Sustainable Model Of Care Research Articles

Effectiveness and sustainability of a multidisciplinary care model for patients with hemodialysis access dysfunction.

A multidisciplinary care model involving the interventional radiologist, vascular surgeon, interventional nephrologist, renal advanced nurse practitioner, and renal coordinators was implemented to improve the care for the patient admitted with dysfunctional hemodialysis access. This study aims to evaluate the effectiveness and sustainability of this multidisciplinary care model. A dedicated interventional nephrology suite was established to perform endovascular procedures for patients admitted with hemodialysis access dysfunction via the emergency department of the hospital. We retrospectively collected data from electronic medical records 1-year before and after the implementation (April 2015). Outcome measures include waiting time for intervention, length of stays (LOS), number of dialysis catheter insertions before the intervention, number of inpatient dialysis required, and success rates of the interventions. The waiting time for intervention and LOS was tracked over the next 3 years to determine the sustainability of the care model. Eight hundred eighty-one endovascular interventions (314 angioplasties, 567 thrombolysis) were performed on 554 patients. Post-implementation, a greater proportion of intervention was performed within 24 h (238 (50.2%) vs 70 (17.2%), p < 0.001) with lesser proportion of patients requiring bridging hemodialysis via temporary catheter, 156 (32.9%) versus 215 (52.8%), p < 0.001. A shorter median LOS and days-to-intervention were reported, 3 (IQR 2-6) versus 5 days (IQR 3-8), p < 0.001 and 1 (IQR 1-2) versus 3 days (IQR 2-4), p < 0.001 respectively. Less hemodialysis session/patient required, 2 (IQR 1-3) versus 3 (IQR 2-4), p < 0.001. The procedural success rate was greater, 440 (92.8%) versus 355 (87.2%), p = 0.020. Three years following implementation, the proportion of patients who received intervention within 24 h and were discharged within 48 h was reported to be persistently greater, 43% versus 13%, p < 0.001, and 27% versus 6%, p < 0.001 respectively. This multi-disciplinary collaboration demonstrated a sustainable care model in improving the delivery of healthcare services for patients with dysfunctional hemodialysis access.

Past trends and future projections of palliative care needs in Chile: analysis of routinely available death registry and population data

BackgroundThe number of people with palliative care needs is projected to increase globally. Chile has recently introduced legislation for universal access to palliative care services for patients with severe and terminal illnesses, including non-cancer conditions. We aimed to estimate the number of people affected by serious health-related suffering and need for palliative care in Chile to 2050.MethodsWe used data on all deaths registered in Chile between 1997-2019 and population estimates for 1997–2050. We used Poisson regression to model past trends in causes of death adjusted by age, sex and population estimates, to project the number of deaths for each cause from 2021 to 2050. We applied the Lancet Commission on Palliative Care and Pain Relief weights to these projections to identify decedents and non-decedents with palliative care needs.ResultsPopulation palliative care needs in Chile are projected to increase from 117 (95% CI 114 to 120) thousand people in 2021 to 209 (95% CI 198 to 223) thousand people in 2050, a 79% increase (IRR 1.79; 95% CI 1.78–1.80). This increase will be driven by non-cancer conditions, particularly dementia (IRR 2.9, 95% CI 2.85–2.95) and cardiovascular conditions (IRR 1.86, 95% CI 1.83–1.89). By 2050, 50% of those estimated to need palliative care will be non-decedents (not expected to die within a year).ConclusionsChile will experience a large increase in palliative care needs, particularly for people with dementia and other non-cancer conditions. Improved availability of high-quality services, expanded clinician training and new sustainable models of care are urgently required to ensure universal access to palliative care.

Exploring Staff Perspectives and Experiences from a Nurse Practitioner-Led Behavioral Health Integration Project in North Carolina Multi-Site Federally Qualified Health Center: A Qualitative Descriptive Study

Purpose As primary care (PC) clinics seek to integrate behavioral health (BH) services into patient care, it is crucial to understand the experiences of the clinic team and the impact on workflow and well-being. This study was designed to identify perspectives and experiences of nurse practitioner-led PC teams as they implemented a behavioral health integration (BHI) model into their Federally Qualified Health Center PC practices. Methods We conducted in-depth qualitative interviews with staff members at three clinic sites that implemented BHI. Interviewees were asked questions about the benefits and challenges encountered in the new BHI workflow, the dynamics of the warm hand-off, the tools and resources they used and desired, and the changes they would like to see to promote efficient workflows. Results We interviewed 21 staff members during May and June of 2020. An analysis of the qualitative data showed the most frequently reported experiences and attitudes focused on (a) the availability of behavioral health consultants (BHC); (b) procedural uses of the warm hand-off; (c) the organization’s productivity goals; and (d) desired tools and resources that are generally unavailable to the clinicians but could make a difference to patient care. Conclusion Our results can assist FQHCs and similar organizations to achieve both BHI and the Quintuple aim. Integrating BH services into PC clinics is valuable and may mitigate clinician-staff burnout. However, PC organizations desiring to integrate new sustainable care models should consider involving staff in every phase of the transitional process phase to increase staff buy-in and staff rapport.

Trends and Racial/Ethnic Disparities in Prenatal Care (PNC) Use from 2016 to 2021 in the United States.

To investigate the trends and racial/ethnic disparities in adequate prenatal care (PNC) use in the USA. A repeated cross-sectional study was conducted using May 2016-May 2021 data from the Pregnancy Risk Assessment Monitoring System (PRAMS). A primary outcome was the Kotelchuck index, a measure of the adequacy of PNC use, and the year was a key independent variable. Multinomial and binary logistic regression analyses were performed to examine PNC utilization using multiple imputations with chained equations. Among the 190,262 pregnant individuals, adequate PNC use was largely consistent from 2016 to 2019. However, there was an immediate drop from 77.4-78.3% between 2016 and 2019 to 75.2% in 2020 and 75.8% in 2021. Conversely, both intermediate and inadequate PNC use tended to increase in 2020 and 2021. Adequate PNC use, when compared to inadequate use, showed significantly lower odds in 2020 (adjusted Odds Ratio [aOR] 0.87, 95% CI 0.78-0.96; p = 0.009) and 2021 (aOR 0.87, 95% CI 0.77-0.99; p = 0.033) than in 2016. Notably, Hispanic participants experienced substantial impacts (aOR 0.75, 95% CI 0.64-0.88; p = 0.001 in 2020 and aOR 0.72, 95% CI 0.59-0.89; p = 0.002 in 2021). While adequate PNC use was a steady, slightly upward trend before 2020, it had a steep decline afterward. It is worth noting that Hispanic individuals were severely affected. Targeted interventions or policies to address barriers to PNC and foster equitable and sustainable care models are required.

Codesigning culturally safe oral health care with First Nations Kidney Warriors experiencing kidney disease in South Australia

BackgroundThis paper describes how First Nations Kidney Warriors (Aboriginal and Torres Strait Islander people living with kidney disease), dental hygienists, kidney health care professionals, an Aboriginal hostel accommodation manager and researchers co-designed an approach to improve oral health in South Australia. Kidney Warriors have strong connection to Country, Community and family that underpins health, wellbeing and approaches to research. However, significant colonisation, racism and marginalisation have impacted Kidney Warriors’ social, cultural and financial determinants of health, leading to increased chronic conditions including kidney disease. Access to culturally safe, affordable and responsive oral health care is vital but challenging for First Nations Peoples undergoing dialysis and kidney transplantation; Australian oral health care is generally provided privately, in metropolitan centres, by professionals who may hold unconscious bias about First Nations Peoples and incorrect assumptions regarding equal access to care.MethodsThe AKction – Aboriginal Kidney Care Together Improving Outcomes Now kidney care oral health working group codesigned strategies to address disparities and gaps in care, and co-create more accessible, responsive, culturally safe and sustainable models of care. A decolonising and collaborative participatory action research was informed by Dadirri Deep Listening and Ganma Knowledge Sharing with repeated cycles of Look and Listen, Think and Discuss, Take Action Together. A small pilot evaluation survey of clinical placement in an Aboriginal setting was undertaken.ResultsFour phases of collaboration were undertaken. Community and health professional consultations identified key gaps and priorities. Clinical yarning and cultural safety training and an interprofessional skills day was co-facilitated. Dental hygienist student clinical placement at Kanggawodli Aboriginal Hostel was initiated and evaluated. First Nations Kidney Warriors were positioned as educators and experts of their own lives and health care needs. A new framework for kidney health—oral health cultural safety and clinical education was developed.ConclusionThis codesigned approach involving inter-professional collaboration and joint decision making with community members has significantly informed improvements in oral health care information, services and referral with and for First Nations Peoples with kidney disease. This project provides a working example of how to decolonise health service and education programs from the ground up.Trial registrationNHMRC PAR 2004389.

Sustainability of rural Victorian maternity services: ‘We can work together’

BackgroundRural maternity service closures and service level reductions are continually increasing across Victoria. There is limited understanding of how rural board members and executives make decisions about their maternity service’s operations and sustainability. AimTo examine perspectives of rural Victorian board members and executives on the sustainability of rural maternity services. MethodsThis was a qualitative study. Interviews were conducted via Zoom™ with 16 rural Victorian hospital board members and executives. Data were thematically analysed. FindingsSevere shortages in the rural maternity workforce, primarily midwives, have contributed to service sustainability decisions. Challenges in offering midwifery workforce incentives cause difficulty in overcoming workforce shortages. A rural maternity workforce strategy harnessing connection with regional services was called for. Innovative models of maternity care were often actioned at the point of service suspension or closure. Participants requested a government policy position and funding for innovative, safe, and sustainable models of care in rural settings. DiscussionThere is an opportunity for workforce planning to occur between regional and rural services to ensure the development of sustainable maternity models such as midwifery group practice and incentivise the workforce to address current deficits and sustain service provision. ConclusionModels of care developed with rural communities, in collaboration with regional services, have the potential to strengthen the delivery of safe, sustainable maternity services. Workforce modelling and centralised government policies aimed at arresting workforce deficits are suggested to provide rural health service leaders with strategic and operational directions to support the delivery of safe, sustainable maternity services.

Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention.

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals' health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental lifestages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability for or resilienceagainst developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders. SUDs are treatable, and evidence of clinically significant benefit exists for medications (in opioid, nicotine and alcohol use disorders), behavioral therapies (in all SUDs), and neuromodulation (in nicotine use disorder). Treatment of SUDs should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with the concomitant treatment of comorbid psychiatric and physical conditions. Involvement of health care providers in detection and management of SUDs, including referral of severe cases to specialized care, offers sustainable models of care that can be further expanded with the use of telehealth. Despite advances in our understanding and management of SUDs, individuals with these conditions continue to be stigmatized and, in some countries, incarcerated, highlighting the need to dismantle policies that perpetuate their criminalization and instead develop policies to ensure support and access to prevention and treatment.

Telehealth Coverage for a Pediatric Gastroenterology Consult Service at a Regional Hospital: An Accepted, Useful, and Sustainable Model of Care

To evaluate a novel telehealth inpatient pediatric gastroenterology (GI) consult service at a regional children's hospital in regard to acceptance, utility, quality, sustainability, and provider resiliency. Patients requiring GI care at a regional children's hospital between July 2020 and June 2021 were treated by an in-person or telehealth physician with physician assistant support, randomly assigned based on a weekly preset staffing schedule. A retrospective, multidomain program evaluation was performed based on the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) and STEM (SPROUT Telehealth Evaluation and Management) frameworks, using statistical analysis to compare the patient cohorts and anonymous surveys to assess provider perceptions. In total, 1051 patient-days of GI care were provided for 348 patients, 17% by telehealth and 83% in-person. There were no significant differences in diagnosis, transfer, or readmission rates between the cohorts. No transfers occurred for reasons other than need to access specialized services not available at the regional hospital. Daily consult workload was slightly greater for telehealth physicians. Primary and consult team providers accepted the practice. The model continued beyond the first year. In total, 75% of local GI physicians reported greater Brief Resilience Scores in the context of shifting 20% of their inpatient call weeks to another campus's physicians. Episodic pediatric GI consult service coverage via telehealth at a regional hospital was well accepted, useful, and sustainable, with improved physician resilience and no adverse outcomes seen. Telehealth holds promise for leveraging pediatric subspecialty physicians across hospitals, allowing complex patients to be admitted closer to home while reducing inpatient coverage requirements for smaller physician groups.

A Narrative Review of Current Status and Future Perspective of Telemedicine for Parkinson's Disease, Dementia, and Intractable Neurological Diseases in Japan

The coronavirus disease 2019 pandemic has uncovered several inherent problems in society. While the demand for telemedicine surged worldwide and some countries responded flexibly, in Japan, most telemedicine services were limited to telephone consultations, and full-fledged telemedicine did not become widespread. In addition, the digitalization process in both medicine and wider society lags behind some other nations. It is necessary to accelerate digital transformation in healthcare to build a sustainable society that is resilient to crises, such as new pandemics. In particular, as Japan is facing an issue of super-aged society, a sustainable care model for people with Parkinson’s disease, dementia, and intractable neurological diseases should be established. Many neurodegenerative and intractable neurological diseases are progressive; as the disease progresses, patients could become difficult to visit specialists. Although online medical care has many advantages, it does not provide the same quality of information as face-to-face consultations. However, new technology can overcome the limitations of online medical care. As an evolutionary direction for telemedicine, three-dimensional telemedicine technologies are being developed, which enable online medical treatment to be delivered as if the patient was sharing the same space. Telemonitoring can enable the objective and continuous evaluation of patient information at home through the use of motion capture, wearable devices, and other devices. The advancement of digital transformation in medical care should be a game-changer in accumulating big data and analyzing it using artificial intelligence.

Mapping care provision for type 1 diabetes throughout Australia: a protocol for a mixed-method study

IntroductionType 1 diabetes (T1D) is a chronic and incurable autoimmune disease, diagnosed in early childhood and managed initially in paediatric healthcare services. In many countries, including Australia, national audit data...

Evaluation of CirrhoCare® – a digital health solution for home management of individuals with cirrhosis

Individuals with cirrhosis discharged from hospital following acute decompensation are at high risk of new complications. This study aimed to assess the feasibility and potential clinical benefits of remote management of individuals with acutely decompensated cirrhosis using CirrhoCare®. Individuals with cirrhosis with acute decompensation were followed up with CirrhoCare® and compared with contemporaneous matched controls, managed with standard follow-up. Commercially available monitoring devices were linked to the smartphone CirrhoCare® app, for daily recording of heart rate, blood pressure, weight, % body water, cognitive function (CyberLiver Animal Recognition Test [CL-ART] app), self-reported well-being, and intake of food, fluid, and alcohol. The app had 2-way patient-physician communication. Independent external adjudicators assessed the appropriateness of CirrhoCare®-based decisions. Twenty individuals with cirrhosis were recruited to CirrhoCare® (mean age 59 ± 10 years, 14 male, alcohol-related cirrhosis [80%], mean model for end-stage liver disease-sodium [MELD-Na] score 16.1 ± 4.2) and were not statistically different to 20 contemporaneous controls. Follow-up was 10.1 ± 2.4 weeks. Fifteen individuals showed good engagement (≥4 readings/week), 2 moderate (2-3/week), and 3 poor (<2/week). In a usability questionnaire, the median score was ≥9 for all questions. Five CirrhoCare®-managed individuals had 8 readmissions over a median of 5 (IQR 3.5-11) days, and none required hospitalisation for >14 days. Sixteen other CirrhoCare®-guided patient contacts were made, leading to clinical interventions that prevented further progression. Appropriateness was confirmed by adjudicators. Controls had 13 readmissions in 8 individuals, lasting a median of 7 (IQR 3-15) days with 4 admissions of >14 days. They had 6 unplanned paracenteses compared with 1 in the CirrhoCare® group. This study demonstrates that CirrhoCare® is feasible for community management of individuals with decompensated cirrhosis with good engagement and clinically relevant alerts to new decompensating events. CirrhoCare®-managed individuals have fewer and shorter readmissions justifying larger controlled clinical trials. As the burden of cirrhosis grows worldwide, increasing demands are being placed on limited healthcare resources, necessitating the adoption of more sustainable care models that allow for at-home patient management. The CirrhoCare® management system was developed to fill this care gap, deploying a novel combination of hardware, apps, and algorithms, to monitor and intervene in individuals at risk of new decompensation. This study highlights the possibility of reducing hospital readmissions for cirrhosis by optimising specialist community care, reducing the need for interventions such as paracentesis, while providing a more sustainable care pathway that is acceptable to patients. However, given the pilot and non-randomised nature of this study, the outcomes require further validation in a larger randomised controlled trial, to assess both clinical effectiveness and cost-effectiveness. Moreover, the data generated will also facilitate data modelling and further research to refine the CirrhoCare® algorithms to increase their detection sensitivity and utility.

Climate adaptive hospital: A systematic review of determinants and actions.

Climate change is among the most renowned concerns of the current century, endangering the lives of millions of people worldwide. To comply with the United Nations Climate Change Conference (COP21), hospitals should be on track to reduce greenhouse gas emissions. Although hospitals contribute to climate change by emitting greenhouse gases, they are also affected by the health consequences of climate change. Despite all the guidance provided, hospitals need more radical measures to confront climate change. The current study was carried out to examine the components of hospitals' adaptation to climate change and to review measures to confront climate change in hospitals. This systematic review was designed and carried out in 2020. The required information was collected from international electronic databases including Scopus, PubMed, Web of Science, EMBASE, and Google Scholar. Moreover, Iranian datasets such as Scientific Database (SID), Irandoc, Magiran, and IranMedex were reviewed. No restriction was considered in the methodology of the study. For the relevant thesis, the ProQuest database was also explored. The related sources were examined and the Snowball method was applied to find additional related studies. The research team also reviewed other accessible electronic resources, such as international guidelines and academic websites. The checklist of the Joanna Briggs Institute (JBI, 2017) was employed in order to evaluate the quality of the included papers. The studies published until June1, 2020, were included in the study. Of 11,680 published documents in the initial search, the full-texts of 140 were read after evaluating the titles and abstracts, of which 114 were excluded due to lack of sufficient information related to countermeasures in hospitals. Finally, the full-texts of 26 studies were reviewed to extract the required components. Two strategies were found, including climate change mitigation and climate change adaptation, with 13 components including water, wastewater, energy, waste, green buildings, food, transportation, green purchasing policy, medicines, chemicals and toxins, technology, sustainable care models, and leadership in hospitals were identified as affecting these measures and strategies. Considering the significance of climate change and strategies to confront it as one of the current challenges and priorities in the world, it is necessary to develop a framework and model to reduce the effects of climate change and adapt to climate changes in hospitals and other health centers. The identification and classification of the measures and components, influencing hospital adaptability and solutions for reducing the climate change impacts could be the first stage in developing this strategy. This is because it is impossible to create this framework without identifying these factors and their mutual impacts at the first. In the present study, through a systematic review using a comprehensive approach, the related components were explored and divided into two categories, including measures to reduce the effects and measures to adapt to climate change. The results of this study can be useful in developing a comprehensive action model to reduce greenhouse gas emissions and adapt hospitals to climate change.

Burden, patterns, and impact of multimorbidity in North India: findings from a rural population-based study

AimTo estimate the prevalence, socio-demographic determinants, common disease combinations, and health impact of multimorbidity among a young rural population.MethodsWe conducted a cross-sectional survey among participants aged ≥30 years in rural Punjab, North India, from Jan 2019 to April 2019. Multimorbidity was defined as the coexistence of ≥two conditions using a 14-condition tool validated in India. We also calculated a multimorbidity-weighted index (MWI), which provides a weight to each disease based on its impact on physical functioning. Logistic regression was conducted to evaluate the association with sociodemographic variables, mental health (PHQ-9), physical functioning (ADL scale), and self-rated health (SRH).ResultsWe analyzed data from 3213 adults [Mean age 51.5 (±13), 54% women]. Prevalence of single chronic condition, multimorbidity, and MWI was 28.6, 18% and − 1.9 respectively. Age, higher wealth index and ever use alcohol were significantly associated with multimorbidity. Overall, 2.8% of respondents had limited physical functioning, 2.1% had depression, and 61.5% reported low SRH. Poorer health outcomes were more prevalent among the elderly, women, less educated, and those having lower wealth index and multimorbidity, were found to be significantly associated with poor health outcomes.ConclusionsThe burden of multimorbidity was high in this young rural population, which portends significant adverse effects on their health and quality of life. The Indian health system should be reconfigured to address this emerging health priority holistically, by adopting a more integrated and sustainable model of care.

OA41 Audit of the rheumatology PIFU pathway at the UHMB Trust

Abstract Background/Aims Patient initiated follow up (PIFU) is an initiative that allows patients to access follow-up when required by initiating their own appointments. The disruptive impact of the COVID-19 pandemic has created significant capacity constraints on many services that were already experiencing pressures prior to the pandemic, piquing interest in PIFU as a sustainable model of care. The BSR has produced draft PIFU guidance to support rheumatology units to develop and deliver safe, robust and sustainable PIFU care models. We audited our PIFU pathway in line with the BSR’s recommended standards to establish its safety and efficacy since its implementation in 2018. Methods This was a retrospective analysis of patients transferred to an active PIFU access plan within UHMBT between February 2018 and November 2019. Patients were identified by the informatics team from the active PIFU access plans. We captured data to include treatments used. The electronic case notes were reviewed to establish reasons for appointment triggers in those who contacted the service, analyse waiting times for clinical review further to making contact and assess subsequent outcomes. Data were entered and analysed in Microsoft Excel 2016. Results We had a total of 420 patients on PIFU. We audited 100 of these. 56 were female. Mean age was 63.4 years (24-96). The most common diagnosis was inflammatory arthritis (n = 78). The majority of patients (n = 53) were on a single disease-modifying anti-rheumatic drug (DMARD). 17 patients were on &amp;gt; 1 DMARD and 5 patients were on prednisolone monotherapy, mean steroid dose 4.9 mg daily. 25 patients were not on any treatment. Of those on DMARDS, 63% (44) were on methotrexate, either as monotherapy or in combination with other DMARDs. 68% (30) of those on methotrexate were on a dose of ≤ 15mg weekly. Of the 100 patients, 9 triggered a review within the follow up period. This was usually via the nurse helpline (n = 7). Occasionally the GP triggered a review on behalf of the patient via the advice and guidance line (n = 2). The most common reason for a trigger was a flare of inflammatory arthritis (n = 7) and the remaining two appointments were due to side effects of DMARDs. Patients were contacted via nurse telephone call back within 48 hours of contacting the helpline (n = 8). One patient required an urgent face-to-face consultant review and was seen within 7 days. After contacting the service, all nine patients were reverted to regular follow-up. Conclusion Our results confirmed a robust PIFU pathway with appropriate safety nets ensuring prompt access to clinician input when needed. The use of PIFU pathway did not compromise care or result in any worsening clinical outcomes. After validation at 2 years, the majority of our patients on this pathway were onwardly managed through the PIFU model. Disclosure S. Achieng: None. L. Gray: None. L. Ottewell: None.

Get Up to Speed on Use of Technology in Psychiatric Care

Back to table of contents Previous article Next article Annual MeetingFull AccessGet Up to Speed on Use of Technology in Psychiatric CareJay Shore, M.D., M.P.H., John Torous, M.D., John Luo, M.D.Jay ShoreSearch for more papers by this author, M.D., M.P.H., John TorousSearch for more papers by this author, M.D., John LuoSearch for more papers by this author, M.D.Published Online:25 Mar 2022https://doi.org/10.1176/appi.pn.2022.04.4.45AbstractPsychiatrists need to become competent around the professional, clinical, legal, cultural, and safety considerations demanded by new modes of clinical care through technology.iStock/alvarezAs COVID-19 has and continues to drive so much care online and into digital formats, psychiatrists have had to quickly adapt to telehealth, smartphone apps, and other technologies. But now as it becomes possible to return to in-person care, psychiatrists have to decide what the future of the field will be and the next chapter of innovation in psychiatry.The Annual Meeting Technology Track is designed to offer psychiatrists a full overview of the digital mental health space to enable better use of digital tools today, the latest intelligence on what the future of digital psychiatry looks like, and the right information to make sure technology helps deliver the best care possible. We also want to explore how technology can be used to ensure care is more inclusive and addresses the social determinants of mental health, and we will have numerous hands-on examples and models of how to make that possible.To accomplish this, we have assembled four sessions featuring many APA leaders in technology and telehealth. Topics include the following:How to build a practice in the digital era and ways that technology can help you create sustainable models of care. This means also understanding the legal, financial, ethical, and clinical risks and knowing how to avoid common pitfalls.How to make electronic medical records, apps, and wearables fit into your already busy clinical workflow.How to achieve work-life balance and avoid burnout regarding technology use, and how to maximize the impact of technology for your own well-being.An evidence-based perspective on mental health apps, CBT programs, chatbots, VR/AR and more. The goal is not to promote any one technology but to provide you with the actual data to make an informed decision.How to ensure digital inclusion and make sure your approach does not leave out any patients.What tools you can use to evaluate any health technology, even if the evidence is still too new, and make sure you select the best tools for use with your patients.The fifth session in the track will cover apps and innovation in the support of psychiatric practice. The COVID-19 pandemic rapidly accelerated the adoption and implementation of many technologies in the practice of psychiatry. Overnight, in-person visits except for emergencies were prohibited, yet technologically ready and savvy organizations and psychiatrists were able to restore access with emergency adoption of videoconferencing technologies. Additionally, adjunctive services such as psychiatric applications on the smartphone were able to provide psychotherapy and medication management whether via secure messaging with a psychiatrist or artificial intelligence–driven chatbots to provide therapy. Social media and online professional networks helped psychiatrists connect their patients to available resources as well as facilitated wellness and decreased their risk for burnout. Speakers will review current best practices as well as future developments such as digital therapeutics and predictive analytics in future psychiatric practice. ■Saturday, May 218 a.m.-9:30 a.m.Digital Psychiatry, Part 1: Health Equity and Digital Divide in COVID Era10:30 a.m.-NoonDigital Psychiatry, Part 2: Work-Life Integration in Virtual World During Pandemic: Patient and Providers1:30 p.m.-3 p.m.Digital Psychiatry, Part 3: Integrating Patient Monitoring in Clinics4 p.m.-5:30 p.m.Digital Psychiatry, Part 4: ABCs: Apps, Bots, and Clinical Interventions Offered by TechnologyTuesday, May 248 a.m.-9:30 a.m.Apps and Innovations to Support the Practice of Psychiatry: Current and Future DevelopmentsJay Shore, M.D., M.P.H., is a professor and director of the Telemedicine Department of Psychiatry at the University of Colorado Anschutz Medical Campus.John Torous, M.D., is program director and director of the Division of Digital Psychiatry at Beth Israel.John Luo, M.D., is the director of Consultation Liaison & Emergency Psychiatry and the psychiatry residency program director at the University of California, Irvine School of Medicine. ISSUES NewArchived

The Negative Bidirectional Interaction Between Climate Change and the Prevalence and Care of Liver Disease: A Joint BSG, BASL, EASL, and AASLD Commentary

The Negative Bidirectional Interaction Between Climate Change and the Prevalence and Care of Liver Disease: A Joint BSG, BASL, EASL, and AASLD Commentary

The Sustainable Care Model for an Ageing Population in Vietnam: Evidence from a Systematic Review

Social demographic studies in Vietnam have shown a growing trend of an ageing population. Demographic trends project that one third of the Vietnamese population will be aged 65 years and older by 2050. Vietnam is a country where the majority of the elderly live with their children, with little savings and pension. The purpose of this review was to explore existing literature on models of care for an ageing population and provide evidence to develop a care model that is suitable for the ageing community in Vietnam. A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was carried out. An extensive literature search was performed, with a focus on articles and other materials with relevance to elderly care in Vietnam in terms of socio-economic, demographic, and associated factors based on comprehensive data sources. The review found that there is a lack of evidence of professional practice for caring for the aged in Vietnam. There also is a lack of evidence of government support for the limited community initiatives to support the ageing. There exist no community models of care for the ageing population in Vietnam. From a global perspective, there exist alternative models of care options to support the elderly through various care models, such as living in assisted-care facilities, home care, and other assistance. Inter-professional practice care models and health services were found to be essential for an ageing population. There is limited literature specifically for the care of an ageing population in Vietnam. Most of the available literature on care models for the aged is drawn from developed countries. The review offers insights into the development of care models for the elderly in Vietnam, with the need for inter-professional efforts in practice settings to support the ageing Vietnamese population. The reviewed literature agrees on the developing global challenges due to ageing. Despite the existing literature on care models for the ageing, there is a lack evidence-based care models concerning the current and future needs of elderly care in middle- and lower-income economies like Vietnam. More evidence is required to establish evidence for best care models for the elderly in developing economies.

Administration of a National Disease Registry in Australia: Lessons from the Development of the CHAANZ Congenital Heart Disease Registry

A review of congenital heart disease (CHD) management across Australia outlined the necessity of a national CHD Registry to improve service delivery [1]. The Congenital Heart Alliance of Australia and New Zealand (CHAANZ) CHD Registry collects information on CHD patients in Australia and New Zealand. The registry will improve understanding of the overall burden of congenital heart disease [2], and will facilitate the delivery of better, more sustainable models of care. In the past 18 months, CHAANZ has developed the framework to govern the 11 major adult and paediatric CHD centres currently contributing to the registry.

Novel models of dementia care: Evidence from national dementia behavior support programs in Australia

AbstractBackgroundBehaviors and psychological symptoms of dementia (BPSD) are frequently experienced by this population, as they reflect unmet biopsychosocial needs.[1] The occurrence of BPSD can be debilitating, distressing and impair quality of life, not only for the person living with dementia but also for their caregivers.[1] As such, people with BPSD have complex care needs that demand dedicated resources, tailored programs and specialized skills which are often missing in mainstream aged care services. To address these needs and to achieve a nationally consistent approach, the Australian Government has been funding the services of Dementia Support Australia (DSA). DSA is the leading national provider of 24/7 dementia‐specific behavior support programs in Australia. DSA programs include the Dementia Behavior Management Advisory Service (DBMAS) for mild‐moderate BPSD and the Severe Behavior Response Teams (SBRT) for moderate‐severe BPSD. These programs entail person‐centered and multimodal nonpharmacological, psychosocial and/or psychoeducational interventions to support people with BPSD and their caregivers. These are achieved through a case management framework that includes an onsite comprehensive/holistic assessment of medicosocial history (e.g. pain), surrounding environment (e.g. over/under‐stimulation) and prescribed medications to identify causes or triggers of BPSD (Figure 1).[1] DSA is delivered through a multidisciplinary and mobile workforce of dementia consultants, geriatricians/psychogeriatricians and support staff. DSA consultants are accredited against an industry‐specific program focused on dementia‐specific competencies and capabilities. Consultants include, but are not limited to, registered and mental health nurses, occupational therapists, physiotherapists, social workers, psychologists, dieticians, speech pathologists, and diversional therapists with significant experience working in dementia and aged care settings. Since establishment in 2016, DSA programs have supported over 30,000 client referrals from residential, community and acute care settings and have supported &gt;80% of residential aged care homes in Australia. Typical demographics for DBMAS and SBRT clients are displayed in Figure 2. Data collected on referrals demonstrated reduced frequency and severity rates of BPSD and high levels of caregiver satisfaction. Thus, DSA programs provide a novel, effective, feasible and sustainable model of care and service delivery specifically designed to address perceived gaps in aged care systems.

Home before Hospital: a whole of system re-design project to improve rates of home-based dialysis therapy: Experience and outcomes over 8 years.

Despite evidence that clinical outcomes for patients treated with peritoneal dialysis (PD) or home haemodialysis are better than for patients treated with conventional satellite or hospital-based haemodialysis, rates of home-based dialysis therapies world-wide remain low. Home-based dialysis care is also cost-effective and indeed the favoured dialysis option for many patients. Using a lean-thinking framework and established change management methodology, a project embracing a system-wide approach at making a change where a 'Home before Hospital' philosophy underpinned all approaches to dialysis care was undertaken. Three multidisciplinary working groups (pathway, outreach and hybrid) were established for re-design and implementation. The primary aim was to improve home-based dialysis therapy prevalence rates from a baseline of 14.8% by ≥2.5%/year to meet a target of 35%, whilst not only maintaining but improving the quality of care provided to patients requiring maintenance dialysis. A 'future' state pathway was developed after review of the 'current' state (Pathway Working Group) and formed the basis on which a nurse-led outreach service (Outreach Working Group) was established. With the support of the multidisciplinary team, the outreach service model focussed on early, consistent, and frequent education, patient support in decision-making, and clinician engagement. A target prevalence of >30% for home-based therapies (mainly achieved with PD) was achieved within 2 years. This prevalence rate reached 35% within 3 years and was maintained at 8 years. In addition, selected patients already on maintenance satellite-based haemodialysis (Hybrid Working Group) were educated to achieve high levels of proficiencies in self-care. Having the system-wide approach to a Quality Improvement Process and using established principles and change management processes, the successful implementation of a new sustainable model of care focussed on home-based dialysis therapy was achieved. A key feature of the model (through outreach) was early nurse-led education and support of patients in decision-making and ongoing support through multidisciplinary care.