Early practice of use of video consultations in rehabilitation of hand injuries in children and adults: Content, acceptability, and cost-effectiveness.

BACKGROUND: Video consultation was implemented as a new service in a hospital hand therapy setting. PURPOSE: To describe the first year's practice of video consultations in the rehabilitation of upper extremity injuries, evaluate the acceptability, and investigate economic effects. STUDY DESIGN: Iterative design including economic evaluation. METHODS: Using the framework early health technology assessment, 13 hand therapists described characteristics of 99 video consultations, under predefined headlines: the patients' municipally, adult vs child, time use, technical, content, and usefulness compared to physical consultations. The text was coded and categorized according to 22 techniques or tools used by hand therapists, and challenges were identified. Acceptability was assessed on a three-graded adjectival scale. To illustrate the costs associated with video vs physical consultations, we drafted different scenarios based on the data and stakeholder insights. RESULTS: Of 99 planned video consultations (16 with children), 88 were completed. Techniques or tools most frequently used were the performance of exercises (n = 55), orthoses (n = 26), and daily activities (n = 23). Technical challenges were common, and observation of children could be difficult. Eleven of the completed consultations were rated as not acceptable and 77 as acceptable and as either useful (n = 28) or very useful (n = 49). Four drafted scenarios showed cost savings of video consultations for the health institution and society, highest at longer travel distances and in other cases where the patient could claim refunds related to travel and time away from work and home. CONCLUSIONS: The results show therapeutic possibilities and points to areas for improvements and illustrate settings where the use of video may save costs for the health institution and society.

Downgrading of referrals to breast cancer patient pathway. / Nedprioritering av henvisninger til pakkeforløp for brystkreft.

BACKGROUND: The purpose of the study was to investigate whether the downgrading of external referrals to breast cancer patient pathways was clinically justifiable and led to a more correct prioritisation of patients who are referred to the specialist health service. MATERIAL AND METHOD: The study included 214 external referrals to breast cancer patient pathways at the Breast Screening Centre, Oslo University Hospital, which were downgraded in 2020 since they did not meet the national criteria. The information obtained from electronic patient records included age, district of Oslo, name of referring doctor, outcome after investigation and treatment, as well as recommended timeframe for initiating the investigation. The quality of the referrals was also assessed. RESULTS: A total of 3 % (7/214) of patients were diagnosed with breast cancer. Five were in the age group 40-50 years (9 %, 5/56), one was over the age of 50 years (1/31) and one was in the age group 35-40 years (1/38). None were below the age of 35 years. A total of 95 doctors had their referrals downgraded. INTERPRETATION: The study indicated that the downgrading of referrals to breast cancer patient pathways led to a more correct prioritisation of patients who are referred to the specialist health service. The results indicated that the downgrading was clinically justifiable for the age groups under 35 years and over 50 years, but that caution must be exercised when downgrading referrals in the age group 40-50 years.

Early assessment of innovation in a healthcare setting.

OBJECTIVES: Early assessment can assist in allocating resources for innovation effectively and produce the most beneficial technology for an institution. The aim of the present study was to identify methods and discuss the analytical approaches applied for the early assessment of innovation in a healthcare setting. METHODS: Knowledge synthesis based on a structured search (using the MEDLINE, Embase, and Cochrane databases) and thematic analysis was conducted. An analytical framework based on the stage of innovation (developmental, introduction, or early diffusion) was applied to assess whether methods vary according to stage. Themes (type of innovation, study, analysis, study design, method, and main target audience) were then decided among the authors. Identified methods and analysis were discussed according to the innovation stage. RESULTS: A total of 1,064 articles matched the search strategy. Overall, thirty-nine articles matched the inclusion criteria. The use of methods has a tendency to change according to the stage of innovation. Stakeholder analysis was a prominent method in the innovation stages and particularly in the developmental stage, as the introduction and early diffusion stage has more availability of data and may apply more complex methods. Barriers to the identified methods were also discussed as all of the innovation stages suffered from lack of data and substantial uncertainty. CONCLUSIONS: Although this review has identified applicable approaches for early assessment in different innovation stages, research is required regarding the value of the available data and methods and tools to enhance interactions between different parties at different stages of innovation.

The effect of employment support integrated in substance use treatment: A health economic cost-effectiveness simulation of three different interventions.

Background: Unemployment rates for individuals in treatment for substance use disorder (SUD) are high, with Norwegian estimates in the range of 81%-89%. Although Individual Placement and Support (IPS) represents a promising method to improved vocational outcome, cross-disciplinary investigations are needed to document implementation benefits and address reimbursements needs. The aim of this study was to model the potential socioeconomic value of employment support integrated in SUD treatment. Methods: Based on scientific publications, an ongoing randomised controlled trial (RCT) on employment support integrated in SUD treatment, and publicly available economy data, we made qualified assumptions about costs and socioeconomic gain for the different interventions targeting employment for patients with SUD: (1) treatment as usual (TAU); (2) TAU and a self-help guide and a workshop; and (3) TAU and IPS. For each intervention, we simulated three different outcome scenarios based on 100 patients. Results: Assuming a 40% employment rate and full-time employment (100%) for 10 years following IPS, we found a 10-year socioeconomic effect of €18,732,146. The corresponding effect for the more conservative TAU + IPS simulation assuming 40% part-time positions (25%) for five years, was €2,519,906. Compared to the two alternative interventions, IPS was cost-effective and more beneficial after six months to two years. Discussion: This concept evaluation study suggests that integrating employment support in the health services is socioeconomically beneficial. Our finding is relevant for decision makers within politics and health. Once employment rates from our ongoing RCT is available, real-life data will be applied to adjust model assumptions and socioeconomic value assumptions.

Enabling Guidelines for the Adoption of eHealth Solutions: Scoping Review.

BACKGROUND: Globally, public health care is under increasing pressure, an economic burden currently amplified by the COVID-19 outbreak. With the recognition that universal health coverage improves the health of a population and reduces health inequalities, universal health coverage has been acknowledged as a priority goal. To meet the global needs in a population with increased chronic illness and longer life expectancy, the health care system is in dire need of new, emerging technologies. eHealth solutions as a method of delivery may have an impact on quality of care and health care costs. As such, it is important to study methods previously used to avoid suboptimal implementation and promote general guidelines to further develop eHealth solutions. OBJECTIVE: This study aims to explore and thematically categorize a selected representation of early phase studies on eHealth technologies, focusing on papers that are under development or undergoing testing. Further, we want to assess enablers and barriers in terms of usability, scaling, and data management of eHealth implementation. The aim of this study to explore early development phase and feasibility studies was an intentional effort to provide applicable guidelines for evaluation at different stages of implementation. METHODS: A structured search was performed in PubMed, MEDLINE, and Cochrane to identify and provide insight in current eHealth technology and methodology under development and gain insight in the future potential of eHealth technologies. RESULTS: In total, 27 articles were included in this review. The clinical studies were categorized thematically by illness comparing 4 technology types deemed relevant: apps/web-based technology, sensor technology, virtual reality, and television. All eHealth assessment and implementation studies were categorized by their focus point: usability, scaling, or data management. Studies assessing the effect of eHealth were divided into feasibility studies, qualitative studies, and heuristic assessments. Studies focusing on usability (16/27) mainly addressed user involvement and learning curve in the adoption of eHealth, while the majority of scaling studies (6/27) focused on strategic and organizational aspects of upscaling eHealth solutions. Studies focusing on data management (5/27) addressed data processing and data sensitivity in adoption and diffusion of eHealth. Efficient processing of data in a secure manner, as well as user involvement and feedback, both throughout small studies and during upscaling, were the important enablers considered for successful implementation of eHealth. CONCLUSIONS: eHealth interventions have considerable potential to improve lifestyle changes and adherence to treatment recommendations. To promote efficient implementation and scaling, user involvement to promote user-friendliness, secure and adaptable data management, and strategical considerations needs to be addressed early in the development process. eHealth should be assessed during its development into health services. The wide variation in interventions and methodology makes comparison of the results challenging and calls for standardization of methods.

A Web-Based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study.

BACKGROUND: Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency and reduce cost. DigiHelse is a Web-based platform designed to reinforce home care service in Norway and is currently undergoing a development process to meet the predefined needs of the country's municipalities. Some of the main features of the platform are digital messages between residents and the home care service, highlighting information on planned and completed visits, the opportunity to cancel visits, and notifications for completed visits. OBJECTIVE: This study aimed to test the usability and economic feasibility of adopting DigiHelse in four districts in Oslo by applying registry and behavioral data collected throughout a one-year pilot study. Early health technology assessment was used to estimate the potential future value of DigiHelse, including the predictive value of behavior data. METHODS: Outcome measures identified by stakeholder insights and scenario drafting in the project's concept phase were used to assess potential socioeconomic benefits. Aggregated data were collected to assess changes in health consumption at baseline, and then 15 and 52 weeks after DigiHelse was implemented. The present value calculation was updated with data from four intervention groups and one control group. A quasi-experimental difference-in-difference design was applied to estimate the causal effect. Descriptive behavioral data from the digital platform was applied to assess the usability of the platform. RESULTS: Over the total study period (52 weeks), rates increased for all outcome estimates: the number of visits (rate ratio=1.04; P=.10), unnecessary trips (rate ratio=1.37; P=.26), and phone calls (rate ratio=1.24; P=.08). A significant gap was found between the estimated value of DigiHelse in the concept phase and after the one-year pilot. In the present pilot assessment, costs are expected to exceed potential savings by €67 million (US $75 million) over ten years, as compared to the corresponding concept estimates of a potential gain of €172.6 million (US $193.6 million). Interestingly, behavioral data from the digital platform revealed that only 3.55% (121/3405) of recipients actively used the platform after one year. CONCLUSIONS: Behavioral data provides a valuable source for assessing usability. In this pilot study, the low adoption rate may, at least in part, explain the inability of DigiHelse to perform as expected. This study points to an early assessment of behavioral data as an opportunity to identify inefficiencies and direct digital development. For DigiHelse, insight into why the recipients in Oslo have not made greater use of the Web-based platform seems to be the next step in ensuring the right improvement measures for the home care service.

Acceptability, usability and utility of a personalised application in promoting behavioural change in patients with osteoarthritis: a feasibility study in Norway.

OBJECTIVE: The dynamic and interactive mobile application Vett was designed to help change behaviour and is based on cognitive, motivational and visual techniques. Our aim is to investigate the acceptability, usability and utility of Vett as a personalised application for goal achievement. SETTING: The trial took place at the rheumatology clinic at Diakonhjemmet Hospital, Oslo, Norway from January to June 2015. PARTICIPANTS: Twelve participants with osteoarthritis were recruited from a 3.5-hour multidisciplinary group-based educational programme (osteoarthritis school). INTERVENTIONS: With the help of a physician, each participant followed a customised 12-week mixed-mode goal achievement plan with digital support based on preset goals, self-monitoring and individual feedback. Acceptability was measured as the perceived degree of goal achievement using a validated habit questionnaire scaled from 0 to 100. Utility and usability were assessed via 10 weekly questions and adherence by fulfilment of predetermined tasks. RESULTS: Mean goal achievement was 73 (95% CI 68 to 78), an increase of 22 (95% Cl 17 to 26, p<0.01), which equals 48% improvement (95% CI 32% to 59%). Mean user satisfaction was 81 (95% CI 76 to 85), and technical usability was 80 (95% CI 75 to 84), which both increased during the study period. CONCLUSION: The high levels of acceptability, usability and utility support the feasibility of the personalised application Vett as a viable goal achievement tool.