Methods Of Service Delivery Research Articles

Telemedicine : New Era of Health Service

Telemedicine has the potential to help facilitate the delivery of health services to rural and remote areas. In somecircumstances, telemedicine may also be useful for the delivery of education and teaching programmes and the facilitation of administrative meetings. In this paper reference is made to a variety of telemedicine applications. An overriding imperative is to focus on the clinical problem first with careful consideration given to the significant organisational changes which are associated with the introduction of a new or alternative method of health service delivery for remote patients. For telemedicine to be effective it is also important that all sites involved are adequately resourced in terms of staff, equipment, telecommunications, technical support and training. In addition, there are a number of logistical factors which are important when considering the development of a telemedicine service including site selection, clinician empowerment, telemedicine management, technological requirements, user training, telemedicine evaluation, and information sharing through publication.
 JCMCTA 2019 ; 30 (1) : 5-11

Voice therapy for Parkinson’s disease via smartphone videoconference in Malaysia: A preliminary study

Introduction Intensive voice therapy is one of the best evidence-based treatments to improve speech and voice difficulties to individuals with Parkinson’s disease (PD). However, accessibility to intensive voice therapy is highly challenging in Malaysia due to the lack of voice specialised speech-language therapists. This study examined the feasibility of using smartphone videoconference to deliver intensive voice therapy to individuals with PD in Malaysia. Methods Intensive voice therapy was delivered to 11 adults with PD using a smartphone videoconference method via WhatsApp Messenger freeware. The therapy consisted of 12 sessions over four weeks and focused on increasing vocal loudness. Outcomes were assessed using objective, perceptual and quality-of-life measures pre and post treatment. Participant satisfaction with the telerehabilitation method was obtained via the Smartphone-Based Therapy Satisfaction Questionnaire. Results Significant gains were reported for sound pressure level in sustained vowels and monologue. Perceptual ratings showed significant improvements in overall mean severity and loudness after treatment. Mean scores of speech intelligibility and Voice Handicap Index-10 were significantly better post treatment. Overall, participants were highly satisfied with the smartphone videoconference method. Discussion Present results suggest that the smartphone videoconference method is feasible to deliver intensive voice therapy to individuals with PD to gain better speech and voice functions. Future studies need to address the standardisation of the system protocol to optimise this novel service delivery method in Malaysia.

A Practical Guide to Establishing an Online Speech Therapy Private Practice

Purpose Telepractice, although not new, is an innovative, rapidly evolving field. Accessible, secure, interactive, and effective are the main benefits of this online method of providing speech therapy services. While a trained clinician is well versed in providing clinical services, the process of establishing a private telepractice can be a daunting task. From setting up the business model, marketing plan, and record-keeping systems to choosing a video conference platform and learning the rules and regulations, this article aims to provide an introductory overview of the logistics and lay the groundwork to facilitate the process of setting up a private telepractice. Conclusion While endorsed by the American Speech-Language-Hearing Association as an appropriate method of service delivery in 2005, public perception, lack of controlled, substantiated research proving the effectiveness of the telepractice model, and the general absence of insurance reimbursement for service are still obstacles in the growth of online speech therapy. Education and advocacy are needed to push this cause forward and fill in the gaps.

Power Data Service Based on Ententes

Entente of data management and service is the definition method of data management and data service delivery. It is not necessary to establish dependencies and relationships between demand and data providers on data specifications and other attributes, but supply and demand can be constrained by signing Ententes. Data Ententes between suppliers and consumers need to build on common domains. Data providers publish their own data capability statement, such as data services method and data specifications. Data demanders need to identify the data and to request for data services. This data management and service method is suitable for establishing a general and flexible power multi-source data and independent management system.

Feasibility of Automatic Speech Recognition for Providing Feedback During Tablet-Based Treatment for Apraxia of Speech Plus Aphasia.

Purpose Individuals with neurogenic speech disorders require ongoing therapeutic support to achieve functional communication goals. Alternative methods for service delivery, such as tablet-based speech therapy applications, may help bridge the gap and bring therapeutic interventions to the patient in an engaging way. The purpose of this study was to evaluate an iPad-based speech therapy app that uses automatic speech recognition (ASR) software to provide feedback on speech accuracy to determine the ASR's accuracy against human judgment and whether participants' speech improved with this ASR-based feedback. Method Five participants with apraxia of speech plus aphasia secondary to stroke completed an intensive 4-week at-home therapy program using a novel word training app with built-in ASR. Multiple baselines across participants and behaviors designs were employed, with weekly probes and follow-up at 1 month posttreatment. Four sessions a week of 100 practice trials each were prescribed, with 1 being clinician-run and the remainder done independently. Dependent variables of interest were ASR-human agreement on accuracy during practice trials and human-judged word production accuracy over time in probes. Also, user experience surveys were completed immediately posttreatment. Results ASR-human agreement on accuracy averaged ~80%, which is a common threshold applied for interrater agreement. All participants demonstrated improved word production accuracy over time with the ASR-based feedback and maintenance of gains after 1 month. All participants reported enjoying using the app with support of a speech pathologist. Conclusion For these participants with apraxia of speech plus aphasia due to stroke, satisfactory gains were made in word production accuracy with an app-based therapy program providing ASR-based feedback on accuracy. Findings support further testing of this ASR-based approach as a supplement to clinician-run sessions to assist clients with similar profiles in achieving higher amount and intensity of practice as well as empowering them to manage their own therapy program. Supplemental Material https://doi.org/10.23641/asha.8206628.

Comparing fly-in fly-out and telehealth models for delivering advanced-practice physiotherapy services in regional Queensland: An audit of outcomes and costs

Introduction Recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities in Queensland, Australia remains a challenge. To overcome this barrier, two different service delivery models (Fly-In, Fly-Out (FIFO), Telehealth) were trialled by one regional facility. This study aims to describe the economic- and service-related outcomes of these two methods of service delivery. Methods A retrospective audit was conducted where two nine-week time periods were selected for each service delivery model. Outcomes of interests include patient demographics and case-mix, service utilisation, clinical actions, adverse events and costs. Net financial position for both models was calculated based upon costs incurred and revenue generated by service activity. Results A total of 33 appointment slots were recorded for each service delivery model. Patient case-mix was variable, where the Telehealth model predominately involved patients with musculoskeletal spinal conditions managed from a neurosurgical waiting list. Appointment slot utilisation and pattern of referral for further investigations were similar between models. No safety incidents occurred in either service delivery model. An estimated cost-savings of 13% for the Telehealth model could be achieved when compared to the FIFO model. Discussion Telehealth is a safe, efficient and viable option when compared to a traditional in-person outreach service, while providing cost-savings. Telehealth should be seen as a service delivery medium in which sustainable recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities can be achieved.

How professional capital and team heterogeneity affect the demands of online team-based medical service

BackgroundThe provision of medical services by Medical Teams (MT) on Online Healthcare Communities (OHCs) is a novel method employed by geographically-dispersed healthcare professionals to serve one patient simultaneously, allowing patients to receive more specific, targeted and comprehensive advice. As a relatively new method of service delivery, little attention has been paid to identifying the determinants of Team-based Service Demands (TSD). Based on Upper Echelons Theory and Social Exchange Theory, this study examines the impact of both professional capital (status capital and decisional capital) and team heterogeneity (team size and dispersion) on TSD.MethodsThis study uses data collected from 890 MTs, employing 3994 team members, operating on haodf.com, a Chinese OHC, to examine effects of both leader and team characteristics on TSD.ResultsOur findings suggest that a MT’s characteristics have a significant impact on TSD. Firstly, the decisional capital of both leaders and teams were positively related with TSD, while only the status capital of leaders saw a positive impact. Secondly, team heterogeneity influenced TSD in two ways: (1) provided a direct negative impact and (2) positively moderated the relationship between professional capital and TSD.ConclusionThis paper comprehensively studies the impact of TSD from the perspectives of professional capital and team heterogeneity, expanding current theoretical understanding of team heterogeneity and social capital in OHCs. Further, it provides practical suggestions for platform development and team leaders managing MTs in online environments.

Report on the Use of Telehealth in Early Intervention in Colorado: Strengths and Challenges with Telehealth as a Service Delivery Method.

The use of telehealth as a service delivery method for early intervention (EI) is in its infancy and few studies have examined its use within the context of a statewide program. The focus of this report was to determine the factors that influence providers’ utilization of telehealth in Colorado’s Part C Early Intervention program (EI Colorado). This report presents information that was gathered through surveys sent to Part C program administrators, service coordinators, providers, and caregivers. Surveys were used to understand perceptions of telehealth, actual experiences with telehealth, and perceived benefits and challenges using this service delivery method. Follow-up focus groups were conducted with program administrators and family members to gather more nuanced information. Participants identified several benefits associated with telehealth including its flexibility, access to providers, and more family engagement. The primary barriers included access to high speed internet and the opinion that telehealth was not as effective as in-person treatment. The results in the report served to identify next steps in the implementation of telehealth in Colorado’s Part C EI program.

Beyond the Revolving Door: Long-Term Lived Experience of Eating Disorders and Specialist Service Provision.

In this study, we undertook a narrative analysis of participants' long-term lived experience of eating disorders and specialist service provision. Eight participants were recruited with service experience across five National Health Service (NHS) Trusts in the United Kingdom. All participants had a minimum of 10 years self-reported experience living with an eating disorder. The data are presented across different temporal stages that demonstrate the development of participants' self-construct in relation to their first contact with specialist services, what had happened in their lives for this to become necessary, and their current relationships with services, before exploring what participants need from services to help them feel heard going forward. Findings suggest that current methods of service delivery result in delayed and inappropriate supports and a consequent "battling" against professionals, which can provide an obstacle to compassionate and collaborative working and promote "revolving door" experiences.

The Interdependence of Motor and Social Skill Development: Influence on Participation.

Participation is a major outcome area for physical therapists serving young children with disabilities. Contemporary models of disability such as the International Classification of Function, developmental theories such as the system perspective, and evidence-based early childhood practices recognize the interdependence of developmental domains, and suggest that change in 1 area of development influences change in another. Physical therapy provided in naturally occurring activities and routines, considered the preferred service delivery method, promotes participation of young children with disabilities. Research indicates that: (1) children develop skills, become independent, and form relationships through participation; and (2) with developing skills, children can increasingly participate. The purpose of this Perspective article is to synthesize the literature examining the relationship between motor skill development and the social interaction dimension of participation in young children. Current research examining the influence of motor skill development on social interactions in children with autism spectrum disorder will be discussed, exemplifying the interdependence of developmental domains. Implications for physical therapist practice and recommendations for future research are provided.

Earlier Physical Therapy Input Is Associated With a Reduced Length of Hospital Stay and Reduced Care Needs on Discharge in Frail Older Inpatients: An Observational Study.

Pressures on hospital bed occupancy in the English National Health Service have focused attention on enhanced service delivery models and methods by which physical therapists might contribute to effective cost savings, while retaining a patient-centered approach. Earlier access to physical therapy may lead to better outcomes in frail older inpatients, but this has not been well studied in acute National Health Service hospitals. Our aim was to retrospectively study the associations between early physical therapy input and length of hospital stay (LOS), functional outcomes, and care needs on discharge. This was a retrospective observational study in a large tertiary university National Health Service hospital in the United Kingdom. We analyzed all admission episodes of people admitted to the department of medicine for the elderly wards for more than 3 months in 2016. Patients were categorized into 2 groups: those examined by a physical therapist within 24 hours of admission and those examined after 24 hours of admission.The outcome variables were as follows: LOS (days), functional measures on discharge (Elderly Mobility Scale and walking speed over 6 m), and the requirement of formal care on discharge. Characterization variables on admission were age, gender, existence of a formal care package, preadmission abode, the Clinical Frailty Scale, Charlson Comorbidity Index, the Emergency Department Modified Early Warning Score, C-reactive protein level on admission, and the 4-item version of the Abbreviated Mental Test.The association between the delay to physical therapy input and LOS before discharge home was evaluated using a Cox proportional hazards regression model. There were 1022 hospital episodes during the study period. We excluded 19 who were discharged without being examined by a physical therapist. Of the remaining 1003, 584 (58.2%) were examined within 24 hours of admission (early assessment) and 419 (41.8%) after 24 hours of admission (late assessment).The median (interquartile range) LOS of the early assessment group was 6.7 (3.1-13.7) versus 10.0 (4.2-20.1) days in the late assessment group, P < .001. The early assessment group was less likely to require formal care on discharge: n = 110 (20.3%) versus n = 105 (27.0%), P = .016. No other statistically significant differences were seen between the 2 groups.In the unadjusted Cox proportional hazards model, the hazard ratio for early assessment compared with late assessment was 1.29 (95% confidence interval: 1.12-1.48, P < .001). Early assessment was associated with a 29% higher probability of discharge to usual residence within the first 21 days after admission than the late assessment. Adjustment for possible confounding variables increased the hazard ratio: 1.34 (1.16-1.55), P < .001. Early physical therapy input was associated with a shorter LOS and lower odds of needing care on discharge. This may be due to the beneficial effect of early physical therapy in preventing hospital-related deconditioning in frail older adults. However, causality cannot be inferred and further research is needed to investigate causal mechanisms.

Health Care Providers' Perspectives on Family Compliance and Behavior Change in a Childhood Obesity Program.

Background. Evidence suggests that children and adolescents growing up in low-income families and those with underrepresented ethnocultural backgrounds tend to have high prevalence rates of obesity and more difficulty adhering to childhood obesity interventions. However, less is known about how intergenerational, family-based approaches to lifestyle interventions for childhood obesity support sustained behavior change. Aims. The aim of this study was to explore the perspectives of health care providers regarding family adherence and behavior change in a childhood obesity program that served ethnoculturally diverse and low-income families. Method. Semistructured in-person interviews were conducted with 18 providers at one of three hospitals participating in a Canadian family-based childhood obesity program. Data were thematically analyzed using a constant comparative approach. Results. The following key themes emerged as challenges from the provider's perspective for family adherence and behavior modification in the childhood obesity program: divergent views about obesity, complicated lives and logistical priorities, parental role modeling, and intergenerational tensions. Discussion and Conclusion. This examination of providers' perspectives on family adherence and behavior modification relevant to the management of childhood obesity highlight the importance of tailoring childhood obesity programs to the complex and diverse needs of families from diverse backgrounds. Recommendations include methods of service delivery that address logistical challenges and are better suited to extended families, particularly grandparents.

Engaging rural young mothers in a technology-based intervention for depression

Peripartum depression is prevalent among young mothers (ages 25 and younger), and low family support can exacerbate depressive symptoms. The current study explores an innovative method for engaging young mothers in a family-based intervention to help reduce peripartum depressive symptoms. This descriptive study includes details on the baseline characteristics of participants, integrative support teams, and a service delivery method to engage families living rural communities. In conclusion, engaging depressed young mothers living in rural communities requires a multifaceted approach. Our approach has demonstrated promise in engaging this hard-to-reach population. Implications for clinical practice and future research are addressed.

Facilitators and Barriers for Implementing an Internet Clinic for the Treatment of Pressure Injuries.

Background:Pressure injuries (PIs) represent a frequent, often preventable, secondary complication of spinal cord injury (SCI) with serious consequences to health, societal participation, and quality of life. Specialized knowledge and service delivery related to treatment and prevention are typically located within major health centers.Introduction:For persons with SCI living at home, it can be challenging to access specialized PI care. A telehealth approach could help mitigate this challenge. This multisite pilot investigation assessed the feasibility of integrating information technologies within the management of PIs.Materials and Methods:Each study site formed a specialized interdisciplinary care team that identified components of their standard clinical care pathway and examined how they could be integrated with study technologies. A monitoring system was utilized to enable patients and caregivers to exchange clinical information with the care team.Results:Clinician and patient focus groups were completed to identify facilitators and barriers for long-term implementation. Findings demonstrate that this method of service delivery is feasible but requires further development.Discussion:This model of care requires refinement to address technological, regulatory, and clinician acceptance barriers; however, increased access to these services has the potential for improving PI healing or prevention rates in comparison with those not able to access specialized services.Conclusions:This project demonstrates that PI treatment services can be delivered effectively through the internet. Future trials can investigate efficacy and cost-effectiveness of this model of care to inform sustained implementation.

Service Delivery Innovation in Health Care for Patient Satisfaction at Primary and Secondary Level

The purpose of this research is to identify and address the service delivery issues faced by patients in hospitals including emergency departments. It illustrates the available solutions and determines the one that best fits the solution among service delivery methods in hospitals to provide quick and quality care with better efficiency. There are various software tools that are used to analyse and minimize the patients waiting times. This research examines and discusses the existing practices and findings that are currently being used in the hospital frameworks. It also examines the factors influencing the service delivery and patient satisfaction through different methods and tools to give a clearer picture of the patient flow at the hospitals utilizing a case study approach in the context of hospitals within NSW Australia. This research paper proposes improvement in service delivery model, which potentially improves patient satisfaction as well as increase efficiency for health care service providers to handle huge overcrowding in many hospitals. It potentially creates opportunities for better health care by providing better services on time and in a better quality.

A musculoskeletal single point of referral in primary care. The effect on physiotherapy, occupational therapy and orthopaedic triage providers

Purpose: A single point of referral was implemented in partnership between Allied Health Professionals Suffolk (AHPS) and Norfolk Community Health and Care (NCHC) forming the Integrated Therapy Partnership (ITP). This aimed to standardise the care pathways for musculoskeletal conditions and ensure primary care referrals are processed to the correct provider first time around. This should avoid unnecessary secondary care referrals, where patients are seen in secondary care, receive no treatment and are referred back to community providers. Referrals are triaged by senior physiotherapists. Similar models have been suggested as effective methods of service delivery by the British Orthopaedic Association (Lennox & Karstad, 2013).

Conquer Panic: a Case Study on Integrating Technology into a Compressed Panic Disorder Treatment for Rural Veterans

In recent years, much of the innovation in patient care at the Veterans Health Administration has focused on improving access to behavioral health treatments. One innovation that can address barriers faced by veterans, especially those living in rural areas, is the use of digital tools such as smartphone applications (apps). This study is a pilot of a newly developed app, entitled Conquer Panic, which is integrated with intensive panic control treatment, a compressed group treatment for panic disorder. Two Operation Enduring Freedom/Operation Iraqi Freedom veterans used the Conquer Panic app as an integrated component of their treatment. Descriptive information obtained from the veterans’ treatment records is presented along with a summary of the veterans’ panic symptoms from pretreatment to 6 months following treatment. In addition, structured feedback given by the veterans concerning the treatment package, as a whole, and the Conquer Panic app are provided. Overall, both veterans indicated favorable opinions of the treatment package and the Conquer Panic app. Benefits of the Conquer Panic app included carry-over of primary treatment components beyond the provider-delivered phase of treatment, accessibility of information before and during actual panic attacks, and ease of use. Also, both veterans demonstrated marked reductions in panic symptom severity following the integrated treatment. Implications of these treatment innovations are discussed along with recommendations and future directions for combining novel service-delivery methods.

How perceived value drives the use of mobile financial services apps

Mobile information services have revolutionized business models and service delivery methods by facilitating consumer access to information and order placement via mobile apps. In developed markets, mobile banking (m-banking) and mobile payment (m-payment) applications have replaced text-based mobile services. However, extant research has not addressed these mobile financial services apps (MFSAs) adequately from the perspective of consumer behavior. Thus, the present study developed and tested a series of hypotheses related to the antecedents of perceived value of MFSA use; it also examined how such use affects the development of customers’ overall relationships with banks. Our hypotheses were tested using two samples (N = 992; N = 524) comprising different types of MFSA end-users in one of the leading countries in digital banking, Finland. The results supported most of the hypotheses and revealed that self-congruence and new product novelty are the principal drivers of perceived MFSA value. In addition, the findings show that the perceived value of MFSAs yields strong positive effects on customers’ overall satisfaction and commitment to their bank. The present study’s key managerial implication is that banks’ investments in developing MFSAs result in improved relationships with customers and increased business.

WIDENING THE SCOPE OF SOCIAL SUPPORT: THE FLORIDA MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAM.

The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is designed to support pregnant women and families in developing skills and utilizing resources necessary to promote their children's physical, social, and emotional development. Little evaluation attention has focused on large-scale, public policy driven home-visiting programs. Social support provision is a critical component of a successful home-visiting program; therefore, there is a need to better understand participants' perceptions of social support provided to them in this context. Forty-five home-visiting participants from five Florida MIECHV programs completed semistructured telephone interviews. Participants discussed their experiences with the MIECHV program, including descriptions of their interactions with home visitors. Content analysis revealed that participants experienced multilayered social support from home-visiting staff. Families needed and received substantial emotional, instrumental, informational, and appraisal support at the individual level. This support was embedded within and strengthened by the strategies and activities of the home-visiting model of service provision. Results highlight the powerful opportunity home visiting offers as a method of service delivery within the larger system of care to increase social support in families experiencing high risk for negative maternal and child health outcomes. Implications for policy and practice are discussed.

Early intervention of Autism Spectrum Disorder: translating research into practice

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder, with increasing prevalence globally. Early intervention has been shown to improve the core deficits and result in a favorable outcome in children with ASD. Various interventional methods, novel mechanisms, and approaches are being widely researched. Though accelerating interventional research in ASD is observed globally, evidence from Indian setting is sparse. Given the uniqueness of cultural, socio-economic conditions, population statistics, existing health care and referral system, it is pivotal to develop and test interventional methods that are applicable and acceptable to the indigenous population. This paper reviews the currently available evidence-based treatment modalities in the Indian settings, with a specific focus on the behavioral interventions. Early diagnosis is seldom seen to translate into early intervention. In the background of the existing challenges, strategies to translate research into practice in terms of developing sustainable methods of service delivery, capacity building, training of trainers, need for liaison between experts and role of health care policy makers are discussed. Improving awareness among parents, medical professionals and stakeholders is the first step forward, towards translating research into practice.