Transform Health Care Delivery Research Articles

Emerging Health Technologies and How They Can Transform Healthcare Delivery

Health technologies have been and shall always be an integral part of the health system. Appropriate technologies provide solutions to improve healthcare services at an affordable cost. New biomedical, bioengineering and digital technologies continue to swamp the health system and consume a major part of the health budget. National authorities should develop a policy framework that articulates needs, standards and projections of safe and cost-effective technologies in the context of local epidemiological data and the felt needs of communities. Efficient implementation of health technologies requires availability of an adequate number of skilled human resources for health and infrastructure, for maintenance and replacement or for upgradation of these technologies.

Characterization of Telehealth Use in Veterans With Spinal Cord Injuries and Disorders.

Individuals with spinal cord injuries and disorders (SCI/D) require frequent interdisciplinary health care to address impairments in mobility, autonomic function, and secondary complications. Telehealth has the capacity to substantially transform health care delivery and improve care by increasing access and communication. However, relatively little is known about telehealth use in this specific population. Here we attempt to fill part of this gap. To investigate the frequency and characteristics associated with telehealth use in Veterans with SCI/D. Cross-sectional, descriptive project. Veterans Health Administration (VHA) facilities. A total of 15 028 Veterans living with SCI/D who received services from the VHA SCI/D System of Care. Not applicable. Frequency and characteristics associated with VHA telehealth utilization. Of the 15 028 Veterans with SCI/D included in the evaluation, 17% used some form of telehealth in VHA Fiscal Year (FY)2017. Veterans older than 65 years of age had lower odds (odds ratio [OR] = 0.88, P < .05, confidence interval [CI] 0.80-0.98) of using telehealth. Being Caucasian (OR = 1.29, P < .01, CI 1.09-1.52), living in rural areas (OR = 1.16, P < .01, CI 1.05-1.28), living greater distances away from the VHA (P < .01 for all distances), and being in priority group 8, meaning that Veterans have higher copayment requirements (OR = 1.46, P < .001, CI 1.19-1.81), were all significantly associated with greater odds of telehealth use. The most frequent types of telehealth used were real-time clinical video and store-and-forward between a provider and patient within the same hub network. There are opportunities to increase telehealth adoption in the SCI/D arena. The findings from this project highlight which Veterans are currently using telehealth services, as well as gaps regarding telehealth adoption in this population.

Digital Health Applications in Heart Failure: a Critical Appraisal of Literature.

Purpose of the reviewDespite advancements in the diagnostic and therapeutic armamentarium, heart failure (HF) remains a major public health concern in the USA and worldwide. Digital health applications hold promise to bridge this gap and improve HF care. This review will provide the reader with a concise overview of the current digital health applications in HF, the main challenges to its use, and discuss the future of digital health for promoting care for HF patients.Recent findingsEmerging evidence continues to support the potential role of digital health across the continuum of HF disease process including primary prevention, early detection, disease management, and reducing associated morbidity. There is also increasing emphasis on the need to pursue rigorous investigations to validate these promising claims, with some successful stories that have changed clinical practices.SummaryDigital health technologies have emerged as potentially useful tools to complement HF care in both research and clinical realms. As digital technologies continue to play an increasing role in transforming healthcare delivery, creating the framework for its effective use would be necessary to ensure that digital health applications consistently improve outcomes and enhance care for HF patients.

Emergency Oral Health Care Provision for Late Squeal of Early Childhood Dental Caries in Covid-19 Lockdown Scenario

COVID-19 denotes an unprecedented persistent global public health challenge transforming health care delivery towards...

Organizational readiness for artificial intelligence in health care: insights for decision-making and practice

PurposeArtificial intelligence (AI) raises many expectations regarding its ability to profoundly transform health care delivery. There is an abundant literature on the technical performance of AI applications in many clinical fields (e.g. radiology, ophthalmology). This article aims to bring forward the importance of studying organizational readiness to integrate AI into health care delivery.Design/methodology/approachThe reflection is based on our experience in digital health technologies, diffusion of innovations and healthcare organizations and systems. It provides insights into why and how organizational readiness should be carefully considered.FindingsAs an important step to ensure successful integration of AI and avoid unnecessary investments and costly failures, better consideration should be given to: (1) Needs and added-value assessment; (2) Workplace readiness: stakeholder acceptance and engagement; (3) Technology-organization alignment assessment and (4) Business plan: financing and investments. In summary, decision-makers and technology promoters should better address the complexity of AI and understand the systemic challenges raised by its implementation in healthcare organizations and systems.Originality/valueFew studies have focused on the organizational issues raised by the integration of AI into clinical routine. The current context is marked by a perplexing gap between the willingness of decision-makers and technology promoters to capitalize on AI applications to improve health care delivery and the reality on the ground, where it is difficult to initiate the changes needed to realize their full benefits while avoiding their negative impacts.

Artificial intelligence in pulmonary medicine: computer vision, predictive model and COVID-19.

Artificial intelligence (AI) is transforming healthcare delivery. The digital revolution in medicine and healthcare information is prompting a staggering growth of data intertwined with elements from many digital sources such as genomics, medical imaging and electronic health records. Such massive growth has sparked the development of an increasing number of AI-based applications that can be deployed in clinical practice. Pulmonary specialists who are familiar with the principles of AI and its applications will be empowered and prepared to seize future practice and research opportunities. The goal of this review is to provide pulmonary specialists and other readers with information pertinent to the use of AI in pulmonary medicine. First, we describe the concept of AI and some of the requisites of machine learning and deep learning. Next, we review some of the literature relevant to the use of computer vision in medical imaging, predictive modelling with machine learning, and the use of AI for battling the novel severe acute respiratory syndrome-coronavirus-2 pandemic. We close our review with a discussion of limitations and challenges pertaining to the further incorporation of AI into clinical pulmonary practice.

1742P Outcomes of the reorganisation of a medical oncology department during the COVID-19 pandemic: Real-word experience

The coronavirus disease 2019 (COVID-19) pandemic has transformed health care delivery in the world, forcing clinicians to make challenging triage decisions. COVID-19 represents a significant harm for cancer patients, who are at high risk of infections due to their immunosuppressed status and serious COVID-19-related events. Portuguese oncologists joined forces to ensure safety of clinical practice without compromising cancer patients care, as the benefit of ensuring an anti-cancer treatment outweighs the risks of COVID-19. Description and outcomes analysis of structural organization measures adopted by a Portuguese Medical Oncology Department during the COVID-19 pandemic. A proactive approach to the actual emergency panorama was promptly implemented: use of individual protection equipment, triage of patients accessing the hospital, use of telemedicine in selected patients with no need for on-site assessment, customising treatment delivery, regularly test patients under immunosuppressive treatments, test all patients prior to admission in oncology wards, limited access for visitors and caregivers, health professionals worked in “mirror teams” and most multidisciplinary boards have been converted in telematic meetings. Despite all the constraints in the activity, the number of consultations (including tele-consultations) increased compared to the same period of the previous year (3245 consultations from 1/03 to 15/05/2020 versus 3305 in the same period of 2019), the number of first consultations remained similar comparatively (15%) and were carried out in a timely manner, indicative that the cancer patient circuit was not compromised. 368 fewer treatments were performed in the same period, compared to 2019. Until May 15th, 288 tests have been carried out. Four patients were positive for COVID-19 without severity criteria, two of them with a diagnosis of cure, currently being under antineoplastic treatment without related complications. Practice recommendations from European and national oncology societies were applied, which translated into a safe continuum of cancer care delivery. In the middle-term, will be a priority to assess the real impact on cancer mortality.

Designing Nudges for Success in Health Care.

Nudges are subtle changes to the design of the environment or the framing of information that can influence our behaviors. There is significant potential to use nudges in health care to improve patient outcomes and transform health care delivery. However, these interventions must be tested and implemented using a systematic approach. In this article, we describe several ways to design nudges for success by focusing on optimizing and fitting them into the clinical workflow, engaging the right stakeholders, and rapid experimentation.

Outpatient Physical, Occupational, and Speech Therapy Synchronous Telemedicine: A Survey Study of Patient Satisfaction with Virtual Visits During the COVID-19 Pandemic.

The COVID-19 pandemic transformed healthcare delivery, including rapid expansion of telehealth. Telerehabilitation, defined as therapy provided by physical therapy, occupational therapy and speech and language pathology, was rapidly adopted with goals to provide access to care and limit contagion. The purpose of this brief report was to describe feasibility of and satisfaction with telerehabilitation. Two-hundred five participants completed online surveys following a telerehabilitation visit. Most commonly, participants were women (53.7%), 35-64 years old, and completed PT (53.7%) for established visits of 30-44 minutes in duration for primary impairments in sports, lower limb injuries, and pediatric neurology. Overall high ratings (“excellent” or “very good” responses) were observed for all patient-centered outcome metrics (ranging 93.7-99%) and value in future telehealth visit (86.8%) across telerehabilitation visits. Women participated more frequently and provided higher ratings than men participants. Other benefits included eliminating travel time, incorporating other healthcare advocates, and convenience delivering care in familiar environment to pediatric patients. Technology and elements of hands-on aspects of care were observed limitations. Recognizing reduced indirect costs of care that telerehabilitation may provide along with high patient satisfaction are reasons policy makers should adopt these services into future healthcare delivery models.

Building capacities of Auxiliary Nurse Midwives (ANMs) through a complementary mix of directed and self-directed skill-based learning\u2014A case study in Pune District, Western India

Auxiliary nurse midwives (ANMs) play a pivotal role in provision of maternal and newborn health at primary level in India. Effective in-service training is crucial for upgrading their knowledge and skills for providing appropriate healthcare services. This paper aims at assessing the effectiveness of a complementary mix of directed and self-directed learning approaches for building essential maternal and newborn health-related skills of ANMs in rural Pune District, India.MethodsDuring directed learning, the master trainers trained ANMs through interactive lectures and skill demonstrations. Improvement and retention of knowledge and skills and feedback were assessed quantitatively using descriptive statistics. Significant differences at the 0.05 level using the Kruskal-Wallis test were analysed to compare improvement across age, years of experience, and previous training received. The self-directed learning approach fulfilled their learning needs through skills mall, exposure visits, newsletter, and participation in conference. Qualitative data were analysed thematically for perspectives and experiences of stakeholders. The Kirkpatrick model was used for evaluating the results.ResultsDirected and self-directed learning was availed by 348 and 125 rural ANMs, respectively. Through the directed learning, ANMs improved their clinical skills like maternal and newborn resuscitation and eclampsia management. Less work experience showed relatively higher improvement in skills, but not in knowledge. 56.6% ANMs either improved or retained their immediate post-training scores after 3 months.Self-directed learning helped them for experience sharing, problem-solving, active engagement through skill demonstrations, and formal presentations. The conducive learning environment helped in reinforcement of knowledge and skills and in building confidence. This intervention could evaluate application of skills into practice to a limited extent.ConclusionsIn India, there are some ongoing initiatives for building skills of the ANMs like skilled birth attendance and training in skills lab. However, such a complementary mix of skill-based ‘directed’ and ‘self-directed’ learning approaches could be a plausible model for building capacities of health workforce. In view of the transforming healthcare delivery system in India and the significant responsibility that rests on the shoulder of ANMs, a transponder mechanism to implement skill building exercises at regular intervals through such innovative approaches should be a priority.

Telehealth transformation: COVID-19 and the rise of virtual care.

The novel coronavirus disease-19 (COVID-19) pandemic has altered our economy, society, and healthcare system. While this crisis has presented the U.S. healthcare delivery system with unprecedented challenges, the pandemic has catalyzed rapid adoption of telehealth, or the entire spectrum of activities used to deliver care at a distance. Using examples reported by U.S. healthcare organizations, including ours, we describe the role that telehealth has played in transforming healthcare delivery during the 3 phases of the U.S. COVID-19 pandemic: (1) stay-at-home outpatient care, (2) initial COVID-19 hospital surge, and (3) postpandemic recovery. Within each of these 3 phases, we examine how people, process, and technology work together to support a successful telehealth transformation. Whether healthcare enterprises are ready or not, the new reality is that virtual care has arrived.

Managing care for patients with sinonasal and anterior skull base cancers during the COVID-19 pandemic.

The SARS‐CoV‐2 pandemic has rapidly transformed health care delivery around the globe. Because of the heavy impact of COVID‐19 spread, cancer treatments have necessarily been de‐prioritized, thus exposing patients to increased risk of morbidity and mortality due to delayed care. In this scenario, cancer specialists need to assess critical oncology patients case by case to carefully balance risk vs benefit in treating tumors and preventing SARS‐CoV‐2 infection. Here, we report early insights into how the management of patients with sinonasal and anterior skull base cancer might be affected by the COVID‐19 pandemic. We provide recommendations for preoperative tests, indications for immediate care vs possible delayed treatment, and warnings relating to dural resection and intracranial dissection, given the potential neurotropism of SARS‐CoV2 and practical suggestions for managing cancer care in a period of limited resources. We also postulate some thoughts on the promising role of telemedicine in multidisciplinary case discussions and posttreatment surveillance.

Nursing in the Age of Artificial Intelligence: Protocol for a Scoping Review.

BackgroundIt is predicted that digital health technologies that incorporate artificial intelligence will transform health care delivery in the next decade. Little research has explored how emerging trends in artificial intelligence–driven digital health technologies may influence the relationship between nurses and patients.ObjectiveThe purpose of this scoping review is to summarize the findings from 4 research questions regarding emerging trends in artificial intelligence–driven digital health technologies and their influence on nursing practice across the 5 domains outlined by the Canadian Nurses Association framework: administration, clinical care, education, policy, and research. Specifically, this scoping review will examine how emerging trends will transform the roles and functions of nurses over the next 10 years and beyond.MethodsUsing an established scoping review methodology, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central, Education Resources Information Centre, Scopus, Web of Science, and Proquest databases were searched. In addition to the electronic database searches, a targeted website search will be performed to access relevant grey literature. s and full-text studies will be independently screened by 2 reviewers using prespecified inclusion and exclusion criteria. Included literature will focus on nursing and digital health technologies that incorporate artificial intelligence. Data will be charted using a structured form and narratively summarized.ResultsElectronic database searches have retrieved 10,318 results. The scoping review and subsequent briefing paper will be completed by the fall of 2020.ConclusionsA symposium will be held to share insights gained from this scoping review with key thought leaders and a cross section of stakeholders from administration, clinical care, education, policy, and research as well as patient advocates. The symposium will provide a forum to explore opportunities for action to advance the future of nursing in a technological world and, more specifically, nurses’ delivery of compassionate care in the age of artificial intelligence. Results from the symposium will be summarized in the form of a briefing paper and widely disseminated to relevant stakeholders.International Registered Report Identifier (IRRID)DERR1-10.2196/17490

Nurse managers implementing the lean management system: A qualitative study in Western Canada.

AimThis study explores the perceptions and experiences of nurse managers involved in implementing the Lean management system in a Western Canadian province.BackgroundThe provincial government of Saskatchewan, Canada, implemented a multimillion‐dollar investment in the Lean management system to transform health care delivery by reducing waste and increasing efficiency of processes and outcomes.MethodsThis qualitative exploratory study employed semi‐structured interviews with 14 nurse managers in urban and rural health regions in one Canadian province.ResultsSix themes outline the difficulties nurse managers experienced in juggling role responsibilities alongside a poorly implemented change system with scarce resources.ConclusionThe results showed tensions in the implementation of a Lean model adapted in the context of health care organisations. The expectations for nurse managers to be pivotal players in the implementation of transformative health care practices that promote and sustain strategies to reduce waste, improve coordination and increase patient safety require investment in leadership development.Implications for Nursing ManagementLean management systems significantly impact the roles of nurse managers who require adequate resources and training to successfully adapt. The results of this study may be used for more effective support mechanisms for nurse managers.

The Role of Health Technology in Transforming Healthcare Delivery and Enhancing Spending Efficiency ​

Objectives: Advances in technology are changing the way healthcare services are delivered. The adoption of different health technologies has significantly improved health access and efficiency. In addition, health-technology adoption can help immensely in improving health outcomes and enhancing public and private healthcare spending efficiency. However, the role of health technology in transforming healthcare delivery and enhancing spending efficiency is not well understood. In this paper, we reviewed the role of emerging technologies in delivering health services that promote health outcomes, improve productivity of the healthcare provider, and reduce healthcare costs. Methods: A narrative review was conducted of published articles as well as grey literature on application of technology in delivering medical care. Studies that met the following criteria were included: addressed a relevant aspect of technology in healthcare delivery; written in English; published between 1994 and June 2020; qualitative and quantitative study designs, systematic reviews, and primary and secondary research. Main results and conclusions: Utilizing technologies in delivering health services showed promise in improving health outcomes, enhancing healthcare productivity, and reducing overall healthcare costs. However, before these technologies are implemented, reimbursement and equity are two main issues that need to be addressed.

Ambulatory Networks: Innovating and Transforming Healthcare Delivery

Ambulatory Networks: Innovating and Transforming Healthcare Delivery

Moving beyond Protection with PULSE - Using A.I. to make healthcare more affordable and accessible

The world has never been more connected. According to leading market intelligence firm, IDC, there will be a staggering 25 million mobile applications by 2020 with a total of 50 trillion GB of data available worldwide. Mobile applications are not only taking the world by storm, it is also redefining and transforming healthcare delivery and experience. Currently there are over 325,000 health apps available in the top app stores worldwide with more than 200 apps being added each day. Worldwide, we are seeing how digital tools are leading to better and faster healthcare and making healthcare more empowering and accessible for the people. Goldman Sachs predicts that the digital revolution could potentially save healthcare providers USD300 billion. While the adoption of digital health tools such as mobile health apps holds great promise of improving healthcare access and patient outcomes, on the flip side, the popularity of health apps is also posing enormous and unprecedented risks to consumers’ privacy. PAMB is proactively transforming itself from a health payer to a holistic health manager through the implementation of PULSE, Prudential’s Health Ecosystem using the Prevent-Postpone-Protect strategy. In addition, Prudential has put measures in place to safeguard consumers’ privacy to ensure that data security is not compromised as we leverage on digital technology to provide consumers with instant, reliable and relevant health information at their fingertips as we empower and encourage the public to take charge of their health anytime, anywhere.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 16

Scoping the Scene: What Do Nurses, Midwives, and Allied Health Professionals Need and Want to Know About Genomics?

Introduction: Rapid changes in genomic technology are transforming healthcare delivery. Although it has been well established that many health professionals lack the adequate knowledge, skills, and confidence to adapt to these changes, the specific educational needs of Australian allied health professionals, nurses, and midwives are not well understood. This diverse group of health professionals is primarily involved in the management of symptoms and psychosocial care of patients with genetic conditions, rather than risk assessment and diagnosis. The relevance of genetics and genomics to their clinical practice may therefore differ from medical practitioners and specialists. Materials and Methods: This paper reports on a study undertaken to identify the perceived genetic knowledge and education needs for this group of health professionals. Allied health professionals, nurses, and midwives were recruited from throughout New South Wales (NSW) and invited to participate in semi-structured telephone or face to face interviews. Results: A total of 24 geographically and professionally diverse individuals (14 allied health, 6 nurses, and 4 midwives) were interviewed. Interview recordings were transcribed and using thematic qualitative analysis recurring themes were identified. The results show that this is a diverse group that is keen to know more about genomics and genetic services but unsure of reliable sources. Discussion: The need for a generic update from a trustworthy source was identified and suggested topics to be covered included genetic fundamentals, recognizing common genetic conditions, and psychosocial/ethical aspects of genetics/testing including informed consent. In addition, the challenge of incorporating education into highly clinical roles was identified as a key barrier and having a readily accessible, accredited learning resource would help overcome this. Findings from this study are informing the development of a targeted, interactive e-learning resource for allied health professionals, nurses, and midwives.

Jerry A. Mansfield Interview

Leadership is a journey, particularly for individuals who influence patient care delivery in hospitals and health care systems throughout the globe. For the nurse leader, it is a daily focus on a myriad of fronts including staff engagement, patient experience, quality and safety and financial performance. Dr. Mansfield made the decision to become a Registered Nurse because of the difference one RN made during his hospitalization as a teenager. This leadership profile offers one leaders’ perception of current challenges and opportunities in the industry; a time of unprecedented and transformative change in health care.

A3 thinking Applied: a Real World Process of Implementing An Asthma Home-Based Management Project(AMP)

Background A3 Lean Methodology/Thinking is a foundational management process and methodological structure for transforming health. Along with PDSA methodology it is a vital tool in problem solving and sustainable QI initiatives/intervention. Delivery System Reform Incentive Payment (DSRIP) is a NY State program aimed at transforming health care delivery and decreasing hospitalizations while transitioning to a more socially and community based system of care. When asked to launch a pediatric asthma management program (AMP) by DSRIP the A3 Lean Methodology was used from the outset. …