Care Project Research Articles

Patient and Clinician Perceptions of Precision Cardiology Care: Findings From the HeartCare Study.

Routine genome-wide screening for cardiovascular disease risk may inform clinical decision-making. However, little is known about whether clinicians and patients would find such testing useful or acceptable within the context of a genomics-enabled learning health system. We conducted surveys with patients and their clinicians who were participating in the HeartCare Study, a precision cardiology care project that returned results from a next-generation sequencing panel of 158 genes associated with cardiovascular disease risk. Six weeks after return of results, we assessed patients' and clinicians' perceived utility and disutility of HeartCare, the effect of the test on clinical recommendations, and patients' attitudes toward integration of research and clinical care. Among 666 HeartCare patients with a result returned during the survey study period, 42.0% completed a full or partial survey. Patient-participants who completed a full survey (n=224) generally had positive perceptions of HeartCare independent of whether they received a positive or negative result. Most patient-participants considered genetic testing for cardiovascular disease risk to have more benefit than risk (88.3%) and agreed that it provided information that they wanted to know (81.2%), while most disagreed that the test caused them to feel confused (77.7%) or overwhelmed (78.0%). For 122 of their patients with positive results, clinicians (n=13) reported making changes in clinical care for 66.4% of patients, recommending changes in health behaviors for 36.9% of patients, and recommending to 33.6% of patients that their family members have clinical testing. Both patients and clinicians thought the HeartCare panel screen for cardiovascular disease risk provided information that was useful in terms of personal or health benefits to the patient and that informed clinical care without causing patients to be confused or overwhelmed. Further research is needed to assess perceptions of genome-wide screening among the US cardiology clinic population.

Awareness of Palliative Care among Healthcare Providers in Pakistan: A Survey

Objective: To assess the awareness of palliative care among healthcare providers in Pakistan.Study Design: Cross-sectional descriptive study.Place and Duration of Study: The study was conducted in healthcare providers from various healthcare setupsin Pakistan, from 20th March 2021 to 21st May 2021.Materials and Methods: A total of 134 responders from various hospitals answered a questionnaire-basedsurvey on the knowledge and palliative care practice among healthcare providers. The questionnaire was madeaccording to guidelines given By Shaheen Palliative Care Project, United Kingdom.For data collection, convenience sampling was used and to present distribution of responses percentages andfrequencies were used. Data were entered and analyzed using SPSS 17.Result: In 134 responders, about 128 (95.5%) responders were involved in palliative care, but only 55 (41.0%)were satisfied with palliative care given. Majority of responders 118 (88.0%) had idea regarding members ofpalliative care team. About 124 (73.4%) responders knew that, palliative care should start at the time ofdiagnosis and 123 (91.7%) gave correct response regarding the goal of palliative care. Most of the responders124 (92.5%) were convinced that palliative care should be the part of curriculum at all health care levels.Conclusion: Among healthcare providers across Pakistan, the majority have fair idea regarding palliative carebut a more than half of the responders were not satisfied with palliative care they are providing which is mainlydue to the lack in palliative medicine training. Palliative care should be the part of curriculum at all health carelevels with more online programs and workshops.
 How to cite this: Kashif S. Awareness of Palliative Care among Healthcare Providers in Pakistan: A Survey. 2022; 3(4): 174-177. doi: http://doi.org/10.37185/LnS.1.1.224

Pregnancy, Fetal, and Neonatal Outcomes Among Women With Traumatic Brain Injury.

There have been no systematic studies of pregnancy outcomes among women with traumatic brain injury (TBI), potentially limiting informed clinical care for women with such injuries. The purpose of this exploratory study was to evaluate pregnancy and fetal/neonatal outcomes among women with a TBI diagnosis recorded during their delivery hospitalization compared with women without TBI. In this cross-sectional study, we identified women with delivery hospitalizations using 2004-2014 data from the Nationwide Inpatient Sample of the Health Care and Cost Utilization Project. We identified deliveries to women with a TBI diagnosis on hospital discharge records, which included all diagnoses recorded during the delivery, and compared them with deliveries of women without a TBI diagnosis. Pregnancy outcomes included gestational diabetes; preeclampsia/eclampsia; placental abruption; cesarean delivery; and others. Fetal/neonatal outcomes included preterm birth; stillbirth; and small or large gestational age. We modeled risk for each outcome among deliveries to women with TBI compared with women without TBI, using multivariate Poisson regression. Models included sociodemographic and hospital characteristics; secondary models added clinical characteristics (eg, psychiatric disorders) that may be influenced by TBI. We identified 3 597 deliveries to women with a TBI diagnosis and 9 106 312 deliveries to women without TBI. Women with TBI were at an increased risk for placental abruption (relative risk [RR] = 2.73; 95% CI, 2.26-3.30) and associated sequelae (ie, antepartum hemorrhage, cesarean delivery). Women with TBI were at an increased risk for stillbirth (RR = 2.55; 95% CI, 1.97-3.29) and having a baby large for gestational age (RR = 1.30; 95% CI, 1.09-1.56). Findings persisted after controlling for clinical characteristics. Risk for adverse pregnancy outcomes, including placental abruption and stillbirth, were increased among women with TBI. Future research is needed to examine the association between TBI and pregnancy outcomes using longitudinal and prospective data and to investigate potential mechanisms that may heighten risk for adverse outcomes.

The influence of viral respiratory season on perioperative outcomes in patients undergoing spinal fusion for neuromuscular scoliosis.

Respiratory complications are common following neuromuscular scoliosis (NMS) spinal fusion. Concern exists regarding the safety to perform complicated procedures in winter months when viral respiratory illness is common. The purpose of this study was to compare perioperative outcomes in children with NMS undergoing spinal fusion during peak (November-March) or non-peak (April-October) viral season. The Health Care and Utilization Project (HCUP) Kids' inpatient database (KID) from 2006 to 2012 was reviewed. Children 20years or younger who underwent spinal fusion for NMS were included. Patients were grouped by date of surgery during peak or non-peak viral season. Continuous variables were compared using t tests and categorical variables were compared using the Rao-Scott Chi-square test. Weighted logistic regression models were performed. This study identified 5082 records, including 1711 and 3371 patients who had surgery in peak and non-peak viral seasons, respectively. Patients who had spinal fusion during peak viral season were less likely to experience respiratory failure (p = 0.0008) and did not demonstrate an increased incidence of aspiration pneumonia (p = 0.26), respiratory complication (p = 0.43), or mortality (p = 0.68). Respiratory failure was associated with younger age (p = 0.0031), the presence of a tracheostomy (p < 0.0001), and the number of chronic conditions (p < 0.0001). Higher number of chronic medical conditions (mean of 5.0) was associated with an increased risk of in-hospital mortality (p < 0.0001), aspiration pneumonia (p = 0.0009), and respiratory failure (p < 0.0001). Spinal fusion for NMS during peak viral season has a lower risk of respiratory failure without an increase in mortality or other complications compared to during non-peak viral season.

Tapping into community expertise: stakeholder engagement in the design process

The Connection to Care (C2C) project, a transdisciplinary work-in-progress, employs community-engaged participatory research and design methods at the nexus of policy adaptation and product innovations. C2C aims to advance practices that identify and leverage the critical junctures at which people with substance use disorder (SUD) seek lifesaving services and treatment, utilizing stakeholder input in all stages of design and development. Beginning in the Fall of 2018, members of our research team engaged with those at the forefront of the addiction crisis, including first responders, harm reduction and peer specialists, treatment providers, and individuals in recovery and in active substance use in a community greatly impacted by SUD. Through this engagement, the concept for programs and products representing a connection to care emerged, including the design of a backpack to meet the needs of individuals with SUD and those experiencing homelessness. From 2020 to 2022, more than 1,200 backpacks with lifesaving and self-care supplies have been distributed in local communities, as one component of the overall C2C initiative. The backpack is a recognized symbol of the program and has served as an impetus for further program and policy explorations, including as a lens to better understand the role of ongoing stigma. Though addiction science has evolved significantly in the wake of the opioid epidemic, artifacts of policies and practices that criminalize and stigmatize SUD remain as key challenges. This paper explains the steps that C2C has taken to address these challenges, and to empower a community that cares.

Quality Improvement in Itself Changes Your Thinking: Lessons From Disseminating Quality Improvement Methods Through a Multisite International Collaborative Palliative Care Project in India.

Seven major palliative care (PC) centers in India were mentored through the Palliative Care-Promoting Assessment and Improvement of the Cancer Experience (PC-PAICE) by US and Australian academic institutions to implement a quality improvement (QI) project to improve the accessibility and quality of PC at their respective centers. The objective was to evaluate the experiences of teams in implementing QI methods across diverse geographical settings in India. A quota sampling approach was used to elicit perspectives of local stakeholders at each site. The Consolidated Framework for Implementation Research informed development of a semistructured interview guide. Analysis leveraged deductive and inductive approaches. We interviewed 44 participants (eight organizational leaders, 12 clinical leaders, and 24 team members) at seven sites and identified five themes. (1) Implementing QI methods enabled QI teams to think analytically to solve a complex problem and to identify resources. (2) Developing a problem statement by identifying specific gaps in patient care fostered team collaboration toward a common goal. (3) Making use of QI tools (eg, A3 process) systematically provided a new, straightforward QI toolkit and improved QI teams' conceptual understanding. (4) Enhancing stakeholder engagement allowed shared understanding of QI team members' roles and processes and shaped interventions tailored to the local context. (5) Designing less subjective processes for patient care such as assessment scales to identify patient's symptomatic needs positively changed work practices and culture. Engaging and empowering multiple stakeholders to use QI methods facilitated the expansion and improvement of PC and cancer services in India. PC-PAICE demonstrated an efficient, effective way to apply QI methods in an international context. The impact of PC-PAICE is being magnified by developing a cadre of Indian QI leaders.

Role of Basic Healthcare Structures in Strengthening the COVID-19 Response Strategy

Role of Basic Healthcare Structures in Strengthening the COVID-19 Response Strategy

Describing the Breadth and Scope of Keck Medical Student Primary Care Research Projects.

Primary care research is an important field of study within medicine, but little research has characterized medical students' projects on this topic. Second-year medical students at the Keck School of Medicine (KSOM) of University of Southern California are required to complete a research project on a topic of their choice. This study seeks to describe the scope of primary care medical student research conducted by KSOM medical students and specifically Primary Care Program (PCP) pipeline students. The PCP consists of students with a vested interest in primary care, and who we hypothesize are more likely to complete a primary care project. To assess students' primary care (PC) research output, we reviewed and sorted 1,408 KSOM abstracts between 2014 and 2020 into PC or non-PC. PC projects were then recategorized into more specific PC topics. χ2 analysis determined significance at P<.05. We reviewed abstracts from 1,408 KSOM medical students (n=122 PCP; 1,286 non-PCP). Results revealed that the number of PC research projects conducted by 122 PCP students (67.2%, n=82) was statistically significantly higher than by 1,286 non-PCP students (14.7%, n=189, P<.00001). The most common PC research topics (n= 271) were education (patient/medical, n=71, 26%), health diversity/disparities (n=60, 22%), mental health/psychiatry/behavioral science (n=58, 21%), and community medicine (n=48, 18%). Our study describes the breadth and scope of Keck medical student PC research. Supporting PC research efforts by medical students may increase the proportion of students conducting PC research, students choosing PC careers, and faculty producing PC scholarship.

Development and validation of algorithms to identify patients with chronic kidney disease and related chronic diseases across the Northern Territory, Australia

BackgroundElectronic health records can be used for population-wide identification and monitoring of disease. The Territory Kidney Care project developed algorithms to identify individuals with chronic kidney disease (CKD) and several commonly comorbid chronic diseases. This study aims to describe the development and validation of our algorithms for CKD, diabetes, hypertension, and cardiovascular disease. A secondary aim of the study was to describe data completeness of the Territory Kidney Care database.MethodsThe Territory Kidney Care database consolidates electronic health records from multiple health services including public hospitals (n = 6) and primary care health services (> 60) across the Northern Territory, Australia. Using the database (n = 48,569) we selected a stratified random sample of patients (n = 288), which included individuals with mild to end-stage CKD. Diagnostic accuracy of the algorithms was tested against blinded manual chart reviews. Data completeness of the database was also described.ResultsFor CKD defined as CKD stage 1 or higher (eGFR of any level with albuminuria or persistent eGFR < 60 ml/min/1.732, including renal replacement therapy) overall algorithm sensitivity was 93% (95%CI 89 to 96%) and specificity was 73% (95%CI 64 to 82%). For CKD defined as CKD stage 3a or higher (eGFR < 60 ml/min/1.732) algorithm sensitivity and specificity were 93% and 97% respectively. Among the CKD 1 to 5 staging algorithms, the CKD stage 5 algorithm was most accurate with > 99% sensitivity and specificity. For related comorbidities – algorithm sensitivity and specificity results were 75% and 97% for diabetes; 85% and 88% for hypertension; and 79% and 96% for cardiovascular disease.ConclusionsWe developed and validated algorithms to identify CKD and related chronic diseases within electronic health records. Validation results showed that CKD algorithms have a high degree of diagnostic accuracy compared to traditional administrative codes. Our highly accurate algorithms present new opportunities in early kidney disease detection, monitoring, and epidemiological research.

L’imputabilité d’une addiction à un trouble post-traumatique est-elle envisageable dans le cadre d’une expertise du dommage corporel ?

ObjectivesIn the context of the psychiatric examination of the damage of a victim, the research for a link of imputability between an event, a post-traumatic syndrome and symptoms of addiction is specially difficult. We attempt to clarify issues related to forensic thinking in psychiatry. Material and methodWe carry out a review of the literature on two points: The first one concerns the notions of imputability, medical causality and legal causality. The second one concerns the links between addictive behaviors and traumatic symptoms. Via PubMed and Ascodocpsy, with the following keywords: “Substance use disorder in patient with post-traumatic stress disorder”. In the psychodynamic field with the notion of “traumatophilia”. Results1/The legal reasoning is part of a retrospective approach and seeks the social assignment of criminal, civil or administrative responsibility. It contradicts the medical reasoning which aims for a care project focused on action, the future and a possible cure. 2/Imputability criteria come from organ medicine and are marked by an organ lesion model. They are irrelevant to psychiatry. 3/The links between trauma and addiction are complex because there is a reciprocal influence between addiction and post-traumatic stress disorder: the persistence of one promotes the relapse or worsening of the other one. On a statistical level, the studies show a clear link between addictive disorders and psycho-traumatic disorders. Patients with PTSD/addiction comorbidity have, compared to isolated PTSD, a more pejorative evolution, especially if PTSD/addiction is associated with a history of childhood abuse, mistreatment, previous pathology, cocaine use and drug abuse opiates, low support by relatives. Four psychopathological models are referred to PTSD/addiction: the high risk of trauma model, the shared vulnerability model, the susceptibility model, the self-medication model. On a psychodynamic level, addiction can be modeled as an attempt at psychic anesthesia, control and binding of traumatic anxieties. On the neurobiological level, the reference models are based on the hypothalamic-pituitary and noradrenergic system, the opioid systems, NMDA and GABA. ConclusionTo clarify the medico-legal reasoning in psychiatry relating to the imputability of an event on psycho-traumatic symptoms and addictive symptoms, we propose to assume the specificities of mental illness. Mental illnesses are functional illnesses. It is therefore necessary to look for modalities of connection, and not of lesion, between different psychic factors. Addiction should be systematically considered as a comorbid factor of a psychotraumatic syndrome. Between an addiction and PTSD: the persistence of one favors the relapse or worsening of the other. The imputability link seems interesting to us to explore according to the hypotheses developed in the somatoform or bipolar comorbidity models. We suggest several standard questions that may help in the pursuit of clinical reasoning around the imputability of disorders. Is the traumatic disorder primary and the addiction sequel? Is addictive behavior primary and after effects disorders? Are the two disorders primary and independent? Are the two disorders the outcome of the same underlying cause? Is the traumatic disorder altered by the addiction? Are the traumatic disorder and the addictive disorder combined to form a neopathology? Is addiction a symptom of traumatic disorder? Does the addiction bring out the traumatic disorder? Is the addiction an attempt to self-medicate for the traumatic disorder? Do addiction and traumatic disorder share common risk factors? Circular causality model: are addiction and traumatic disorder mutually reinforcing?

Exploring healthcare provider and patient perspectives on current outpatient care of venous leg ulcers and potential interventions to improve their treatment: a mixed methods study in the ulcus cruris care project

BackgroundThe project "Ulcus Cruris Care" aims to improve primary care for patients with venous leg ulcer (VLU) in General Practitioner (GP) practices using a complex intervention comprised of educational components, standardized treatment recommendations, computer-assisted documentation, and case management by non-physician medical assistants (MAs). Prior to implementing and testing the intervention components in general practices, in-depth exploration of current outpatient treatment of VLU patients and relevant implementation determinants was pursued.MethodsA mixed-methods study explored views of GPs, MAs, and patients regarding current VLU outpatient care and the planned intervention components to identify potential implementation determinants. Data were collected through semi-structured guide-based telephone interviews (n = 29) and a survey questionnaire (n = 28). Interviews were transcribed verbatim. Analysis was inductive initially and finalized in a deductive-inductive approach based on domains of the Theoretical Domains Framework to support structuring of relevant implementation determinants. Survey data were analyzed descriptively.ResultsCurrent VLU outpatient care was described as frequently tailored to individual wounds and gradient. In general, workload was shared by GPs (diagnostics, counselling) and MAs (wound care). All care providers were aware of compression therapy, yet not all of them considered it essential for VLU care. Standardized operating procedures and educational components including e-learning were considered supportive. Stronger involvement of non-physician assistants was seen as opportunity to optimize VLU care. Concerns were identified regarding integration of software-supported case management into daily practice routines and regarding potential limitations in decision-making autonomy when using standard operating procedures.ConclusionsFindings in this study emphasize a need for educational interventions addressing VLU care providers as well as patients, particularly with regards to compression therapy. The conception of the planned intervention appears to be adequate and a structured guideline-based case management might be a promising approach for optimization of VLU treatment.

Australian residential aged care home staff experiences of implementing an intervention to improve palliative and end-of-life care for residents: A qualitative study.

Access to high-quality and safe evidence-based palliative care (PC) is important to ensure good end-of-life care for older people in residential aged care homes (RACHs). However, many barriers to providing PC in RACHs are frequently cited. The Quality End-of-Life Care (QEoLC) Project was a multicomponent intervention that included training, evidence-based tools and tele-mentoring, aiming to equip healthcare professionals and careworkers in RACHs with knowledge, skills and confidence in providing PC to residents. This study aims to understand: (1) the experiences of healthcare professionals, careworkers, care managers, planners/implementers who participated in the implementation of the QEoLC Project; and (2) the barriers and facilitators to the implementation. Staff from two RACHs in New South Wales, Australia were recruited between September to November 2021. Semi-structured interviews and thematic data analysis were used. Fifteen participants (seven health professionals [includes one nurse, two clinical educators, three workplace trainers, one clinical manager/nurse], three careworkers and five managers) were interviewed. Most RACH participants agreed that the QEoLC Project increased their awareness of PC and provided them with the skills/confidence to openly discuss death and dying. Participants perceived that the components of the QEoLC Project had the following benefits for residents: more appropriate use of medications, initiation of timely pain management and discussions with families regarding end-of-life care preferences. Key facilitators for implementation were the role of champions, the role of the steering committee, regular clinical meetings to discuss at-risk residents and mentoring. Implementation barriers included: high staff turnover, COVID-19 pandemic, time constraints, perceived absence of executive sponsorship, lack of practical support and systems-related barriers. The findings underline the need for strong leadership, supportive organisational culture and commitment to the implementation of processes for improving the quality of end-of-life care. Furthermore, the results highlight the need for codesigning the intervention with RACHs, provision of dedicated staff/resources to support implementation, and integration of project tools with existing systems for achieving effective implementation outcomes.

Implementing a standardized protocol to improve cervical cancer screening rates in primary care.

Routine cervical cancer screening for women aged 21-65 is a recommended standard practice. Early identification and treatment of cervical cancer improves patient outcomes. Cervical cancer screening rates at the primary care project site were 51%, well below the national benchmark of 87%. The purpose of this quality improvement project was to increase cervical cancer screening rates by implementing a standardized eligibility assessment protocol. This initiative took place at an outpatient family practice site over 7.5 months and included 2,018 eligible patients. Evidence-based interventions included a standardized process change that shifted eligibility assessment from an opportunistic screening by providers to a proactive screening by clinical staff. Using a system reminder prompt, clinical staff began assessing all eligible patients during rooming and proactively scheduling future Pap appointments in office or placing OBGYN referrals, per patient preference. A statistically significant increase in cervical cancer screening rates occurred, 33% ( p < .001). The rate of scheduled Pap appointments increased by 124% ( p < .001), the rate of OBGYN referrals increased by 300% ( p < .001), and the rate of completed Pap tests in office increased by 280% ( p < .001). The results suggest that implementing a proactive, standardized screening process can increase cervical cancer screening rates in primary care.

"Illustrated guide for the observation of the sensory-motor behavior of the preterm newborn"

Developmental care is defined by a personalized approach to the premature child. Observation of sensory-motor behavior is a key part of this approach and requires specific training and the use ofobservation tools. This study analyzes the use of an illustrated guide during the observation and evaluation of the sensory-motor behavior of the premature baby; this didactic contribution constitutes a real added value for the professionals, allowing the elaboration of a care project.

Determinants of Health-Related Quality of Life Among Community-Dwelling Thai Older Adults in Chiang Mai, Northern Thailand.

BackgroundPopulation aging has been growing worldwide and Thailand has become an aged society with 20% of its population aged 60 and over. Age-related decline in physical and mental health impacts the health-related quality of life (HRQOL) of older adults.PurposeWe aimed to describe the HRQOL of Thai older adults, residing in the community.MethodsThis cross-sectional survey was part of a Community-Integrated Intermediary Care project (CIIC), TCTR20190412004. A total of 1509 participants from an intervention arm of a cluster randomized controlled trial were included. A Thai version of the Euro-Qol questionnaire (EQ-5D-5L) was used to determine the HRQOL and associated sociodemographic background, health behaviors and underlying diseases of a representative sample from Maehia, Chiang Mai, Thailand. SPSS version 24 was used to analyze data via descriptive analysis and binary logistic regression.ResultsThe mean age of the participants was 69.31±7.10 years, and nearly a quarter (23.8%) was older than 75 years. The mean EQ index score was 0.81±0.23 and older age, lower educational attainment, unemployment, lack of exercise habits, current smokers, having history of a fall in the last 6 months, diabetes, hyperlipidemia, dependency assessed using Barthel’s Activity of Daily Living (ADL) Index, and depression using the Geriatric Depression Scale (GDS) were more likely to represent HRQOL-related problems.ConclusionOur findings have highlighted the factors affecting the HRQOL of community-dwelling older adults which could be of importance in preparing for active and healthy aging communities. The routine dependency assessment using the ADL index will be useful in estimating the HRQOL of the aging population. Fall prevention programs are also recommended to reduce dependency. Moreover, the association of having diabetes and hyperlipidemia with problems in HRQOL dimensions highlight the need for public health intervention not only to prevent the increasing burden of non-communicable diseases but also to improve the HRQOL of older adults.

고령자 커뮤니티케어 실현을 위한 BIM활용 공동주택개조 시뮬레이션 개발

Recently, housing renovation support has been strengthened to improve the residential environment of elderly households through integrated community care projects. Although the support is mainly concentrated on the disadvantaged in housing, it is evaluated as a desirable effort in terms of reinforcing the welfare system to provide aging residents with housing remodeling support, and revitalizing the housing recycling industry through these projects. However, the housing renovation support has very low accessibility due to the lack of public relation efforts, limited eligibility, and the insecurity and uncertainty of the system. The most efficient way to increase its accessibility can be an approach using actual cases. However, as few cases have been recorded to date and there is a limitation in face-to-face contact with all eligible residents, access via an online virtual experience can be an effective alternative. This study therefore focused on collective housing buildings where the majority of the elderly currently reside and spatial information can be easily acquired. The objectification process used to construct a Building Information Model (BIM) was performed by reflecting the physical obstacles and body functions of the elderly specific to each lifestyle. A simulation system based on this model was established by setting and applying views by space. This would enable the system to generate comparative images of the conditions before and after the construction to enhance the user’s understanding as well as the drawings and details of the construction. Since construction details are also part of object information, estimates can be created by linking them with unit price information. This virtual simulation system is expected to reduce the waste of renovation costs and resident dissatisfaction, and increase the accessibility of the support project by reaching a wide range of users via an online approach.

Clinical outcomes of digital health in adults with cystic fibrosis

BackgroundThe aim of this study was to assess the long-term clinical impact of the application of e-health as part of a virtual model of care in patients with Cystic Fibrosis (CF). MethodsDigital care group (DCG) were deemed suitable for using the NuvoAir Home platform to monitor their disease at home as part of a virtual model of care project. The usual care group (UCG) remained on usual care. NuvoAir Home platform consists of a smartphone application, Bluetooth spirometer and a clinician portal. Data on pulmonary function, Cystic Fibrosis Questionnaire–Revised (CFQR) and pulmonary exacerbations were collected at baseline and after twelve months. A survey for the digital care group was emailed to evaluate their experience using the technology. ResultsBetween February 2020 and May 2020 a cohort of 43 CF patients were recruited for the DCG (26 females; mean age 31.6 ± 6.8; 16 homozygous for delta F508; FEV1 48.4 ± 16.3% predicted) and 36 CF patients for UCG (18 females; mean age 29.1 ± 9.4; 6 homozygous for delta F508; FEV1 77.0 ± 25.0% predicted). CFQ-R score improved significantly through 12 months in the DCG with a mean change of 13.8 points, p < 0.0001, and no changes for the UCG (p = 0.73). When we analyzed the subgroup of CF patients on digital and usual care who did not receive CFTR modulator therapy, we found a change in CFQ-R score which was significantly associated with the use of digital technology while adjusting for baseline differences (p = 0.020). There was no significant difference in the change in lung function and number of exacerbations. 90% of patients reported they understood their CF better using the NuvoAir Home platform. No changes in medical treatment were reported during that time. ConclusionsThe application of digital technologies in the management of adults with CF showed an improvement in patients’ quality of life. Using a virtual model of care was well accepted by CF patients and improved their understanding of their medical condition.

‘Value-based methodology for person-centred, integrated care supported by Information and Communication Technologies’ (ValueCare) for older people in Europe: study protocol for a pre-post controlled trial

BackgroundOlder people receive care from multiple providers which often results in a lack of coordination. The Information and Communication Technology (ICT) enabled value-based methodology for integrated care (ValueCare) project aims to develop and implement efficient outcome-based, integrated health and social care for older people with multimorbidity, and/or frailty, and/or mild to moderate cognitive impairment in seven sites (Athens, Greece; Coimbra, Portugal; Cork/Kerry, Ireland; Rijeka, Croatia; Rotterdam, the Netherlands; Treviso, Italy; and Valencia, Spain). We will evaluate the implementation and the outcomes of the ValueCare approach. This paper presents the study protocol of the ValueCare project; a protocol for a pre-post controlled study in seven large-scale sites in Europe over the period between 2021 and 2023.MethodsA pre-post controlled study design including three time points (baseline, post-intervention after 12 months, and follow-up after 18 months) and two groups (intervention and control group) will be utilised. In each site, (net) 240 older people (120 in the intervention group and 120 in the control group), 50–70 informal caregivers (e.g. relatives, friends), and 30–40 health and social care practitioners will be invited to participate and provide informed consent. Self-reported outcomes will be measured in multiple domains; for older people: health, wellbeing, quality of life, lifestyle behaviour, and health and social care use; for informal caregivers and health and social care practitioners: wellbeing, perceived burden and (job) satisfaction. In addition, implementation outcomes will be measured in terms of acceptability, appropriateness, feasibility, fidelity, and costs. To evaluate differences in outcomes between the intervention and control group (multilevel) logistic and linear regression analyses will be used. Qualitative analysis will be performed on the focus group data.DiscussionThis study will provide new insights into the feasibility and effectiveness of a value-based methodology for integrated care supported by ICT for older people, their informal caregivers, and health and social care practitioners in seven different European settings.Trial registrationISRCTN registry number is 25089186. Date of trial registration is 16/11/2021.

Digital Health Care Industry Ecosystem: Network Analysis.

As the need for digital health care based on mobile devices is increasing, with the rapid development of digital technologies, especially in the face of the COVID-19 pandemic, gaining a better understanding of the industrial structure is needed to activate the use of digital health care. The aim of this study was to suggest measures to revitalize the digital health care industry by deriving the stakeholders and major issues with respect to the ecosystem of the industry. A total of 1822 newspaper articles were collected using Big Kings, a big data system for news, for a limited period from 2016 to August 2021, when the mobile health care project was promoted in Korea centered on public health centers. The R and NetMiner programs were used for network analysis. The Korean government and the Ministry of Health and Welfare showed the highest centrality and appeared as major stakeholders, and their common major issues were "reviewing the introduction of telemedicine," "concerns about bankruptcy of local clinics," and "building an integrated platform for precision medicine." In addition, the major stakeholders of medical institutions and companies were Seoul National University Hospital, Kangbuk Samsung Hospital, Ajou University Hospital, Samsung, and Vuno Inc. This analysis confirmed that the issues related to digital health care are largely composed of telemedicine, data, and health care business. For digital health care to develop as a national innovative growth engine and to be institutionalized, the development of a digital health care fee model that can improve the regulatory system and the cost-effectiveness of patient care, centering on the Ministry of Health and Welfare as a key stakeholder, is essential.

National Development and Regional Differences in eHealth Maturity in Finnish Public Health Care: Survey Study.

BackgroundeHealth increasingly affects the delivery of health care around the world and the quest for more efficient health systems. In Finland, the development of eHealth maturity has been systematically studied since 2003, through surveys conducted every 3 years. It has also been monitored in several international studies. The indicators used in these studies examined the availability of the electronic patient record, picture archiving and communication system, health information exchange, and other key eHealth functionalities.ObjectiveThe first aim is to study the national development in the maturity level of eHealth in primary health care and specialized care between 2011 and 2020 in Finland. The second aim is to clarify the regional differences in the maturity level of eHealth among Finnish hospital districts in 2020.MethodsData for this study were collected in 2011, 2014, 2017, and 2020, using web-based questionnaires from the Use of information and communication technology surveys in Finnish health care project. In total, 16 indicators were selected to describe the status of eHealth, and they were based on international eHealth studies and Finnish eHealth surveys in 3 areas: applications, regional integration, and data security and information and communications technology skills. The indicators remain the same in all the study years; therefore, the results are comparable.ResultsAll the specialized care organizations (21/21, 100%) in 2011, 2014, 2017, and 2020 participated in the study. The response rate among primary health care organizations was 86.3% (139/161) in 2011, 88.2% (135/153) in 2014, 85.8% (121/141) in 2017, and 95.6% (130/136) in 2020. At the national level, the biggest developments in eHealth maturity occurred between 2011 and 2014. The development has since continued, and some indicators have been saturated. Primary health care lags behind specialized care organizations, as measured by all the indicators and throughout the period under review. Regionally, there are differences among different types of organizations.ConclusionseHealth maturity has steadily progressed in Finland nationally, and its implementation has also been promoted through various national strategies and legislative changes. Some eHealth indicators have already been saturated and achieved an intensity of use rate of 100%. However, the scope for development remains, especially in primary health care. As Finland has long been a pioneer in the digitalization of health care, the results of this study show that the functionalities of eHealth will be adopted in stages, and deployment will take time; therefore, national eHealth strategies and legislative changes need to be implemented in a timely manner. The comprehensive sample size used in this study allows a regional comparison in the country, compared with previous country-specific international studies.