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PubMed2004

Approaches towards a regional, shared electronic patient record for health care facilities of different health care organizations--IT-strategy and first results.

Today, information processing in healthcare facilities is usually primarily directed towards the information needs of the respective institution. This stands in apparent contradiction to the fact that patients may not be solely treated in one general practice or hospital. More information processing towards patient-centered, shared care would better support high quality as well as efficient health care. We developed a stepwise approach transforming trans-institutional information system architectures (TISAs) from an inefficient state caused by redundancy and media cracks towards a state which better supports patient centered, shared care. In a total of three steps we want to establish electronic communication between existing information systems of different healthcare facilities for transmission of discharge summaries and diagnostic results. In further stages we plan to expand this communication solution to a regional comprehensive and consistent electronic patient record for multiple hospitals and general practices in Tyrol, Austria. In addition, two related approaches towards supporting shared care have been compared with our approach. The aim of this paper is to report on our approach and first experiences.

Ambulatory Care Information Systems↗
PubMed2001

Consumers' views of quality in the consultation and their relevance to 'shared decision-making' approaches.

BACKGROUND: There is a recognized need to assess the effects of shared decision-making and other communication interventions. However, the outcomes usually assessed for evidence of 'effectiveness' are determined by researchers and have not been based on consumers' views. AIM: This study aimed to identify the important outcomes of consultations for consumers, and to compare with those reported in the current literature. SETTING AND PARTICIPANTS: Forty-seven participants attending six focus group interviews. Most interviews took place in and all were orientated towards the UK primary care setting. METHODS: Focus group study. RESULTS: Many affective outcomes were identified, consistent with the current literature trends. However, many cognitive and behavioural outcomes that are assessed in the current literature were not noted by participants as important. Furthermore, a broader range of outcomes than is evident in the current literature was viewed as important to these participants. CONCLUSIONS: There is a need to revisit the outcomes which are assessed in decision-making and communication research. The outcomes of greatest importance to consumers must be identified and confirmed by new research which is based directly on the views of consumers themselves.

Consumer Behavior↗
PubMed2006

[EbM and patient perspective--a 5-step approach].

OBJECTIVES: Shared decision making describes a way of involving patients in the planning and management of their individual healing process. Doing this effectively seems to be quite a challenge for both physicians and patients. The mutual transfer of information appears to be one of the main steps of this process. Clinical patient information or patient guidelines can help to explain complex medical processes in a non-specialist way and thus improve communication and self-management. In order to develop an "evidence-based asthma patient guideline" we tried to focus on both evidence-based recommendations and patients' perspectives. Patients were asked about their individual needs and knowledge and took part in the subsequent review. METHODS: In order to explore patients' perspectives and needs we implemented two additional steps to our existing concept of guideline development: (1) a questionnaire for asthma patients with 10 items dealing with patients' knowledge about asthma and a personal grading of 16 "asthma-related questions", and (2) patients joining the actual guideline review panel. RESULTS: By evaluating the results of the questionnaire we discovered a gap between what patients consider to be interesting and/or important and what is necessary from the point of view of medicine and health policy. Although the patients showed a great interest in an autonomous approach to life with asthma [important items: "what can I do by myself" (68%); "how can I prevent an asthma attack" (86%); "how can I live a better life with asthma" (77%)], they were less interested in topics that would give them more autonomy ["structured educational programs" (41%); "how to use inhaling devices" (64%) or "peak flow measurement" (36%)]. Patients participating in the review panel emphasized the need for more or better information about pollution (i.e. ozone), complementary/alternative methods and the administration of cortisone during the asthma attack--topics that were not mentioned in the physicians' guideline. CONCLUSIONS: To acquire an "implementable" evidence-based patient guideline it is not sufficient to "translate" existing asthma guidelines into lay language. We should focus on the needs of individual asthma patients and the problems they encounter every day. Therefore patients should be asked what they want to know and what they do not know, and they should review the results and include their own views into the guideline. We applied this concept to the above mentioned evidence-based patient guideline and received a thematic ranking focused on patients' daily needs as well as a to-do list of topics that require increased attention (like peak flow measurement and structured education programs). The patients' perspectives changed our perspective on our patient guideline more than we expected.

Evidence-Based Medicine↗
PubMed1994

Sharing your research project: a continuing education approach.

CONTINUING EDUCATION PROGRAMS as a practical approach for the CNS to share research results are described in this article. Strategies for planning and implementing this approach are shared, a case example is provided, and benefits to the program are described.

Diffusion of Innovation↗
PubMed1997

Copy management in a shared care environment using the Internet.

A new approach to sharing medical records using a demand-based database replication method and the Internet e-mail facility is proposed. The underlying model allows subscribed physicians to collect patient records from distant nodes and have local access to these records when needed. A system called the Internet-Based Distributed Medical Information System has been developed and implemented in a shared care environment comprising outpatient clinics, independent practitioners, and diagnostic laboratories. This tool may be highly beneficial in improving coordination among health care professionals and reducing unnecessary repeat investigations.

Ambulatory Care Information Systems↗
PubMed1988

Policies and procedures for scheduling student nurses.

A smoothly operating system for student clinical affiliations can save staff time and positively influence recruitment and retention. To ensure a systematic approach to scheduling students, the author shares her approach, policies, and procedures.

Clinical Clerkship↗
PubMedDate not supplied

Shared governance as a way to involve staff in decision-making.

Increasing the involvement of clinicians in decision-making is a key part of recent NHS policy. One model designed to increase involvement is shared governance. This article describes the approach to shared governance developed at Kettering General Hospital. Ongoing evaluation of the scheme suggests benefits in terms of personal and professional development for those involved.

Communication↗
PubMed1987

Computerized data bases: an integrated approach to monitoring quality of patient care.

Common information is shared by rehabilitation program evaluation, utilization review, and quality assurance. These administrative functions sometimes operate in isolation, not taking advantage of information sharing. This approach fails to recognize the potential for increased efficiency of integrating pertinent information to produce timely and useful reports. We report on a system design which addresses this concern by encouraging information sharing, reducing data duplication and creating a data base to produce needed statistical and management reports. Our discussion highlights the key elements of program evaluation, utilization review, and quality assurance. These elements are described as an integrated approach to meet the Commission on Accreditation of Rehabilitation Facilities and revised Joint Commission on Accreditation of Hospitals standards.

Database Management Systems↗
PubMed2004

A shared random effect parameter approach for longitudinal dementia data with non-ignorable missing data.

A significant source of missing data in longitudinal epidemiologic studies on elderly individuals is death. It is generally believed that these missing data by death are non-ignorable to likelihood based inference. Inference based on data only from surviving participants in the study may lead to biased results. In this paper we model both the probability of disease and the probability of death using shared random effect parameters. We also propose to use the Laplace approximation for obtaining an approximate likelihood function so that high dimensional integration over the distributions of the random effect parameters is not necessary. Parameter estimates can be obtained by maximizing the approximate log-likelihood function. Data from a longitudinal dementia study will be used to illustrate the approach. A small simulation is conducted to compare parameter estimates from the proposed method to the 'naive' method where missing data is considered at random.

Aged↗
PubMed2006

Evaluation of a discussion forum for knowledge sharing among emergency practitioners: a social network approach.

Peer to peer knowledge sharing is recognized as a key contributor to the development of expert practice for health care professionals. Emergency departments with access to extensive expertise, such as in urban hospital settings, present greater potential for rich collaborative learning opportunities as compared with rural settings where expertise is at times scarce. Collaborative technologies such as electronic discussion boards may assist in leveling the "knowledge" playing field and increase opportunities for the growth of a strong social network for emergency clinicians. A social network perspective is used to explore the effectiveness of a discussion forum to support knowledge sharing among emergency practitioners in rural and urban emergency departments in Nova Scotia.

Cooperative Behavior↗
PubMed1999

The effect of a respiratory home nurse intervention in patients with chronic obstructive pulmonary disease (COPD).

BACKGROUND: Chronic obstructive pulmomary disease (COPD) is associated with substantial mortality, morbidity, and costs to the health care system. With the increasing interest in outreach care programmes it is important to evaluate their impact upon patients and health services, for conditions such as COPD. AIM: To determine the effectiveness of an outreach respiratory nurse in a shared care approach, with collaboration between general practitioners and hospital services, in the management of patients with severe COPD. METHODS: Patients with severe COPD attending The Queen Elizabeth Hospital, Adelaide participated in a randomised controlled trial of a home based nursing intervention (HBNI) over 12 months with outcome measures including mortality rate, hospital service utilisation, FEV1 and health related quality of life (HRQL) using a modified Dartmouth Primary Care Co-operative Quality of Life questionnaire. RESULTS: There were 48 subjects in each study arm, with no differences in mortality rate (eight deaths in the HBNI group and seven in the control group), hospital admissions, length of stay, number of outpatient and Emergency Service visits. The study had inadequate follow-up of FEV1 and HRQL within the control group. Within the HBNI group, a small improvement in HRQL (in three of ten indices measured) was demonstrated, despite a deterioration in FEV1 (11% reduction, p=0.04) compared to baseline. Quality of life of HBNI subjects' carers did not change. CONCLUSION: An increased level of care given by an outreach respiratory nurse in a shared care approach for patients with severe COPD produced small improvements in HRQL but did not result in the prevention of deaths or reduced health care utilisation.

Aged↗
PubMed1988

A game-theoretic approach to donor kidney sharing.

Graft survival in renal transplantation is a function, amongst other things, of the degree of histocompatibility lymphocyte-A (HLA) tissue matching achieved between donor and recipient. Yet a donor procured at centre A might match a transplant candidate at centre B and vice versa. This raises the question of whether, and under what circumstances, surgeons will offer and exchange donor kidneys and gain from such trade in terms of graft survival. We analyse the problem in a game-theoretic framework where the choice of strategy 'to offer or not?' is evaluated in the context of the uncertainty of reciprocation by the other player(s) in the game. The equilibrium solution to a number of variations of the game is predicted to be non-cooperation resulting in collectively sub-optimal graft survival rates. Some policy options for improving cooperation are considered including exchange incentives and coercive measures.

Cooperative Behavior↗
PubMed2006

Risk factor management and depression post-stroke: the value of an integrated model of care.

BACKGROUND AND PURPOSE: Shared care initiatives, albeit commonly utilised in managing other chronic conditions have not been implemented in the area of stroke in Australia. The aims of this project were to adopt a shared care approach for stroke survivors comparing an experimental "shared-care" group with a "treatment-as-usual" control group in reference to the normalization or reversal of vascular risk factors and the detection and management of post-stroke depression. METHODS: A randomised controlled experimental research design was implemented with participants randomized to an intervention or control group and followed over a 12-month period. The treatment group consisted of a randomly selected group of patients, discharged from an acute stroke unit and transferred into the shared care model. Risk factors for stroke and depression were compared between the two groups. RESULTS: Of 97 patients originally included in the study, 17 dropped out. At 12 months, 80 patients remained for analysis (35 in the intervention group and 45 in the control group). The findings demonstrated positive trends for patients within the intervention group that were not found within the control group. The percentage of intervention patients reaching target systolic blood pressure (sBP) of 140 mmHg after 12 months tended to be greater than in the control group (p=0.11, NS). In the intervention group, at 12 months, the total cholesterol greater than 5.18 mmol/L was 12.5% compared to 58.8% at discharge. In contrast this trend was not so distinct in the control group (57.7% to 42.9%). The percentage of patients reaching target (recommended) total cholesterol of 5.18 mmol/L was significantly greater in the shared care patients intervention group relative to the control group (p=0.02). The average number of walks per week was also significantly greater in intervention group compared to the control group (p=0.048). Moreover, 45% of the control group screened as depressed compared with 20% of the intervention group at 12 months (p=0.06). CONCLUSIONS: This study demonstrates that major risk factors for recurrent stroke and vascular disease in general are better managed with the shared care model than with usual post-discharge care. The significantly reduced depression as found on the screening PHQ9 at 12 months indicated that the intervention was beneficial not only in the detection of depression but also treatment.

Blood Pressure↗
PubMed2004

Sharing genomes: an integrated approach to funding, managing and distributing genomic clone resources.

National biological resource centres have a vital role in archiving and distributing biological reagents that result from large-scale genome programmes. These reagents are invaluable to the research community as they enable independent validation of results disclosed in peer review and provide tools that facilitate the next steps in discovery science. Here we address the crucial issues of open access, quality of materials, integration with public databases and sustainability of resources.

Biological Specimen Banks↗
PubMed2005

Comparisons of case-selection approaches based on allele sharing and/or disease severity index: application to the GAW14 simulated data.

For mapping complex disease traits, linkage studies are often followed by a case-control association strategy in order to identify disease-associated genes/single-nucleotide polymorphisms (SNPs). Substantial efforts are required in selecting the most informative cases from a large collection of affected individuals in order to maximize the power of the study, while taking into consideration study cost. In this article, we applied and extended three case-selection strategies that use allele-sharing information method for families with multiple affected offspring to select most informative cases using additional information on disease severity. Our results revealed that most significant associations, as measured by the lowest p-values, were obtained from a strategy that selected a case with the most allele sharing with other affected sibs from linked families ("linked-best"), despite reduction in sample size resulting from discarding unlinked families. Moreover, information on disease severity appears to be useful to improve the ability to detect associations between markers and disease loci.

Alleles↗