Process For Healthcare Providers Research Articles

A discrete choice experiment with health professions trainees to improve the urban-rural health care access disparity in Appalachia: Study protocol.

Globally, those who live in rural areas experience significant barriers to accessing health care due to a maldistribution of health care providers. Those who live in rural areas in the Appalachian region of the United States face one of the worst shortages of health care providers despite experiencing more complex health needs compared to Americans in more affluent, urban areas. Prior research has failed to identify effective solutions to narrow the provider maldistribution, despite it being a policy focus for decades. More work is needed to better understand the complex, multidimensional process in which health care providers select jobs and how job, community, and providers' intrapersonal characteristics influence job selection. This paper is a protocol for a study aimed at identifying effective policies and incentives to improve recruitment of healthcare providers for their first job in rural Appalachia. We will use rigorous, theoretically grounded discrete choice experiment methodology (DCE) to accomplish the study's objective. The main outcome will be the relative importance of alternative community and job characteristics for trainees' choices of jobs in rural Appalachia. secondary outcomes of interest will be trade-offs that these trainees make when selecting a job, described in the form of marginal rates of substitution (mRS). Participants include medical residents and fellows, PA students and NP students in their final year of training. The choice context will be the recruitment of these trainees for their first job. Data will be analyzed using mixed logit analysis. Results from this DCE will improve our understanding of the job selection process for health care providers. The identification and prioritization of predictors of trainees' rural job choices will allow for the development of policies and incentives that will enable policymakers and health care systems to recruit more providers to rural and underserved areas.

COVID-19 and people's continued trust in eHealth systems: a new perspective

ABSTRACT Individuals’ use of eHealth services has increased significantly. However, the recent pandemic of coronavirus disease 2019 (COVID-19) has resulted in a significant reallocation of health resources and support. This study investigated the impact of service quality dimensions on individuals’ continued trust in eHealth during COVID-19. A decision-making trial and evaluation laboratory (DEMATEL) approach was used to identify and analyse the causal relationships between service quality dimensions and individuals’ continued trust in eHealth services. A total of 134 eHealth users (78 males and 56 females; aged 29–61 years) responded to the DEMATEL questionnaire. The results showed a variation in the impact of service quality factors on individuals’ continued trust in eHealth services. This study found three core factors (responsiveness, assurance and tangibility) that influence individuals’ continued trust in eHealth services. Other secondary factors (e.g. content quality, reliability, efficiency and hedonic benefits) were found to be primarily influenced by the core factors. The identified relationships in this study can aid the decision-making process of healthcare providers and increase the efficiency of healthcare delivery.

Healthcare Data Analytics.

Health analytics is a branch of analysis that focuses on the analysis of complex and large amounts of health data that are characterized by high dimensionality, irregularities and rarities. Their aim is to improve and increase the efficiency of the process of healthcare providers, working with patients, managing costs and resources, improve diagnostic procedures and treatments, etc. The prime focus is investigating historical data and finding templates for different scenarios. As a final product, usually different visualisation tools are produced to support practitioners in patient care to provide better services, and to improve existing procedures.

2157-PUB: The Effects of an External Shoe-Lift on Off-Loading the Diabetic Foot

Diabetic foot ulcers (DFUs) are a complication of diabetes, reducing patients’ quality of life, increasing morbidities, and contributing to more the $30B annually in increased for the U.S. healthcare system. Total Contact Cast (TCC) is considered the gold standard for healing DFUs. Within the last decade a number of prefabricated TCC kits such as TCC-EZ have been introduced, which offer a user-friendly casting process for healthcare providers. However, these casts and their associated boots or shoes cause asymmetry in gait. They may also result in reduction of weight bearing on the casted side and eventually affect the healing of DFUs. The purpose of this exploratory study was to determine the effectiveness of a shoe balancer called Evenup in redistribution of plantar peak pressure (PP) during gait. Sixteen subjects provided informed consent, 5 of whom had diabetic neuropathy (one Type I, four Type II), and completed three trials of 30-m walking while fitted with TCC-EZ and TCC, either with or without Evenup, in a randomized order. A pair of automated wireless photogate sensors captured time to traverse the distance, and pedobarographic insoles (Novel, Germany) measured and recorded plantar pressures. For each trial, the mid-gait six steps for each side were analyzed. Paired t-tests were used to compare bilateral PP difference, as well as whether presence of Evenup changed differences in pressure side to side. Bilateral PP difference in TCC (p=0.166) and TCC-EZ (p=0.123) arms did not reveal significance due to presence of Evenup (p>0.05) while both modalities showed significant PP reduction side to side (p≤0.001). More research is necessary to reveal the potential clinical benefits of the use of shoe lifts in diabetic foot offloading, falls in diabetic patients and healing rates in a larger cohort. Disclosure A. Ersen: None. D. Jupiter: None. K.M. Raspovic: Consultant; Self; Orthofix. L.A. Lavery: Advisory Panel; Self; Acelity, Bayer AG. Consultant; Self; Boehringer Ingelheim International GmbH. Research Support; Self; AstraZeneca, Cardinal Health, EO2 Concepts, Integra LifeSciences, MedImmune, Smith & Nephew. M. Yavuz: Research Support; Self; Integra LifeSciences. Other Relationship; Self; Vivonics Inc. Funding Integra LifeSciences

A Biomechanical Examination of Prefabricated Total Contact Cast Kits: Relevance to Patients With Diabetic Neuropathy.

The traditional Total Contact Cast (TCC) is considered the gold standard for treating plantar diabetic ulcers. A number of prefabricated TCC kits have been introduced, which offer a user-friendly casting process for health care providers. Our objective was to evaluate pressure reduction and gait characteristics after application of a TCC kit (TCC-EZ) and traditional TCC. Fifteen individuals (9 males, 6 females; median age of 51.5 years [range = 40.5-71.2 years]) completed 30-m walking trials while fitted with TCC-EZ and TCC in a randomized order. A pair of automated wireless photogate sensors captured time to traverse the distance and pedobarographic insoles measured and recorded plantar pressures. Paired t tests were used to compare peak pressure, gait speed, and cast weights across the 2 modalities. Peak pressure and cast weight were significantly lower in the TCC-EZ arm (169.6 ± 41.3 kPa vs 214.9 ± 63.2 kPa, P = .0048; and 1.79 ± 0.17 kg vs 2.11 ± 0.25 kg, P = .0004). Contact area and gait speed were not significantly different between the 2 modalities (140.4 ± 25.8 cm2 vs 126.9 ± 37.8 cm2, P = .0228, Cohen's d = 0.40; and 0.94 ± 0.19 m/s vs 0.83 ± 0.26 m/s, P = .0532, Cohen's d = .48). TCC-EZ was found to provide more favorable pressure distributions compared with TCC. TCC-EZ is also lighter and may be a preferred treatment modality for patients. More research is necessary to reveal the clinical effectiveness of prefabricated total contact kits.

Transitioning to ED: A Difficult but Improvable Process

Transitioning to ED: A Difficult but Improvable Process

Suppliers view on benefits and challenges of the PCP process for healthcare providers and SMEs

DECIPHER is a pre-commercial procurement (PCP) project seeking mHealth solutions for cross border health services. The 4phase PCP process is meant to be a tool for procurers to develop together with SMEs solutions to their specific needs. SMEs may have excellent solutions as well as the flexibility and adoptability to react adequately to procurers needs. But with little access to competitions, information about their solutions is not always reaching procurers …

Generating Treatment Plan in Medicine: A Data Mining Approach

This study reports on a research effort on generating treatment plan to handle the error and complexity of treatment process for healthcare providers. Focus has been given for outpatient and was based on data collected from various health centers throughout Malaysia. These clinical data were recorded using SOAP (Subjective, Objective, Assessment and Plan) format approach as being practiced in medicine and were recorded electronically via Percuro Clinical Information System (Percuro). Cross-Industry Standard Process for Data Mining (CRISP-DM) model has been utilized for the entire research. We used data mining analysis through decision trees technique with C5 algorithm. The scopes that have been set are patient’s complaint, gender, age, race, type of plan and detailed item given to patient. Acute upper respiratory infection disease or identified as J06.9 in International Classification of Diseases 10 by World Health Organization has been selected as it was the most common problem encountered. The model created for J06.9 disease is that type of plan recommended through giving drug to patients without the need to consider patient’s complaint, gender, age and race, with accuracy obtained for the model is 94.73%. Inspite of that, we also identified detailed items that have been given to J06.9 patients and the occurancy of them. This can be as a guideline for future treatment with item recommendation is less than 0.078% compared to item inventory in Percuro database. The research is expected to aid healthcare provider as well as to minimize error during treatment process while benefited from technology information to increase the health care delivery.

A Service Or a Right: Informed Consent for HIV-Positive Latin American Men in Japan

Since April 1996, Japanese health care providers who practise informed consent have been financially rewarded. Although there is no precedent for this financial gain, there are no detailed studies. Focused on a group of Latin American men living with HIV/AIDS, this paper clarifies the actual practices of informed consent at Japanese medical facilities. Twenty HIV-positive men were interviewed in order to investigate how they obtained medical treatment and how they were informed about their physical condition. From April to September 2002 and during August 2003 and 2004, a set of six interviews were conducted with each male, who were 28–37 years old. Participants were acquired through a hospital and a non-governmental organization, and by snowball sampling. The interviews showed that most of the informants received information concerning medical treatment, but they were advised neither about alternative treatments nor about the feasibility of seeking a third party's advice. Informed consent and communication between the informants and physicians were obstructed by language and structural, as well as cultural barriers. In conclusion, this paper adds a new dimension to the understanding of informed consent as the authors regard the practice as an educational process for health care providers and patients.

Clinical decision making in the care of the aged.

This study examines the decision-making process of health care providers working with older patients. Data were obtained through telephone interviews from a random sample of 251 health care providers at three Veterans Administration medical centers. Responding to a hypothetical clinical vignette, the majority of providers chose to give the one remaining bed in an ICU to a younger versus an older patient. Individuals relied on the patient's expected quality of life as well as the medical risk to the patient as important factors in this decision. In another vignette, less than 15% of the sample strongly supported a life-prolonging intervention for an 85-year-old man whose obstructive pulmonary disease had taken a terminal course. Expected quality of life was the most important determinant of the decision not to intubate. Respondents of different professions consistently ranked DNR orders as the decision with which they were most comfortable and termination of life supports as the decision with which they were least comfortable. A discussion of the different medical, social, and institutional factors that influence decision making is provided.