care continuum, from screening, to timely diagnosis and treatment of cancer, and through survivorship. Pioneered in Harlem, NY, patient navigation is being widely replicated nationally and is receiving considerable support for demonstration projects and research to test its effectiveness. Patient navigation has evolved as a strategy to reduce cancer health disparities by eliminating barriers to timely diagnosis and treatment of cancer. The largest and longest effort to test the efficacy of PN is the $25 million, five-year Patient Navigation Research Program (PNRP) undertaken by the National Cancer Institute (NCI). The Chicago patient navigation program, for example, was funded through the NCI PNRP to increase the proportion of patients reaching diagnostic resolution and reduce the time from abnormal screening test to definitive diagnostic resolution among low income underserved women with abnormal breast (n=352) or cervical (n=545) screening results. We found that compared to control subjects who received usual care, a higher percentage of navigated subjects reached a diagnostic resolution by 60 days (83.0% vs. 52.7%) for breast and by 365 days (98.7% vs. 81.0%) for cervical cancer. But, the effects of patient navigation are defined and measured in different ways across programs. In order to make meaningful comparisons across diverse programs, outcome measures must be concordant. Therefore, in March 2010, the National Patient Navigation Leadership Summit comprised of cancer clinicians, researchers, practicing public health and measurement experts, funders, and patient navigators, met to develop a national consensus on common outcomes to solidify the scientific evidence and efficacy of patient navigation using a principles from community-based participatory research. The goal of the Summit was to develop and propose core metrics to measure outcomes of navigation on individuals as well as populations across the continuum. The process used to engage all key stakeholders and current national efforts will be discussed along with the outcomes of this approach. Funding: The Chicago Patient Navigation grant was supported by the National Institute of Health grant 1 U01 CA116875-01. The leadership conference and Cancer supplement were cosponsored by Pfizer Oncology, Livestrong (Lance Armstrong Foundation), Susan G. Komen for the Cure, the Oncology Nursing Society (ONS), the American College of Surgeons Commission on Cancer, the American Cancer Society, and AstraZeneca. Citation Format: Elizabeth A. Calhoun. Breast cancer control in federally qualified health centers. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr FO02-03.

Applying cluster analysis to build a patient-centric healthcare service strategy for elderly patients

Cluster analysis can be viewed as a cornerstone for customer-centred services since it contributes to classification and segmentation of customers. The proposed six-step approach is based on a Customer Relationship Management (CRM) perspective and hence enables both patient segmentation by cluster analysis and development of customised services. The six steps are selection, preprocessing, transformation, data mining, evaluation and integration. Therefore, the proposed approach is a procedure to support knowledge management for strategic decision making. In the empirical study, we show how to deploy the proposed approach to build a customised service strategy for elderly patients. This procedure can also be applied to other data sets.

Recognising relationships: reflections on evidence-based practice.

This paper argues for a broadening of the way evidence is developed and used in health-care. It contends that the current political and policy imperatives and the evidence-based practice movement are in direct tension with the other major ideological movements that promote patient-centred healthcare services. Nursing is affected by this tension because it is more naturally focused on relationships with clients to achieve health outcomes. The unresolved and mounting tension could be alleviated by embracing a broader definition of what counts as evidence and by focusing more on patient-centred healthcare methodologies and acknowledging the interdependency of distinct ways of generating new knowledge. A number of case studies are used to illustrate how research focusing on patient perspectives and nurses' response to patient experiences can improve the evidence base for nursing.