Towards an Explainable AI Platform to Study Interruptions in Cancer Radiation Therapy.

Radiation therapy interruptions drive cancer treatment failures; they represent an untapped opportunity for improving outcomes and narrowing treatment disparities. This research reports on the early development of the X-CART platform, which uses explainable AI to model cancer treatment outcome metrics based on high-dimensional associations with our local social determinants of health dataset to identify and explain causal pathways linking social disadvantage with increased radiation therapy interruptions.

Sistema informático para el seguimiento y rastreo de casos y contactos estrechos de COVID-19 en Puerto Madryn, Chubut / Computer System for Monitoring and Tracing Cases and Close contacts of COVID-19 in Puerto Madryn, Chubut

RESUMEN INTRODUCCIÓN Se realizó una intervención en la ciudad de Puerto Madryn, Chubut. La pandemia marcó la necesidad de una identificación oportuna, un seguimiento sistematizado y un control de foco de los casos de COVID-19, sus contactos estrechos y los eventos asociados. El objetivo general fue mejorar la calidad de trabajo del equipo de salud y la respuesta del sistema sanitario mediante la implementación de un software denominado RastreAr. MÉTODOS Se utilizó un enfoque cuasi experimental. Se apuntó a demostrar la causalidad entre la intervención y los objetivos alcanzados. Se efectuó una evaluación pre- y posintervención. RESULTADOS Antes de su puesta en marcha, RastreAr se comparó con un sistema basado en hojas de cálculo. En funcionamiento, se contrastó con el registro nacional de casos. Presentó una mejora en términos de eficiencia y calidad respecto al primero, y mostró una optimización de recursos y mayor efectividad que el registro nacional, ya que registraba no solo los casos confirmados sino también los contactos estrechos y permitía el seguimiento de ambos. DISCUSIÓN A partir de la identificación de los distintos brotes ocurridos durante la operatoria del sistema RastreAr, es factible integrar la información en términos de vigilancia epidemiológica a fin de contribuir a una mejora en la calidad de sus procesos y asistir al personal de salud.

ABSTRACT INTRODUCTION An intervention was carried out in the city of Puerto Madryn, Chubut. The pandemic showed the need for timely identification, systematic tracking, and focus control of COVID-19 cases, close contacts, and associated events. The general objective was to improve the quality of health team work and the response of the health system through the implementation of a software called RastreAr. METHODS A quasi-experimental approach was used. The aim was to show the causality between the intervention and the objectives achieved. A pre- and post-intervention assessment was conducted. RESULTS Prior to its implementation, RastreAr was compared to a spreadsheet-based system. In operation, it was contrasted with the national registry of cases. It presented an improvement in terms of efficiency and quality compared to the first, optimizing resources and being more effective than the national registry, as it recorded not only confirmed cases but also close contacts and allowed tracking of both. DISCUSSION Through the identification of the different outbreaks that occurred during the operation of the RastreAr system, it is feasible to integrate the information in terms of epidemiological surveillance, in order to contribute to an improvement in process quality and assist health personnel.

Estratégia e-sus atenção primária em consultórios na rua: análise de um processo de educação permanente / E-sus strategy primary care in street offices: evaluation of a continuing education process / Estrategia e-sus atención primaria en oficinas de calle: evaluación de un proceso de educación continua

Objetivo: Analisar o uso da estratégia e-SUS Atenção Primária pelas equipes de Consultório na Rua, após processo de educação permanente. Métodos: Estudo descritivo-exploratório de abordagem qualitativa do tipo pesquisa-intervenção, realizado com 23 profissionais de três Consultórios na Rua da Região Centro-Oeste do Brasil em 2016. A intervenção consistiu em um seminário teórico-prático sobre a estratégia e-SUS Atenção Primária, com avaliação mediada por grupos focais. Os dados foram submetidos à Análise de Conteúdo, modalidade Temática, com auxílio do software ATLAS.ti. Resultados: Houve reflexões sobre a necessidade de transformação da prática profissional e valorização dos registros eletrônicos de saúde das atividades realizadas pelas equipes para elevar a qualidade da assistência e dar mais visibilidade ao trabalho empreendido pelos profissionais. Passaram a incorporar a estratégia e-SUS Atenção Primária nos processos de trabalho dos serviços de forma gradual. Conclusão: O processo de educação permanente proporcionou aos profissionais e gestores um espaço de reflexão e ressignificação da prática profissional em relação aos registros eletrônicos de saúde, sensibilizando-os para a importância da informatização nos processos de trabalho. Ao longo do processo interventivo, ficou evidenciado que os participantes foram mobilizados quanto à compreensão e atitudes em relação à estratégia e-SUS Atenção Primária no seu cotidiano. (AU)

Objective: To analyze the use of the e-SUS Primary Care strategy by the Street Clinic teams, after a continuing education process. Methods: Descriptive-exploratory study with a qualitative research-intervention approach carried out with 23 professionals from three clinics in Rua da Centro-Oeste do Brasil in 2016. The intervention consisted of a theoretical-practical seminar on the e-SUS Primary Care strategy with assessment mediated by focus groups. Data were submitted to Content Analysis, Thematic modality, with the help of the ATLAS.ti software. Results: There were reflections on the need to transform professional practice and value electronic health records of the activities carried out by the teams to raise the quality of care and give more visibility to the work undertaken by professionals. They began to gradually incorporate the e-SUS Primary Care strategy into the work processes of the services. Conclusion: The continuing education process provided professionals and managers with a space for reflection and resignification of professional practice in relation to electronic health records, making them aware of the importance of computerization in work processes. Throughout the intervention process, it was evident that the participants were mobilized regarding their understanding and attitudes towards the e-SUS Primary Care strategy in their daily lives. (AU)

Objectivo: Analizar el uso de la estrategia de Atención Primaria e-SUS por los equipos de Clínica de Calle, luego de un proceso de educación continua. Métodos: Estudio descriptivo-exploratorio con enfoque de investigación-intervención cualitativo realizado con 23 profesionales de tres oficinas de la Rua da Centro-Oeste de Brasil en 2016. La intervención consistió en un seminario teórico-práctico sobre la estrategia e-SUS de Atención Primaria con evaluación mediada por grupos focales. Los datos fueron sometidos a Análisis de Contenido, modalidad Temática, con la ayuda del software ATLAS.ti. Resultados: Se reflexionó sobre la necesidad de transformar la práctica profesional y valorar la historia clínica electrónica de las actividades que realizan los equipos para elevar la calidad de la atención y dar más visibilidad al trabajo realizado por los profesionales. Comenzaron a incorporar gradualmente la estrategia de Atención Primaria e-SUS en los procesos de trabajo de los servicios. Conclusión: El proceso de formación continua brindó a los profesionales y directivos un espacio de reflexión y resignificación del ejercicio profesional en relación a la historia clínica electrónica, sensibilizándolos sobre la importancia de la informatización en los procesos de trabajo. A lo largo del proceso de intervención, se evidenció que los participantes se movilizaron en cuanto a su comprensión y actitudes hacia la estrategia de Atención Primaria e-SUS en su vida diaria. (AU)

An anti-infodemic virtual center for the Americas / Un centro virtual contra la infodemia para la Región de las Américas / Um centro virtual anti-infodemia para as Américas

ABSTRACT The Pan American Health Organization/World Health Organization (PAHO/WHO) Anti-Infodemic Virtual Center for the Americas (AIVCA) is a project led by the Department of Evidence and Intelligence for Action in Health, PAHO and the Center for Health Informatics, PAHO/WHO Collaborating Center on Information Systems for Health, at the University of Illinois, with the participation of PAHO staff and consultants across the region. Its goal is to develop a set of tools—pairing AI with human judgment—to help ministries of health and related health institutions respond to infodemics. Public health officials will learn about emerging threats detected by the center and get recommendations on how to respond. The virtual center is structured with three parallel teams: detection, evidence, and response. The detection team will employ a mixture of advanced search queries, machine learning, and other AI techniques to sift through more than 800 million new public social media posts per day to identify emerging infodemic threats in both English and Spanish. The evidence team will use the EasySearch federated search engine backed by AI, PAHO's knowledge management team, and the Librarian Reserve Corps to identify the most relevant authoritative sources. The response team will use a design approach to communicate recommended response strategies based on behavioural science, storytelling, and information design approaches.

RESUMEN El centro virtual contra la infodemia para la Región de las Américas de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) es un proyecto liderado por el Departamento de Evidencia e Inteligencia para la Acción en la Salud de la OPS y el Center for Health Informatics de la Universidad de Illinois, centro colaborador de la OPS/OMS en sistemas de información para la salud, con la participación de personal y consultores de la OPS en toda la Región. Su objetivo es crear un conjunto de herramientas que combinen inteligencia artificial (IA) y los criterios humanos para apoyar a los ministerios de salud y las instituciones relacionadas con la salud en la respuesta a la infodemia. Los funcionarios de salud pública recibirán formación sobre las amenazas emergentes detectadas por el centro y recomendaciones sobre cómo abordarlas. El centro virtual está estructurado en tres equipos paralelos: detección, evidencia y respuesta. El equipo de detección empleará una combinación de consultas mediante búsqueda avanzada, aprendizaje automático y otras técnicas de IA para evaluar más de 800 millones de publicaciones nuevas en las redes sociales al día con el fin de detectar amenazas emergentes en el ámbito de la infodemia tanto en inglés como en español. El equipo de evidencia hará uso del motor de búsqueda federado EasySearch y, con el apoyo de la IA, el equipo de gestión del conocimiento de la OPS y la red Librarian Reserve Corps, determinará cuáles son las fuentes autorizadas más pertinentes. El equipo de respuesta utilizará un enfoque vinculado al diseño para difundir las estrategias recomendadas sobre la base de las ciencias del comportamiento, la narración de historias y el diseño de la información.

RESUMO O Centro Virtual Anti-Infodemia para as Américas (AIVCA, na sigla em inglês) da Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) é um projeto liderado pelo Departamento de Evidência e Inteligência para a Ação em Saúde da OPAS e pelo Centro de Informática em Saúde da Universidade de Illinois, EUA (Centro Colaborador da OPAS/OMS para Sistemas de Informação para a Saúde), com a participação de funcionários e consultores da OPAS de toda a região. Seu objetivo é desenvolver um conjunto de ferramentas — combinando a inteligência artificial (IA) com o discernimento humano — para ajudar os ministérios e instituições de saúde a responder às infodemias. As autoridades de saúde pública aprenderão sobre as ameaças emergentes detectadas pelo centro e obterão recomendações sobre como responder. O centro virtual está estruturado com três equipes paralelas: detecção, evidência e resposta. A equipe de detecção utilizará consultas de pesquisa avançada, machine learning (aprendizagem de máquina) e outras técnicas de IA para filtrar mais de 800 milhões de novas postagens públicas nas redes sociais por dia, a fim de identificar ameaças infodêmicas emergentes em inglês e espanhol. A equipe de evidência usará o mecanismo de busca federada EasySearch, com apoio de IA, da equipe de gestão de conhecimento da OPAS e do Librarian Reserve Corps (LRC), para identificar as fontes abalizadas mais relevantes. A equipe de resposta usará uma abordagem de design para comunicar estratégias de resposta recomendadas com base em abordagens de ciência comportamental, narração de histórias e design da informação.

NTD Health: An electronic medical record system for neglected tropical diseases / NTD Health: un sistema de historias clínicas electrónicas para enfermedades tropicales desatendidas

Introduction: The use of technological resources to support processes in health systems has generated robust, interoperable, and dynamic platforms. In the case of institutions working with neglected tropical diseases, there is a need for specific customizations of these diseases. Objectives: To establish a medical record platform specialized in neglected tropical diseases which could facilitate the analysis of treatment evolution in patients, as well as generate more accurate data about various clinical aspects. Materials and methods: A set of requirements to develop state of the art forms, concepts, and functionalities to include neglected tropical diseases were compiled. An OpenMRS distribution (version 2.3) was used as reference to build the platform, following the recommended guidelines and shared-community modules. Results: All the customized information was developed in a platform called NTD Health, which is web-based and can be upgraded and improved by users without technological barriers. Conclusions: The electronic medical record system can become a useful tool for other institutions to improve their health practices as well as the quality of life for neglected tropical disease patients, simplifying the customization of healthcare systems able to interoperate with other platforms.

Introducción. El uso de recursos tecnológicos destinados a apoyar procesos en los sistemas de salud ha generado plataformas sólidas, interoperables y dinámicas. En el caso de las instituciones que trabajan con enfermedades tropicales desatendidas, existe la necesidad de personalizaciones específicas en las herramientas de uso médico. Objetivos. Establecer una plataforma para historias clínicas especializada en enfermedades tropicales desatendidas, con el fin de facilitar el análisis de la evolución del tratamiento de los pacientes, además de generar datos más precisos sobre diversos aspectos clínicos. Materiales y métodos. Se compiló un conjunto de requisitos para implementar formularios, conceptos y funcionalidades que permitan incluir enfermedades tropicales desatendidas. Se utilizó una distribución de OpenMRS (versión 2.3) como referencia para construir la plataforma, siguiendo las pautas recomendadas y módulos compartidos por la comunidad. Resultados. Toda la información personalizada se implementó en una plataforma llamada NTD Health, la cual se encuentra almacenada en la web y los usuarios pueden actualizarla y mejorarla sin barreras tecnológicas. Conclusiones. El sistema de historias clínicas electrónicas puede convertirse en una herramienta útil para que otras instituciones mejoren sus prácticas en salud, así como la calidad de vida de los pacientes con enfermedades tropicales desatendidas, simplificando la personalización de los sistemas de salud capaces de interoperar con otras plataformas.

Experiencia en la implementación de un sistema informático para la gestión de camas hospitalarias / Implementation experience of an informatic system for the management of hospital beds

La gestión de camas al interior de los centros asistenciales es fundamental para la atención de las necesidades de salud de la población. Actualmente, en Chile se cuenta con escasas herramientas informáticas que agilicen las funciones que realizan las unidades de gestión de camas de los centros asistenciales. El objetivo del presente artículo es describir la implementación de un sistema informático de gestión de camas en tres hospitales de mediana (Modular en La Serena) y alta complejidad (San José del Carmen en Copiapó y San Juan de Dios en La Serena) de la red pública de salud de Chile. El proceso utilizó el de diseminación e implementación, lo que permitió contar con un flujo coherente de gestión de camas, a saber: solicitud, asignación de cama, traslado, hospitalización y egreso de paciente. Asimismo, se identificaron los actores relevantes y las variables mínimas para el adecuado proceso. La implementación del sistema se llevó a cabo en etapas de validación y configuración de la plataforma en cada centro asistencial, capacitaciones a los usuarios y acompañamiento de la puesta en marcha. A la fecha, los tres hospitales cuentan operativamente con el sistema informático de gestión de camas hospitalarias, no reportando dificultades en su uso. El próximo desafío es efectuar una evaluación integral del impacto de la plataforma, utilizando los indicadores acordados con los equipos clínicos/administrativos de los centros de salud.

The management of beds within healthcare centers is essential for meeting the health needs of the population. Currently, in Chile there are few computer tools that streamline the functions performed by the Bed Management Units of healthcare centers. The objective of this article is to describe the implementation of a bed management computer system in three hospitals of medium (Modular-La Serena) and high complexity (San José del Carmen-Copiapó y San Juan de Dios-La Serena) of the Chilean public health network. The process used the Framework of dissemination and implementation, which allowed for a consistent flow of bed management, namely: request, allocation of bed, transfer, hospitalization and patient discharge. Likewise, the relevant actors and the minimum variables for the adequate process were identified. The implementation of the system was carried out in stages of validation and configuration of the platform in each healthcare center, user training and follow-up of the start-up. To date, the three hospitals have an operational computer system for managing hospital beds, reporting no difficulties in its use. The next challenge is to carry out a comprehensive evaluation of the impact of the platform, using the indicators agreed upon with the clinical/administrative teams of the health centers.

Developing a Mobile Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events Administration System to Capture Postradiation Toxicity in Oncology: Usability and Feasibility Study.

BACKGROUND: Accurate self-reported symptomatic toxicity documentation via the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) is essential throughout cancer treatment to ensure safety and understand therapeutic efficacy. However, the capture of accurate toxicities from patients undergoing radiation therapy is challenging because this is generally provided only at the time of scheduled visits. OBJECTIVE: This study seeks to establish the usability and feasibility of a mobile PRO-CTCAE Administration System (mPROS) to capture toxicities related to radiation therapy. METHODS: English-speaking adult patients who were undergoing radiation therapy for cancer were enrolled and given a brief demonstration of the Say All Your Symptoms (SAYS) and Symptom Tracking Entry Program (STEP) interfaces of the mPROS app, followed by a patient-use phase where patient actions were observed as they navigated mPROS to enter toxicities. Patient feedback was captured via a semistructured interview and brief questionnaire. RESULTS: We enrolled 25 patients (age: mean 60.7 years; females: n=13, 52%; White patients: n=13; 52%; non-Hispanic patients: n=19, 76%; college graduates: n=17, 68%). Patients almost equally preferred the SAYS (n=14, 56%) or STEP (n=11, 44%) interfaces, with 21 patients (84%) agreeing that they would use mPROS to report their symptoms to their health care team and 19 patients (76%) agreeing that they would recommend mPROS to others. CONCLUSIONS: The mPROS app is usable and feasible for facilitating the patient reporting of radiation therapy-related symptomatic toxicities. A revised version of mPROS that incorporates patient input and includes electronic health record integration is being developed and validated as part of a multicenter trial.

The use of electronic health records to inform cancer surveillance efforts: a scoping review and test of indicators for public health surveillance of cancer prevention and control.

INTRODUCTION: State cancer prevention and control programs rely on public health surveillance data to set objectives to improve cancer prevention and control, plan interventions, and evaluate state-level progress towards achieving those objectives. The goal of this project was to evaluate the validity of using electronic health records (EHRs) based on common data model variables to generate indicators for surveillance of cancer prevention and control for these public health programs. METHODS: Following the methodological guidance from the PRISMA Extension for Scoping Reviews, we conducted a literature scoping review to assess how EHRs are used to inform cancer surveillance. We then developed 26 indicators along the continuum of the cascade of care, including cancer risk factors, immunizations to prevent cancer, cancer screenings, quality of initial care after abnormal screening results, and cancer burden. Indicators were calculated within a sample of patients from the New York City (NYC) INSIGHT Clinical Research Network using common data model EHR data and were weighted to the NYC population using post-stratification. We used prevalence ratios to compare these estimates to estimates from the raw EHR of NYU Langone Health to assess quality of information within INSIGHT, and we compared estimates to results from existing surveillance sources to assess validity. RESULTS: Of the 401 identified articles, 15% had a study purpose related to surveillance. Our indicator comparisons found that INSIGHT EHR-based measures for risk factor indicators were similar to estimates from external sources. In contrast, cancer screening and vaccination indicators were substantially underestimated as compared to estimates from external sources. Cancer screenings and vaccinations were often recorded in sections of the EHR that were not captured by the common data model. INSIGHT estimates for many quality-of-care indicators were higher than those calculated using a raw EHR. CONCLUSION: Common data model EHR data can provide rich information for certain indicators related to the cascade of care but may have substantial biases for others that limit their use in informing surveillance efforts for cancer prevention and control programs.

Enhancing cancer prevention and survivorship care with a videoconferencing model for continuing education: a mixed-methods study to identify barriers and incentives to participation.

OBJECTIVE: To enhance cancer prevention and survivorship care by local health care providers, a school of public health introduced an innovative telelearning continuing education program using the Extension for Community Healthcare Outcomes (ECHO) model. In ECHO's hub and spoke structure, synchronous videoconferencing connects frontline health professionals at various locations ("spokes") with experts at the facilitation center ("hub"). Sessions include experts' didactic presentations and case discussions led by spoke site participants. The objective of this study was to gain a better understanding of the reasons individuals choose or decline to participate in the Cancer ECHO program and to identify incentives and barriers to doing so. MATERIALS AND METHODS: Study participants were recruited from the hub team, spoke site participants, and providers who attended another ECHO program but not this one. Participants chose to take a survey or be interviewed. The Consolidated Framework for Implementation Research guided qualitative data coding and analysis. RESULTS: We conducted 22 semistructured interviews and collected 30 surveys. Incentives identified included the program's high-quality design, supportive learning climate, and access to information. Barriers included a lack of external incentives to participate and limited time available. Participants wanted more adaptability in program timing to fit providers' busy schedules. CONCLUSION: Although the merits of the Cancer ECHO program were widely acknowledged, adaptations to facilitate participation and emphasize the program's benefits may help overcome barriers to attending. As the number of telelearning programs grows, the results of this study point to ways to expand participation and spread health benefits more widely.

Use of WhatsApp by older adults screened for depression in socioeconomically deprived areas of Guarulhos, São Paulo State, Brazil: challenges and possibilities for telehealth / Uso do WhatsApp por idosos depressivos em áreas socioeconomicamente carentes de Guarulhos, São Paulo, Brasil: desafios e possibilidades para a telessaúde / Uso de WhatsApp por ancianos deprimidos en áreas desfavorecidas socioeconómicamente en Guarulhos, São Paulo, Brasil: retos y posibilidades de la telesalud

This study aimed to investigate the relationship between sociodemographic characteristics, depressive symptomatology, mobile phone ownership, and different uses of WhatsApp among older adults enrolled in primary care clinics in Guarulhos, São Paulo State, Brazil. This is a secondary data analysis, using data collected in the screening of participants to be included in the PROACTIVE cluster randomized trial. Individuals aged ≥ 60 years, registered in primary care clinics in Guarulhos, were assessed for sociodemographic characteristics, depressive symptoms according to the PHQ-9, mobile phone ownership, and use of WhatsApp. We performed multiple logistic regression models to investigate characteristics of the potential users of digital interventions. Of 3,356 older adults screened for depression, 45.7% said they use WhatsApp to receive/send messages. In the subsample that presented depressive symptomatology (n = 1,020), 41.9% stated using WhatsApp. Younger older adults and those with better socioeconomic status used more WhatsApp and were more likely to own a mobile phone. Participants with higher levels of symptoms of depression were less likely to use WhatsApp. Gender, age, schooling level, income, and depressive symptomatology are variables associated with the possession of a cell phone and with the use of WhatsApp by the older adults of the sample. These findings can help to implement digital health programs better suited to disadvantaged populations in Brazil and other low- and middle-income countries through mental telehealth interventions using WhatsApp and mobile health services to the older people.

Este estudo teve como objetivo investigar a relação entre características sociodemográficas, sintomatologia depressiva, posse de telefone celular e diferentes usos do WhatsApp entre idosos cadastrados em unidades básicas de saúde de Guarulhos, São Paulo, Brasil. Trata-se de uma análise de dados secundários com informações coletadas na triagem dos participantes a serem incluídos neste estudo randomizado em cluster PROATIVO. Indivíduos com 60 anos ou mais, cadastrados em unidades básicas de saúde de Guarulhos, foram avaliados quanto a características sociodemográficas, sintomas depressivos, de acordo com o PHQ-9, posse de telefone celular e uso do WhatsApp. Foram utilizados modelos de regressão logística múltipla para investigar as características dos potenciais usuários de intervenções digitais. Dos 3.356 idosos depressivos, 45,7% usavam o WhatsApp para receber/enviar mensagens. Na subamostra que apresentou sintomatologia depressiva (n = 1.020), 41,9% disseram usar o WhatsApp. Adultos mais jovens e com melhor status socioeconômico usavam mais o WhatsApp e eram mais propensos a possuir um telefone celular. Participantes com níveis mais altos de sintomas de depressão eram menos propensos a utilizar o WhatsApp. Sexo, idade, escolaridade, renda e sintomatologia depressiva são variáveis associadas à posse de telefone celular e ao uso do WhatsApp pelos idosos da população estudada. Esses achados podem ajudar a implementar programas de saúde digital mais adequados para populações desfavorecidas no Brasil e em outros países de baixa e média renda, principalmente intervenções de telessaúde mental que utilizem o WhatsApp e serviços móveis de saúde para idosos.

Este estudio tuvo como objetivo determinar la relación entre las características sociodemográficas, los síntomas depresivos, la tenencia de teléfono celular y los diferentes usos de WhatsApp entre los ancianos inscritos en unidades básicas de salud en Guarulhos, São Paulo, Brasil. Este es un análisis de datos secundarios, que recopiló la información del triaje de los participantes a ser incluidos en este estudio aleatorio en un clúster PROACTIVO. Se evaluaron las características sociodemográficas, los síntomas depresivos según el PHQ-9, la tenencia de celular y el uso de WhatsApp de los participantes de 60 años o más, registrados en unidades básicas de salud de Guarulhos. Se utilizaron los modelos de regresión logística múltiple para identificar las características de los potenciales usuarios de las intervenciones digitales. De los 3.356 ancianos deprimidos, el 45,7% utilizaba WhatsApp para recibir/enviar mensajes. En la submuestra que presentó síntomas depresivos (n = 1.020), el 41,9% dijo usar WhatsApp. Los adultos más jóvenes con mejor nivel socioeconómico usaban más WhatsApp y tenían más probabilidades de tener un teléfono celular. Los participantes con niveles más altos de síntomas de depresión tenían menos probabilidades de usar WhatsApp. El sexo, la edad, la educación, la renta y los síntomas depresivos fueron las variables asociadas a la tenencia de celular y al uso de WhatsApp por parte de los ancianos de la población estudiada. Estos hallazgos pueden ayudar a implementar programas de salud digital que sean más adecuados para las poblaciones desfavorecidas en Brasil y en otros países de bajos y medianos ingresos, en particular las intervenciones de telesalud mental que utilizan WhatsApp y servicios de salud móviles para ancianos.

Vinculación de datos administrativos y su utilidad en salud pública: el caso de Ecuador / Administrative data linkage and its usefulness in public health: the case of Ecuador / Vinculação de dados administrativos e sua utilização em saúde pública: o caso do Equador

RESUMEN Los objetivos de este artículo son describir las características del abordaje de vinculación de bases de datos administrativos y sus usos en investigación en salud pública, y discutir las potencialidades y retos para su implementación en Ecuador. La vinculación de bases de datos permite integrar datos de una misma persona dispersos en distintos subsectores como salud, educación, justicia, inmigración y programas sociales, y posibilita investigaciones que informen una gestión más eficiente de programas y políticas sociales y de salud. Las principales ventajas del uso de bases de datos relacionadas son la diversidad de datos, la cobertura poblacional, la estabilidad temporal y el costo menor en comparación con la recolección de datos primarios. A pesar de la disponibilidad de herramientas para procesar, vincular y analizar grandes conjuntos de datos, el uso de este abordaje es mínimo en los países de América Latina. Ecuador tiene un alto potencial para explotar este abordaje, debido a la obligatoriedad del uso de un identificador único en la prestación de servicios de salud, que permite la vinculación con otros sistemas de información nacionales. Sin embargo, enfrenta una serie de retos técnicos, ético-legales, culturales y políticos. Para aprovechar su potencial, Ecuador necesita desarrollar una estrategia de gobernanza de datos que incluya normativas de acceso y uso de los datos, de manera simultánea con mecanismos de control y calidad de los datos, una mayor inversión en formación profesional en el uso de los datos dentro y fuera del sector salud, y colaboraciones entre entidades gubernamentales, universidades y organizaciones de la sociedad civil.

ABSTRACT The objective of this article is to describe the characteristics of addressing the linkage of administrative databases and the uses of such linkages in public health research, and also to discuss the opportunities and challenges for implementation in Ecuador. The linkage of databases makes it possible to integrate a person's data that may be scattered across different subsectors such as health, education, justice, immigration, and social programs. It also facilitates research that can inform more efficient management of social and health programs and policies. The main advantages of using linked databases are: diversity of data, population coverage, stability over time, and lower cost in comparison to primary data collection. Despite the availability of tools to process, link, and analyze large data sets, there has been minimal use of this approach in Latin American countries. Ecuador is well positioned to implement this approach, due to compulsory use of a unique ID in health services delivery, which permits linkages with other national information systems. However, the country faces several cultural, technical, ethical, legal, and political challenges. To take advantage of its potential, Ecuador needs to develop a data governance strategy that includes standards for data access and data use, as well as mechanisms for data control and quality, greater investment in professional training in data use both within and beyond the health sector, and collaborations between government entities, universities, and civil society organizations.

RESUMO Os objetivos deste artigo são descrever as características do método de vinculação de bancos de dados administrativos e sua utilização em pesquisa em saúde pública e examinar o potencial e os desafios para sua implementação no Equador. A vinculação de bancos de dados possibilita integrar dados de uma mesma pessoa dispersos em subsetores diversos como saúde, educação, justiça, imigração e programas sociais e realizar pesquisas para subsidiar a gestão mais eficiente de programas e políticas sociais e de saúde. Entre as principais vantagens de utilizar bancos de dados vinculados estão diversidade dos dados, cobertura populacional, estabilidade temporal e custo menor em comparação à coleta de dados primários. Apesar de existirem ferramentas para processar, vincular e analisar grandes conjuntos de dados, a utilização deste método é mínima nos países da América Latina. O Equador possui um grande potencial para beneficiar-se com este método devido à obrigatoriedade do uso de um identificador único na prestação de serviços de saúde, o que permite a vinculação com outros sistemas de informação nacionais, mas enfrenta uma série de desafios técnicos, éticos-legais, culturais e políticos. Para aproveitá-lo, o país precisa elaborar uma estratégia de governança de dados contendo um conjunto de normas para o acesso e a utilização simultâneos com mecanismos de controle e qualidade dos dados, maior investimento em formação profissional no uso dos dados dentro e fora da área da saúde e colaboração entre entidades governamentais, universidades e organizações da sociedade civil.

Multimorbidity Patterns of Chronic Diseases among Indonesians: Insights from Indonesian National Health Insurance (INHI) Sample Data.

Given the increasing burden of chronic diseases in Indonesia, characteristics of chronic multimorbidities have not been comprehensively explored. Therefore, this research evaluated chronic multimorbidity patterns among Indonesians using Indonesian National Health Insurance (INHI) sample data. We included 46 chronic diseases and analyzed their distributions using population-weighted variables provided in the datasets. Results showed that chronic disease patients accounted for 39.7% of total patients who attended secondary health care in 2015-2016. In addition, 43.1% of those were identified as having chronic multimorbidities. Findings also showed that multimorbidities were strongly correlated with an advanced age, with large numbers of patients and visits in all provinces, beyond those on Java island. Furthermore, hypertension was the leading disease, and the most common comorbidities were diabetes mellitus, cerebral ischemia/chronic stroke, and chronic ischemic heart disease. In addition, disease proportions for certain disease dyads differed according to age group and gender. Compared to survey methods, claims data are more economically efficient and are not influenced by recall bias. Claims data can be a promising data source in the next few years as increasing percentages of Indonesians utilize health insurance coverage. Nevertheless, some adjustments in the data structure are accordingly needed to utilize claims data for disease control and surveillance purposes.

Impacto das mensagens de texto para redução do absenteísmo às consultas especializadas: um estudo aleatorizado / Impacto de los mensajes de texto para reducir el absentismo en consultas especializadas: un estudio aleatorio / Impact of text messages to reduce absenteeism in specialized consultations: a aleatorized study

O objetivo deste estudo foi testar o impacto de um lembrete por mensagem de texto eletrônica, via WhatsApp®, sobre a taxa de absenteísmo nas consultas de subespecialidades pediátricas. Este estudo aleatorizado foi composto por um grupo controle e um experimental. Os participantes do grupo experimental receberam um aviso por WhatsApp® lembrando a data da consulta. Foram incluídos no estudo todos os usuários agendados (primeira vez e retornos) para consultas de subespecialidades pediátricas. Para as análises foi calculado os percentuais e realizou-se o teste Qui-quadrado de associação. Um total de 998 participantes foram incluídos para análise. A maioria dos participantes era do sexo masculino (59 porcent). A taxa de absenteísmo no grupo experimental foi de 24 porcent e no grupo controle, 25,5 porcent, representando uma diferença de 1,5 porcent (p= 0,580). A taxa de absenteísmo era particularmente mais alta para consultas agendadas na segunda-feira, com 30 porcent (p= 0,009). Globalmente, o uso de lembretes por mensagens de texto em estudos com diferentes populações reduz a taxa de absenteísmo. No entanto, nossas descobertas sugerem que o envio de mensagens de texto via WhatsApp® como lembretes de consulta não é uma ferramenta eficaz na redução do absenteísmo de subespecialidades pediátricas(AU)

El objetivo de este estudio fue evaluar el impacto de un recordatorio a través de un mensaje de texto por WhatsApp® sobre la tasa de absentismo en las consultas de subespecialidades pediátricas. Este estudio aleatorizado fue compuesto por un grupo control y un grupo experimental. Los participantes del grupo experimental recibieron un recordatorio a través de WhatsApp® que rememoraba la fecha de la consulta. Todas las consultas programadas de la subespecialidad pediátrica, tanto las realizadas por primera vez como las siguientes, fueron incluidas en el estudio. Para el análisis fueron calculados los porcentajes mediante la prueba chi-cuadrado. Fueron incluidos 998 participantes en el análisis, de los cuales la mayoría eran hombres (59 por ciento). La tasa de absentismo del grupo experimental fue de 24 por ciento, mientras la del grupo control fue de 25,5 por ciento, lo que representa una diferencia del 1,5 por ciento (p= 0,580). La tasa de absentismo fue del 30 por ciento (p= 0,009), lo que resultó particularmente alta para las consultas programadas para los lunes. Generalmente los estudios que utilizaron mensajes de texto en diferentes poblaciones, como recordatorio, redujeron la tasa de absentismo de las consultas. Sin embargo, nuestros resultados sugieren que enviar mensajes de texto a través del WhatsApp® como recordatorio de consultas médicas no es una herramienta efectiva para reducir el absentismo en las subespecialidades pediátricas(AU)

The purpose of the study was to evaluate the impact of WhatsApp® text messaging reminders on the rate of non-attendance to pediatric specialty consultation. Randomized examination was conducted of a control group and an experimental group. Participants in the experimental group received a WhatsApp® reminder of the appointment date. All the appointments scheduled for the pediatric subspecialty were included, i.e. first-time appointments as well as those following. Data analysis was based on percentage estimation by the chi-square test. A total 998 participants were included in the analysis, most of whom were men (59 percent). The non-attendance rate was 24 percent in the experimental group and 25.5 percent in the control group, for a difference of 1.5 percent (p= 0.580). The non-attendance rate was 30 percent (p= 0.009), particularly high for appointments scheduled for Mondays. In general terms, studies using text messaging as reminders in different populations reduced the rate of non-attendance to consultation. However, our results suggest that sending WhatsApp® text messages as reminders of medical appointments is not an effective tool to reduce non-attendance to pediatric consultation(AU)

Methods to improve the quality of smoking records in a primary care EMR database: exploring multiple imputation and pattern-matching algorithms.

BACKGROUND: Primary care electronic medical record (EMR) data are emerging as a useful source for secondary uses, such as disease surveillance, health outcomes research, and practice improvement. These data capture clinical details about patients' health status, as well as behavioural risk factors, such as smoking. While the importance of documenting smoking status in a healthcare setting is recognized, the quality of smoking data captured in EMRs is variable. This study was designed to test methods aimed at improving the quality of patient smoking information in a primary care EMR database. METHODS: EMR data from community primary care settings extracted by two regional practice-based research networks in Alberta, Canada were used. Patients with at least one encounter in the previous 2 years (2016-2018) and having hypertension according to a validated definition were included (n = 48,377). Multiple imputation was tested under two different assumptions for missing data (smoking status is missing at random and missing not-at-random). A third method tested a novel pattern matching algorithm developed to augment smoking information in the primary care EMR database. External validity was examined by comparing the proportions of smoking categories generated in each method with a general population survey. RESULTS: Among those with hypertension, 40.8% (n = 19,743) had either no smoking information recorded or it was not interpretable and considered missing. Those with missing smoking data differed statistically by demographics, clinical features, and type of EMR system used in the clinic. Both multiple imputation methods produced fully complete smoking status information, with the proportion of current smokers estimated at 25.3% (data missing at random) and 12.5% (data missing not-at-random). The pattern-matching algorithm classified 18.2% of patients as current smokers, similar to the population-based survey (18.9%), but still resulted in missing smoking information for 23.6% of patients. The algorithm was estimated to be 93.8% accurate overall, but varied by smoking status category. CONCLUSION: Multiple imputation and algorithmic pattern-matching can be used to improve EMR data post-extraction but the recommended method depends on the purpose of secondary use (e.g. practice improvement or epidemiological analyses).

Acceptance and use of the Information System of the National Immunization Program* / Aceitação e uso do Sistema de Informação do Programa Nacional de Imunização* / Aceptación y uso del Sistema de Información del Programa Nacional de Inmunización*

Objective: to analyze the acceptance and use of the Information System of the National Immunization Program in primary health care vaccination rooms. Method: a unique case study of a qualitative approach in the light of the Unified Theory of Acceptance and Use of Technology. Data collection included an interview with 18 professionals responsible for the implementation of the information system, observation of vaccination rooms in 12 municipalities of the West Macro-region of Minas Gerais, selected from a preliminary study. Data was systematized and analyzed through Content Analysis. Results: the interviewees are satisfied with the usefulness and ease of the system usage, but do not have the same satisfaction with the organizational infrastructure due to the lack of computers and low Internet connectivity in the health units, as well as with the incipient training for the use of the information system and the lack of skills with the technology among the human resources. Conclusion: nursing professionals perceive advantages in the acceptance and use of the Information System of the National Immunization Program. It was clear that the vaccinated individual's history control and the decrease of records in paper are evidenced as facilitators of this acceptance. The system was considered reliable and secure.

Objetivo: analisar a aceitação e o uso do Sistema de Informação do Programa Nacional de Imunização nas salas de vacinação da atenção primária à saúde. Método: estudo de caso único de abordagem qualitativa à luz da Teoria Unificada de Aceitação e Uso de Tecnologia. A coleta de dados compreendeu entrevista com 18 profissionais, responsáveis pela implantação do sistema de informação, observação das salas de vacinação de 12 municípios da Macrorregião Oeste de Minas Gerais, selecionados a partir de estudo preliminar. Os dados foram sistematizados e analisados por meio da Análise de Conteúdo. Resultados: os entrevistados sentem-se satisfeitos com a utilidade e facilidade de uso do sistema, porém não apresentam a mesma satisfação com a infraestrutura organizacional devido à falta de computadores e à baixa conectividade da internet nas unidades de saúde, além da incipiente capacitação para utilização do sistema de informação e da falta de habilidade dos recursos humanos com a tecnologia. Conclusão: os profissionais de enfermagem percebem vantagens na aceitação e uso do Sistema de Informação do Programa Nacional de Imunização. Revela-se que o controle do histórico do vacinado e a diminuição de registros em papéis são evidenciados como facilitadores desta aceitação. O Sistema foi considerado confiável e seguro.

Objetivo: analizar la aceptación y uso del Sistema de Información del Programa Nacional de Inmunización en centros de vacunación de atención primaria de salud. Método: estudio de caso único con un enfoque cualitativo a la luz de la Teoría Unificada de Aceptación y Uso de Tecnología. La recopilación de datos comprendió una entrevista con 18 profesionales, responsables de implementar el sistema de información, observando los centros de vacunación de 12 municipios en la Macrorregión Oeste de Minas Gerais, seleccionados en función de un estudio preliminar. Los datos fueron sistematizados y analizados utilizando el Análisis de Contenido. Resultados: los entrevistados están satisfechos con la utilidad y facilidad de uso del sistema, pero no muestran la misma satisfacción con la infraestructura organizacional debido a la falta de computadoras y a la baja conectividad a Internet en los centros de salud. A estos factores deben sumarse la capacitación incipiente para el uso del sistema de información y la falta de habilidad de los recursos humanos con la tecnología. Conclusión: los profesionales de enfermería perciben ventajas en la aceptación y uso del Sistema de Información del Programa Nacional de Inmunización. Se revela que el control del historial de vacunación y la reducción de los registros en papel se evidencian como facilitadores de esta aceptación. El sistema se consideró confiable y seguro.

The use of model constructs to design collaborative health information technologies: A case study to support child development.

OBJECTIVE: Health information technology could provide valuable support for inter-professional collaboration to address complex health issues, but current HIT systems do not adequately support such collaboration. Existing theoretical research on supporting collaborative work can help inform the design of collaborative HIT systems. Using the example of supporting collaboration between child development service providers, we describe a deductive approach that leverages concepts from the literature and analyzes qualitative user-needs data to aid in collaborative system design. MATERIALS AND METHODS: We use the Collaboration Space Model to guide the deductive qualitative analysis of interviews focused on the use of information technology to support child development. We deductively analyzed 44 interviews from two separate research initiatives and included data from a wide range of stakeholder groups including parents and various service providers. We summarized the deductively coded interview excerpts using quantitative and qualitative methods. RESULTS: The deductive analysis method provided a rich set of design data, highlighting heterogeneity in work processes, barriers to adequate communication, and gaps in stakeholder knowledge in supporting child development work. DISCUSSION: Deductive qualitative analysis considering constructs from a literature-based model provided useful, actionable data to aid in design. Design implications underscore functions needed to adequately share data across many stakeholders. More work is needed to validate our design implications and to better understand the situations where specific system features would be most useful. CONCLUSIONS: Deductive analysis considering model constructs provides a useful approach to designing collaborative HIT systems, allowing designers to consider both empirical user data and existing knowledge from the literature. This method has the potential to improve designs for collaborative HIT systems.

Percepções de gestores, profissionais e usuários acerca do registro eletrônico de saúde e de aspectos facilitadores e barreiras para a sua implementação / Views of health system administrators, professionals, and users concerning the electronic health record and facilitators and obstacles to its implementation / Percepciones de gestores, profesionales y usuarios acerca del registro electrónico de salud y de aspectos facilitadores y barreras para su implementación

Resumo: A concepção e a implementação de tecnologias complexas, como o registro eletrônico de saúde (RES), envolvem tanto aspectos técnicos quanto questões pessoais, sociais e organizacionais. Há no cenário brasileiro público e privado diferentes iniciativas locais e regionais de implementação de RES. Existe ainda, por parte do Ministério da Saúde, a proposta de conformação de um RES nacional. O estudo aqui apresentado buscou propiciar uma visão abrangente das percepções de gestores, profissionais e usuários do sistema de saúde acerca de suas experiências com o RES e suas opiniões acerca da perspectiva de conformação de um RES nacional. Trata-se de um estudo qualitativo que envolveu a realização de 28 entrevistas semiestruturadas. Os resultados obtidos explicitaram, além da diversidade de fatores que podem influenciar a implementação do RES, a existência de confluências e de aspectos que tendem a ser valorizados de modo distinto, conforme os diferentes pontos de vista. Dentre os aspectos chave destacados nas percepções dos entrevistados, vale enfatizar as discussões acerca de atributos e do impacto do RES no cuidado de saúde, especialmente no caso dos RES de uso local; as preocupações com os custos e com o sigilo e privacidade, relativos aos RES em geral; e as possíveis implicações decorrentes da opção pela centralização ou descentralização do armazenamento das informações, no caso do RES nacional. Ficou patente nas falas dos entrevistados a necessidade de que seja estabelecida uma comunicação mais efetiva entre as partes interessadas, e que as diferentes perspectivas sejam consideradas na formulação e implementação de RES nos níveis local, regional e nacional.

Abstract: The design and deployment of complex technologies like the electronic health record (EHR) involve technical, personal, social, and organizational issues. The Brazilian public and private scenario includes different local and regional initiatives for implementation of the electronic health record. The Brazilian Ministry of Health also has a proposal to develop a national EHR. The current study aimed to provide a comprehensive view of perceptions by health system administrators, professionals, and users concerning their experiences with the electronic health record and their opinions of the possibility of developing a national EHR. This qualitative study involved 28 semi-structured interviews. The results revealed both the diversity of factors that can influence the implementation of an electronic health record and the existence of convergences and aspects that tend to be valued differently according to the different points of view. Key aspects include discussions on the electronic health record's attributes and it impact on healthcare, especially in the case of local electronic health records, concerns over costs and confidentiality and privacy pertaining to electronic health records in general, and the possible implications of centralized versus decentralized data storage in the case of a national EHR. The interviews clearly showed the need to establish more effective communication among the various stakeholders, and that the different perspectives should be considered when drafting and deploying an EHR at the local, regional, and national levels.

Resumen: La concepción y la implementación de tecnologías complejas, como el registro electrónico de salud (RES), involucran tanto aspectos técnicos como cuestiones personales, sociales y organizacionales. Hay un escenario brasileño público y privado, diferentes iniciativas locales y regionales de implementación de RES. Existe incluso, por parte del Ministerio de Salud, la propuesta de conformación de un RES nacional. El estudio aquí presentado buscó propiciar una visión amplia de las percepciones de gestores, profesionales y usuarios del sistema de salud acerca de sus experiencias con el RES y sus opiniones acerca de la perspectiva de conformación de un RES nacional. Se trata de un estudio cualitativo que implicó la realización de 28 entrevistas semiestructuradas. Los resultados obtenidos explicitaron, además de la diversidad de factores que pueden influenciar la implementación del RES, la existencia de confluencias y de aspectos que tienden a ser valorados de modo distinto, conforme los diferentes puntos de vista. Entre los aspectos clave destacados en las percepciones de los entrevistados, vale enfatizar las discusiones acerca de atributos y del impacto del RES en el cuidado de salud, especialmente en el caso de los RES de uso local; las preocupaciones con los costes y con el sigilo y privacidad, relativos a los RES en general; y las posibles implicaciones derivadas de la opción por la centralización o descentralización del almacenamiento de la información, en el caso del RES nacional. Quedó patente en las intervenciones de los entrevistados la necesidad de que sea establecida una comunicación más efectiva entre las partes interesadas, y que las diferentes perspectivas sean consideradas en la formulación e implementación de RES en los niveles local, regional y nacional.

Disseminating health evidence summaries to increase evidence use in health care

ABSTRACT OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.

Health care providers' perceptions of use and influence of clinical decision support reminders: qualitative study following a randomized trial to improve HPV vaccination rates.

BACKGROUND: Human Papillomavirus (HPV) leads to serious health issues and remains the most common sexually transmitted infection. Despite availability of effective vaccines, HPV vaccination rates are suboptimal. Furthermore, providers recommend the HPV vaccine less than half the time for eligible patients. Prior informatics research has demonstrated the effectiveness of computer-based clinical decision support (CDS) in changing provider behavior, especially in the area of preventative services. METHODS: Following a randomized clinical trial to test the effect of a CDS intervention on HPV vaccination rates, we conducted semi-structured interviews with health care providers to understand whether they noticed the CDS reminders and why providers did or did not respond to the prompts. Eighteen providers, a mix of medical doctors and nurse practitioners, were interviewed from five publicly-funded, urban health clinics. Interview data were qualitatively analyzed by two independent researchers using inductive content analysis. RESULTS: While most providers recalled seeing the CDS reminders, few of them perceived the intervention as effective in changing their behavior. Providers stated many reasons for why they did not perceive a change in their behavior, yet the results of the trial showed HPV vaccination rates increased as a result of the intervention. CONCLUSIONS: CDS reminders may be effective at changing provider behavior even if providers perceive them to be of little use. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02551887 Registered on September 15, 2015.