Exploring behavior change techniques for reablement: A scoping review.

BACKGROUND: Reablement is a team-based person-centered health and social care model, most commonly available for community-dwelling older adults. Understanding the components of reablement and how it is delivered, received, and enacted facilitates best evidence and practice. Determining behavior change techniques (BCTs) or strategies is an important step to operationalize implementation of reablement. OBJECTIVE: We conducted a scoping review of peer-reviewed literature to identify BCTs used within reablement studies. METHODS: We registered our study with the Joanna Briggs Institute and conducted five database searches. Inclusion criteria were peer-reviewed studies focused on adults and older adults without significant cognitive impairment or dementia receiving reablement, and all study designs, years, and languages. We excluded studies focused on reablement for people with dementia or reablement training programs. The last search was on April 8, 2021. Two authors screened independently at Level 1 (title and abstract) and 2 (full text). Two authors adjudicated BCTs for each study, and a third author confirmed the final list. RESULTS: We identified 567 studies (591 publications) and included 21 studies (44 publications) from six global locations. We identified 27 different BCTs across all studies. The three most common BCTs for reablement were goal setting (behavior), social support (unspecified), and instruction on how to perform a behavior. CONCLUSIONS: We highlight some behavioral components of reablement and encourage detailed reporting to increase transparency and replication of the intervention. Future research should explore effective BCTs (or combinations of) to include within reablement to support health behavior adoption and maintenance.

Defining and implementing patient-centered care: An umbrella review.

OBJECTIVES: Patient- or person-centered care (PCC) integrates people's preferences, values, and beliefs into health decision-making. Gaps exist for defining and implementing PCC; therefore, we aimed to identify core elements of PCC and synthesize implementation facilitators and barriers. METHODS: We conducted an overview of systematic reviews (umbrella review) and included peer-reviewed literature for adults in community/primary care settings. Two reviewers independently screened at Level 1 and 2, extracted data and appraised the quality of reviews. Three reviewers conducted a thematic analysis, and we present a narrative synthesis of findings. RESULTS: There were 2371 citations screened, and 10 systematic reviews included. We identified 10 PCC definitions with common elements, such as patient empowerment, patient individuality, and a biopsychosocial approach. Implementation factors focused on communication, training healthcare providers, and organizational structure. CONCLUSIONS: We provide a synthesis of key PCC elements to include in a future definition, and an overview of elements to consider for implementing PCC into practice. We extend existing literature by identifying clinician empowerment and culture change at the systems-level as two future areas to prioritize to enable routine integration of PCC into practice. PRACTICE IMPLICATIONS: Findings may be useful for researchers and or health providers delivering and evaluating PCC.

Team-based care Evaluation and Adoption Model (TEAM) Framework: Supporting the comprehensive evaluation of primary care transformation over time.

OBJECTIVE: To introduce the new Team-based care Evaluation and Adoption Model (TEAM) Framework. QUALITY OF EVIDENCE: The initial TEAM Framework was derived from a series of reviews and consultations with academic and clinical experts. In a parallel process, team-based primary and community care evaluation in Canada was assessed through a structured review of academic literature, followed by a review of policy literature of existing primary care evaluation frameworks. MAIN MESSAGE: The review of academic articles alongside an analysis of policy documents and existing evaluation frameworks in primary care resulted in the development of the 10-dimension TEAM Framework. CONCLUSION: Primary care transformation requires evaluation over time. The TEAM Framework provides a comprehensive framework for assessing evidence needed to support short- and long-term actionable improvements for team-based primary and community care in Canada. This framework will inform the development of an evaluation tool kit for primary care teams.

Team Mapping: A Novel Method to Help Community Primary Healthcare Practices Transition to Team-Based Care.

The team mapping method engages participants in rapid, facilitated co-creation workshops to help groups explore how to work together in a primary care team. It uses patient personas (local evidence-based simulated cases) to explore team structure through paper prototyping circles of care (the persona's healthcare system). Roles and tasks are collectively defined through the discussion. Team mapping builds on three foundational methods and, through a three-stage process, facilitates the formation and strengthening of new and existing relationships, fostering team development through the process. This paper describes team mapping, outlines when it can be applied and highlights the benefits for teams.

Lead User Design: Medication Management in Electronic Medical Records.

Improvements in medication management may lead to a reduction of preventable errors. Usability and user experience issues are common and related to achieving benefits of Electronic Medical Records (EMRs). This paper reports on a novel study that combines the lead user method with a safety engineering review to discover an innovative design for the medication management module in EMRs in primary care. Eight lead users were recruited that represented prescribers and clinical pharmacists with expertise in EMR design, evidence-based medicine, medication safety and medication research. Eight separate medication management module designs were prototyped and validated, one with each lead user. A parallel safety review of medicaiton management was completed. The findings were synthesized into a single common set of goals, activities and one interactive, visual prototype. The lead user method with safety review proved to be an effective way to elicit diverse user goals and synthesize them into a common design. The resulting design ideas focus on meeting the goals of quality, efficiency, safety, reducing the cognitive load on the user, and improving communication wih the patient and the care team. Design ideas are being adapted to an existing EMR product, providing areas for further work.

Conditions potentially sensitive to a personal health record (PHR) intervention, a systematic review.

BACKGROUND: Personal Health Records (PHRs) are electronic health records controlled, shared or maintained by patients to support patient centered care. The potential for PHRs to transform health care is significant; however, PHRs do not always achieve their potential. One reason for this may be that not all health conditions are sensitive to the PHR as an intervention. The goal of this review was to discover which conditions were potentially sensitive to the PHR as an intervention, that is, what conditions have empirical evidence of benefit from PHR-enabled management. METHODS: A systematic review of Medline and CINAHL was completed to find articles assessing PHR use and benefit from 2008 to 2014 in specific health conditions. Two researchers independently screened and coded articles. Health conditions with evidence of benefit from PHR use were identified from the included studies. RESULTS: 23 papers were included. Seven papers were RCTs. Ten health conditions were identified, seven of which had documented benefit associated with PHR use: asthma, diabetes, fertility, glaucoma, HIV, hyperlipidemia, and hypertension. Reported benefits were seen in terms of care quality, access, and productivity, although many benefits were measured by self-report through quasi-experimental studies. No study examined morbidity/mortality. No study reported harm from the PHR. CONCLUSION: There is a small body of condition specific evidence that has been published. Conditions with evidence of benefit when using PHRs tended to be chronic conditions with a feedback loop between monitoring in the PHR and direct behaviours that could be self-managed. These findings can point to other potentially PHR sensitive health conditions and guide PHR designers, implementers, and researchers. More research is needed to link PHR design, features, adoption and health outcomes to better understand how and if PHRs are making a difference to health outcomes.

Awareness of technology-induced errors and processes for identifying and preventing such errors.

There is a need to determine if organizations working with health information technology are aware of technology-induced errors and how they are addressing and preventing them. The purpose of this study was to: a) determine the degree of technology-induced error awareness in various Canadian healthcare organizations, and b) identify those processes and procedures that are currently in place to help address, manage, and prevent technology-induced errors. We identified a lack of technology-induced error awareness among participants. Participants identified there was a lack of well-defined procedures in place for reporting technology-induced errors, addressing them when they arise, and preventing them.

Designing electronic medication reconciliation for patients: the lead user method.

There is a potential to reduce medication errors by supporting the use of medication reconciliation through electronic Personal Health Records. The lead user method was used to identify specific goals and activities that are required to have in an electronic medication reconciliation tool and to provide a synthesized visual design that would reflect these requirements. Lead users identified two major functionalities of a proposed medication reconciliation tool: ability to view and edit certain medication information when reconciling medication lists and share most current, reconciled medication lists with selected providers.

Integrating heuristic evaluation with cognitive walkthrough: development of a hybrid usability inspection method.

Developing more usable healthcare information systems has become an important goal in health informatics. Although methods from usability engineering have appeared and been effectively applied in the design and evaluation of healthcare systems, there continues to be reports of deployment of unusable systems and issues with adoption of healthcare IT worldwide. In this paper we propose a new cost-effective usability engineering approach for healthcare IT that integrates two of the major usability inspection approaches (heuristic evaluation and cognitive walkthrough) into one combined approach that leverages the advantages of both heuristic evaluation and cognitive walkthrough. The approach will be described as will a pilot application of the method in evaluating the usability of a well-known electronic health record system. Implications and future work will also be described.

Using Usability Evaluation to Inform Alberta's Personal Health Record Design.

Alberta Health is deploying the Personal Health Portal (PHP) (MyHealth.Alberta.ca) to all people in the province of Alberta, Canada. The PHP will include several components such as a Personal Health Record (PHR) where users can enter and access their own health data. For the first PHR of its kind in Canada, Alberta Health asked the University of Victoria's eHealth Observatory to evaluate the PHP, including the PHR. The evaluation includes pre-design, design, and adoption evaluation. This paper focuses on early usability evaluations of the PHR software. Persona-based usability inspection was combined with usability testing sessions using think aloud. These evaluations found that while people were familiar with the web-based technology, several aspects of the PHR information architecture, content, and presentation could be improved to better support and provide value to the users. The findings could be helpful to others designing and implementing similar PHR software.

Methodological approaches to comparing information about bicycle accidents internationally: a case study involving Canada and Germany.

The use of bicycles as a mean of healthy and eco-friendly transportation is currently actively promoted in many industrialized countries. However, the number of severe bicycle accidents rose significantly in Germany and Canada in 2011. In order to identify risk factors for bicycle accidents and possible means of prevention, a study was initiated that analyses bicycle accidents from selected regions in both countries. Due to different healthcare systems and regulations, the data must be selected in different ways in each country before it can be analyzed. Data is collected by means of questionnaires in Germany and using hybrid electronic-paper records in Canada. Using this method, all relevant data can be collected in both countries.

Characteristics of patients at risk for adverse drug events: designing for patient safety and decision support.

Adverse drug events are a significant global health issue. In this paper we describe our research work to date in identifying the characteristics of patients who are at risk for adverse drug events. We conducted a focus group study with health professionals to identify those characteristics of patients that health professionals attend to if they believe a patient is at risk for an adverse drug event. This work is being undertaken in order to develop an electronic decision support system that will alert health professionals to the presence of such patient characteristics in order to support their clinical decision making.

Adapting usability testing techniques to gather user requirements: an illustrative proposal.

Usability testing could greatly aid in gathering requirements for a system prior to its planning and design. An illustrative pilot usability study was carried out aiming to develop methodology for determining the functionality of the medical imaging software that is required to accurately assess medical images in emergency situations in a specific trauma department. Two individuals participated in the study. The proposed methodology for carrying out usability testing in a pre-planning and pre-development phase is illustrated in this proposal. The illustration showed that data collected in this manner may have a significant value. We, therefore, recommend a full pilot study to validate the findings.