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1.
BMJ Open ; 14(9): e079475, 2024 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-39260847

RESUMEN

INTRODUCTION: Care aides are health workers who deliver hands-on care to patients across the healthcare continuum. The use of technology in healthcare delivery is increasing, and evidence regarding how care aides' attitudes may either facilitate or hinder the adoption of healthcare technologies is lacking.The aim of the proposed scoping review is to examine available evidence regarding care aides' attitudes towards the adoption of innovation and factors that may influence the sustainable use of technology in healthcare delivery. Published studies, grey literature and review articles that identify a method for the review, conference abstracts and website publications regarding the attitude, uptake and sustainable use of technology in care delivery by care aides will be included. For abstracts that have resulted in publications, the full publications will be included. The search for evidence commenced in June 2023 and will end in March 2024. METHODS AND ANALYSIS: The Joanna Briggs Institute (JBI) method will be used to conduct the review. The CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, PROSPERO, Web of Science and JBI Evidence Synthesis databases will be searched using keywords for publications within the last 20 years to examine trends in health technology and attitudes of care aides towards innovation over the last two decades. A search of grey literature and websites will be conducted. The reference list of the retrieved articles will be used to identify additional literature. The search results will be exported into a literature management tool for screening and analysis. Article screening will be performed by two authors and if a third is needed to resolve any differences. Data analysis will be guided by two theoretical frameworks. ETHICS AND DISSEMINATION: No ethics approval is required. The findings will be disseminated in a peer-reviewed journal and presented in conferences. REGISTRATION DETAILS: https://doi.org/10.17605/OSF.IO/CZQUP.


Asunto(s)
Actitud del Personal de Salud , Humanos , Técnicos Medios en Salud/psicología , Técnicos Medios en Salud/estadística & datos numéricos , Tecnología Biomédica/estadística & datos numéricos , Atención a la Salud/estadística & datos numéricos , Proyectos de Investigación , Literatura de Revisión como Asunto
2.
Soc Sci Med ; 352: 117014, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38906087

RESUMEN

Increasing evidence suggests that new technologies tend to substitute for low skilled labour and complement highly skilled labour. This paper considers the manner in which new technology impacts on two distinct groups of highly skilled health care labour, cardiologists and cardiac surgeons. We consider the diffusion impact of PCI as it replaces CABG in the treatment of cardiovascular disease in the English NHS, and explicitly estimate the degree to which the cardiac surgical workforce reacts to this newer technology. Using administrative data we trace the complementarity between CABG and PCI during the mature phase of technology adoption, mapped against an increasing employment of cardiologists as they replace cardiothoracic surgeons. Our findings show evidence of growing employment of cardiologists, as PCI is increasingly expanded to older and sicker patients. While in cardiothoracic surgery, surgeons compensate falling CABG rates in a manner consistent with undertaking replacement activity and redeployment. While for cardiologists this reflects the general findings in the literature, that new technology enhances rather than substitutes for skilled labour, for the surgeons the new technology leads to redeployment rather than a downsizing of their labour.


Asunto(s)
Medicina Estatal , Humanos , Medicina Estatal/organización & administración , Puente de Arteria Coronaria/estadística & datos numéricos , Puente de Arteria Coronaria/métodos , Tecnología Biomédica/tendencias , Tecnología Biomédica/estadística & datos numéricos , Reino Unido , Cirujanos/estadística & datos numéricos , Cirujanos/provisión & distribución
3.
Cancer Res Treat ; 53(3): 635-640, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34176252

RESUMEN

Charted-particle therapy (CPT) benefits cancer patients by localizing doses in the tumor volume while minimizing the doses delivered to normal tissue through its unique physical and biological characteristics. The world's first CPT applied on humans was proton beam therapy (PBT), which was performed in the mid-1950s. Among heavy ions, carbon ions showed the most favorable biological characteristics for the treatment of cancer patients. Carbon ions show coincidence between the Bragg peak and maximum value of relative biological effectiveness. In addition, they show low oxygen enhancement ratios. Therefore, carbon-ion radiotherapy (CIRT) has become mainstream in the treatment of cancer patients using heavy ions. CIRT was first performed in 1977 at the Lawrence Berkeley Laboratory. The CPT technology has advanced in the intervening decades, enabling the use of rotating gantry, beam delivery with fast pencil-beam scanning, image-guided particle therapy, and intensity-modulated particle therapy. As a result, as of 2019, a total of 222,425 and 34,138 patients with cancer had been treated globally with PBT and CIRT, respectively. For more effective and efficient CPT, many groups are currently conducting further studies worldwide. This review summarizes recent technological advances that facilitate clinical use of CPT.


Asunto(s)
Tecnología Biomédica/tendencias , Radioterapia de Iones Pesados/métodos , Neoplasias/radioterapia , Tecnología Biomédica/estadística & datos numéricos , Radioterapia de Iones Pesados/instrumentación , Radioterapia de Iones Pesados/estadística & datos numéricos , Radioterapia de Iones Pesados/tendencias , Humanos
4.
Med J Aust ; 215(10): 473-478, 2021 11 15.
Artículo en Inglés | MEDLINE | ID: mdl-34148253

RESUMEN

INTRODUCTION: Type 1 diabetes presents significant challenges for optimal management. Despite intensive glycaemic control being the standard of care for several decades, glycaemic targets are infrequently achieved and the burden of complications remains high. Therefore, the advancement of diabetes management technologies has a major role in reducing the clinical and economic impact of the disease on people living with type 1 diabetes and on health care systems. However, a national framework is needed to ensure equitable and sustainable implementation of these technologies as part of holistic care. MAIN RECOMMENDATIONS: This consensus statement considers technologies for insulin delivery, glucose sensing and insulin dose advice that are commercially available in Australia. While international position statements have provided recommendations for technology implementation, the ADS/ADEA/APEG/ADIPS Working Group believes that focus needs to shift from strict trial-based glycaemic criteria towards engagement and individualised management goals that consider the broad spectrum of benefits offered by technologies. CHANGES IN MANAGEMENT AS RESULT OF THIS STATEMENT: This Australian consensus statement from peak national bodies for the management of diabetes across the lifespan outlines a national framework for the optimal implementation of technologies for people with type 1 diabetes. The Working Group highlights issues regarding equity of access to technologies and services, scope of clinical practice, credentialling and accreditation requirements, regulatory issues with "do-it-yourself" technology, national benchmarking, safety reporting, and ongoing patient advocacy.


Asunto(s)
Tecnología Biomédica/estadística & datos numéricos , Diabetes Mellitus Tipo 1/terapia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Australia , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 1/diagnóstico , Utilización de Instalaciones y Servicios , Disparidades en Atención de Salud , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Sistemas de Infusión de Insulina , Educación del Paciente como Asunto
5.
J Am Coll Surg ; 232(2): 138-145.e2, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33122038

RESUMEN

BACKGROUND: Dissemination of new surgical technology is a major contributor to healthcare spending growth. Accountable care organization (ACO) policy aims to control spending while maintaining quality. As a result, ACOs provide incentive for hospitals to selectively adopt newer procedures with high value. STUDY DESIGN: We conducted a retrospective cohort study using a 20% sample of national Medicare claims from 2010 to 2015. We identified hospitals that performed 1 of 6 sets of procedures: abdominal aortic aneurysm repair, aortic valve replacement, carotid endarterectomy or stent, lung lobectomy, colectomy, and prostatectomy. We identified hospitals participating in a Medicare Shared Savings Program ACO and a set of matched non-ACO control hospitals. We used a difference-in-differences approach to compare rate of surgical treatment and use of newer surgical technology for each set of procedures in ACO and non-ACO hospitals. RESULTS: We included 707 ACO-hospitals and 1,770 control hospitals. ACO hospitals performed surgery for carotid stenosis at a lower rate than non-ACO hospitals. There was no difference in the rate of surgical treatment for all other procedure sets. ACO hospitals were less likely to use an endovascular approach for abdominal aortic aneurysm repair (85.2% vs 88.2%, p < 0.001) and more likely to use a minimally invasive approach for lung lobectomy (42.2% vs 34.7%, p = 0.004) than non-ACO hospitals. In difference-in-differences analysis, ACO participation was not associated with any significant difference in use of surgical care for any of the 6 procedure sets, nor with any significant difference in use of newer surgical technology. CONCLUSIONS: Despite ACO policy incentives to selectively adopt newer surgical technology, ACO participation was not associated with differences in rate of surgery or use of newer surgical technology for 6 major surgical procedures.


Asunto(s)
Organizaciones Responsables por la Atención/economía , Tecnología Biomédica/economía , Ahorro de Costo , Medicare/economía , Procedimientos Quirúrgicos Operativos/economía , Organizaciones Responsables por la Atención/organización & administración , Anciano , Tecnología Biomédica/estadística & datos numéricos , Femenino , Política de Salud , Humanos , Masculino , Medicare/organización & administración , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Estados Unidos
6.
Artículo en Inglés | MEDLINE | ID: mdl-33187163

RESUMEN

The evolving field of mobile health (mHealth) is revolutionizing collection, management, and quality of clinical data in health systems. Particularly in low- and middle-income countries (LMICs), mHealth approaches for clinical decision support and record-keeping offer numerous potential advantages over paper records and in-person training and supervision. We conducted a content analysis of qualitative in-depth interviews using the Technology Acceptance Model 3 (TAM-3) to explore perspectives of providers and health managers in Madhya Pradesh and Rajasthan, India who were using the ASMAN (Alliance for Saving Mothers and Newborns) platform, a package of mHealth technologies to support management during the peripartum period. Respondents uniformly found ASMAN easy to use and felt it improved quality of care, reduced referral rates, ensured timely referral when needed, and aided reporting requirements. The TAM-3 model captured many determinants of reported respondent use behavior, including shifting workflow and job performance. However, some barriers to ASMAN digital platform use were structural and reported more often in facilities where ASMAN use was less consistent; these affect long-term impact, sustainability, and scalability of ASMAN and similar mHealth interventions. The transitioning of the program to the government, ensuring availability of dedicated funds, human resource support, and training and integration with government health information systems will ensure the sustainability of ASMAN.


Asunto(s)
Tecnología Biomédica , Periodo Periparto , Instalaciones Públicas , Tecnología Biomédica/normas , Tecnología Biomédica/estadística & datos numéricos , Electrónica , Femenino , Humanos , India , Recién Nacido , Atención Posnatal/métodos , Atención Posnatal/normas , Atención Posnatal/estadística & datos numéricos , Instalaciones Públicas/estadística & datos numéricos
7.
JMIR Mhealth Uhealth ; 8(11): e24718, 2020 11 27.
Artículo en Inglés | MEDLINE | ID: mdl-33104517

RESUMEN

BACKGROUND: The burden of population aging and chronic conditions has been reported worldwide. Older adults, especially those with high needs, experience social isolation and have high rates of emergency visits and limited satisfaction with the care they receive. Mobile health (mHealth) technologies present opportunities to address these challenges. To date, limited information is available on Canadian older adults' attitudes toward and use of mHealth technologies for self-tracking purposes-an area that is increasingly important and relevant during the COVID-19 era. OBJECTIVE: This study presents contributions to an underresearched area on older adults and mHealth technology use. The aim of this study was to compare older adults' use of mHealth technologies to that of the general adult population in Canada and to investigate the factors that affect their use. METHODS: A cross-sectional survey on mHealth and digital self-tracking was conducted. A web-based questionnaire was administered to a national sample of 4109 Canadian residents who spoke either English or French. The survey instrument consisted of 3 sections assessing the following items: (1) demographic characteristics, health status, and comorbidities; (2) familiarity with and use of mHealth technologies (ie, mobile apps, consumer smart devices/wearables such as vital signs monitors, bathroom scales, fitness trackers, intelligent clothing); and (3) factors influencing the continued use of mHealth technologies. RESULTS: Significant differences were observed between the older adults and the general adult population in the use of smart technologies and internet (P<.001). Approximately 47.4% (323/682) of the older adults in the community reported using smartphones and 49.8% (340/682) indicated using digital tablets. Only 19.6% (91/463) of the older adults using smartphones/digital tablets reported downloading mobile apps, and 12.3% (47/383) of the older adults who heard of smart devices/wearables indicated using them. The majority of the mobile apps downloaded by older adults was health-related; interestingly, their use was sustained over a longer period of time (P=.007) by the older adults compared to that by the general population. Approximately 62.7% (428/682) of the older adults reported tracking their health measures, but the majority did so manually. Older adults with one or more chronic conditions were mostly nontrackers (odds ratio 0.439 and 0.431 for traditional trackers and digital trackers, respectively). No significant differences were observed between the older adults and the general adult population with regard to satisfaction with mHealth technologies and their intention to continue using them. CONCLUSIONS: Leveraging mHealth technologies in partnership with health care providers and sharing of health/well-being data with health care professionals and family members remain very limited. A culture shift in the provision of care to older adults is deemed necessary to keep up with the development of mHealth technologies and the changing demographics and expectations of patients and their caregivers.


Asunto(s)
Factores de Edad , Tecnología Biomédica/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Autocuidado/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19 , Canadá/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , SARS-CoV-2 , Encuestas y Cuestionarios , Adulto Joven
8.
J Foot Ankle Res ; 13(1): 63, 2020 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-33059721

RESUMEN

BACKGROUND: The arrival of the novel coronavirus (SARS-CoV-2) has impacted the many aspects of modern life, especially, in the immediate term, the delivery of healthcare. CONTEXT: This commentary examines the profession of podiatry and how it has adapted and responded to the emerging crisis. It focusses on but is not exclusive to the position in the United Kingdom (UK) and the edicts and direction from the UK Government. PODIATRY ROLES DURING THE PANDEMIC: It describes the role of podiatry in the pandemic and highlights the deployment of podiatry resources to fight the pandemic beyond traditional podiatric practice. It also looks at the shift from conventional consultation to digital solutions for managing patients in an effort to achieve the goals of maintenance of foot health whilst reducing the spread of the virus. The commentary summarises the emerging data related to a possible foot related presentation of the coronavirus. CONCLUSION: The podiatry profession proved its flexibility and adaptability during the pandemic, to adjust rapidly to ensure that patients were able to access treatment to reduce risk of infection, ulceration and amputation. Dermatological presentations on the feet have been associated with Covid-19 in adolescents as is often the case in viral infections. CPD webinars to support clinicians and manage and prevent the spread of Covid-19 have been widely disseminated along with algorithms to ensure that patients that need treatment are being treated appropriately. Podiatrists have embraced remote technology to ensure that patients are correctly and safely triaged and, signposted and given appropriate self-care advice. MSK podiatrists have the ability to play an intrinsic role within the post discharge rehabilitation pathway.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Atención a la Salud/estadística & datos numéricos , Neumonía Viral/epidemiología , Podiatría/organización & administración , Anciano , Anciano de 80 o más Años , Tecnología Biomédica/métodos , Tecnología Biomédica/estadística & datos numéricos , COVID-19 , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/virología , Atención a la Salud/tendencias , Enfermedades del Pie/prevención & control , Humanos , Pandemias/prevención & control , Docilidad , Neumonía Viral/prevención & control , Neumonía Viral/virología , Podiatría/estadística & datos numéricos , Conducta de Reducción del Riesgo , SARS-CoV-2 , Reino Unido/epidemiología
10.
Popul Health Manag ; 23(5): 361-367, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32857014

RESUMEN

Technology has played an important role in responding to the novel coronavirus (SARS-CoV-2) and subsequent COVID-19 pandemic. The virus's blend of lethality and transmissibility have challenged officials and exposed critical limitations of the traditional public health apparatus. However, throughout this pandemic, technology has answered the call for a new form of public health that illustrates opportunities for enhanced agility, scale, and responsiveness. The authors share the Microsoft perspective and illustrate how technology has helped transform the public health landscape with new and refined capabilities - the efficacy and impact of which will be determined by history. Technologies like chatbot and virtualized patient care offer a mechanism to triage and distribute care at scale. Artificial intelligence and high-performance computing have accelerated research into understanding the virus and developing targeted therapeutics to treat infection and prevent transmission. New mobile contact tracing protocols that preserve patient privacy and civil liberties were developed in response to public concerns, creating new opportunities for privacy-sensitive technologies that aid efforts to prevent and control outbreaks. While much progress is still needed, the COVID-19 pandemic has highlighted technology's importance to public health security and pandemic preparedness. Future multi-stakeholder collaborations, including those with technology organizations, are needed to facilitate progress in overcoming the current pandemic, setting the stage for improved pandemic preparedness in the future. As lessons are assessed from the current pandemic, public officials should consider technology's role and continue to seek opportunities to supplement and improve on traditional approaches.


Asunto(s)
Tecnología Biomédica/métodos , Infecciones por Coronavirus/prevención & control , Control de Infecciones/organización & administración , Pandemias/prevención & control , Neumonía Viral/prevención & control , Salud Pública/normas , Terapia de Exposición Mediante Realidad Virtual/métodos , Tecnología Biomédica/estadística & datos numéricos , COVID-19 , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/epidemiología , Femenino , Recursos en Salud/economía , Humanos , Masculino , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Gestión de la Salud Poblacional , Medición de Riesgo , Rol , Programas Informáticos/estadística & datos numéricos , Estados Unidos , Terapia de Exposición Mediante Realidad Virtual/estadística & datos numéricos
12.
Int J Med Inform ; 139: 104156, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32387819

RESUMEN

BACKGROUND: Healthcare wearable devices (HWDs) enable continuous monitoring of consumers' health signals and have great potential to improve the efficiency and quality of healthcare. However, factors influencing consumer acceptance of HWDs are not well understood. Moreover, extant studies seem to fail to consider whether an HWD has appropriate functions to fit the requirements of consumers' healthcare activities. OBJECTIVES: The objective of this study was to develop and empirically test a model by integrating the Unified Theory of Acceptance and Usage of Technology (UTAUT) and Task-Technology Fit (TTF) models to understand how consumers accept HWDs. METHODS: A self-administered questionnaire was designed based on validated measurement scales. Data from 406 valid samples were analyzed using partial least squares structural equation modeling. RESULTS: The results indicated that performance expectancy, effort expectancy, facilitating conditions, social influence, and task-technology fit positively affected consumers' behavioral intention to use HWDs, and together accounted for 68.0 % of its variance. Both task and technology characteristics were significant determinants of task-technology fit and exerted impacts on behavioral intention through the mediating roles of task-technology fit and effort expectancy. CONCLUSIONS: The key findings showed that consumer acceptance of HWDs was affected by both users' perceptions (i.e., performance expectancy, effort expectancy, social influence and facilitating conditions) and the task-technology fit. The theoretical and practical implications and contributions were provided for future researchers and practitioners to increase consumers' use of HWDs in their healthcare activities.


Asunto(s)
Tecnología Biomédica/estadística & datos numéricos , Comportamiento del Consumidor , Modelos Psicológicos , Aceptación de la Atención de Salud/psicología , Dispositivos Electrónicos Vestibles/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Intención , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
14.
J Healthc Qual Res ; 34(4): 177-184, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31713528

RESUMEN

OBJECTIVE: To analyse trends in the use of diagnostic test in breast cancer screening programs in Spain. MATERIALS AND METHODS: Retrospective study of 542,695 women who had undergone at least one screening mammogram in any of the screening centres of three administrative regions in Spain, between 1996 and 2011. Process measures were: overall recall rate, overall invasive test rate, and rates of each type of invasive test (fine-needle aspiration biopsy, core-needle biopsy and surgical biopsy). As results measures were included detection of benign lesions rate, ductal in situ cancer rate and invasive cancer rate. Adjusted by age rates were estimated year by year for each measure and, also, the annual percent of change and its corresponding joint points. RESULTS: Core-needle biopsy rates decreased between 1996 and 1999 and changed trends in 1999-2011 with an increase of 4.9% per year. Overall recall rate declined by 4.6% from 1999 to 2004, invasive test rate declined between 1996 and 2004 by 24.3%. Fine-needle aspiration biopsy rate changes were: a 22.4% declined per year (1996-1998), and 13.5% declined per year (1998-2005). Benign lesions rate decreased from 1996 to 2011, 21.4% per year (1996-2001) and 6.0% (2001-2011). Ductal carcinoma in situ and invasive cancer had no-statistically significant changes. CONCLUSION: The introduction of core-needle biopsy was slow and not concurrent with the reduction in the use of other diagnostic tests, but also represented a reduction in the rate of overall diagnostic tests and in the detection rate of benigns lesions without affecting the cancer detection rates.


Asunto(s)
Tecnología Biomédica/estadística & datos numéricos , Biopsia con Aguja Fina/estadística & datos numéricos , Neoplasias de la Mama/diagnóstico , Carcinoma Intraductal no Infiltrante/diagnóstico , Difusión de Innovaciones , Retratamiento/estadística & datos numéricos , Factores de Edad , Tecnología Biomédica/tendencias , Biopsia/estadística & datos numéricos , Biopsia/tendencias , Biopsia con Aguja Fina/tendencias , Biopsia con Aguja Gruesa/estadística & datos numéricos , Biopsia con Aguja Gruesa/tendencias , Enfermedades de la Mama/diagnóstico , Enfermedades de la Mama/epidemiología , Enfermedades de la Mama/patología , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/epidemiología , Carcinoma Intraductal no Infiltrante/patología , Femenino , Humanos , Tamizaje Masivo/estadística & datos numéricos , Tamizaje Masivo/tendencias , Estudios Retrospectivos , España/epidemiología , Factores de Tiempo
15.
Ciênc. Saúde Colet. (Impr.) ; 24(11): 4043-4052, nov. 2019. tab, graf
Artículo en Portugués | LILACS | ID: biblio-1039527

RESUMEN

Resumo O objetivo deste artigo foi identificar a utilização de tecnologias e estimar o custo direto da atenção hospitalar de crianças e adolescentes com condições crônicas complexas em um hospital público federal especializado na assistência de alta complexidade a pacientes pediátricos. O trabalho foi realizado concomitantemente com um estudo de coorte durante o período de um ano e incluiu 146 pacientes com condições complexas crônicas e 37 pacientes não-crônicos. A análise identificou que a maioria dos pacientes com condições complexas crônicas internou em média duas vezes em um ano e que tinham doenças com o envolvimento de pelo menos dois sistemas orgânicos. O uso de drenos e cateteres e a gastrostomia foram as tecnologias de maior utilização. Na comparação com os pacientes não-crônicos, o custo direto mediano dos pacientes com condições complexas crônicas foi superior quando se comparou a utilização de tecnologias. O estudo indica um elevado custo da atenção hospitalar para esses pacientes. Documentar a utilização de tecnologias e o custo da atenção hospitalar permite subsidiar os gestores e contribuir para a tomada de decisões de planejamento, gestão e financiamento das políticas de saúde na área pediátrica.


Abstract This paper aimed to identify the use of technology and to analyze the cost of hospital care for children and adolescents with medical complex chronic conditions at a public federal hospital specialized in high-complexity pediatric care, and was performed concomitantly with a prospective cohort study conducted over a one-year period. It included 146 patients with complex medical chronic conditions and 37 non-chronic patients. The analysis showed that most patients had, on average, two hospitalizations a year and were diagnosed with diseases related to at least two organic systems. Catheters, drains and gastrostomy were the most common technologies used. Median direct costs of patients with medically complex chronic conditions were higher than those of non-chronic patients when comparing the use of technology. The study shows high hospitalization cost to these patients. Technology use and hospitalization care costs documentation yields more data to support decision-makers in the planning, managing, and financing of pediatric health policies.


Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Costos de Hospital/estadística & datos numéricos , Tecnología Biomédica/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Enfermedad Crónica , Estudios Retrospectivos , Estudios de Cohortes , Tecnología Biomédica/economía , Hospitalización/economía
16.
Cien Saude Colet ; 24(11): 4043-4052, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31664377

RESUMEN

This paper aimed to identify the use of technology and to analyze the cost of hospital care for children and adolescents with medical complex chronic conditions at a public federal hospital specialized in high-complexity pediatric care, and was performed concomitantly with a prospective cohort study conducted over a one-year period. It included 146 patients with complex medical chronic conditions and 37 non-chronic patients. The analysis showed that most patients had, on average, two hospitalizations a year and were diagnosed with diseases related to at least two organic systems. Catheters, drains and gastrostomy were the most common technologies used. Median direct costs of patients with medically complex chronic conditions were higher than those of non-chronic patients when comparing the use of technology. The study shows high hospitalization cost to these patients. Technology use and hospitalization care costs documentation yields more data to support decision-makers in the planning, managing, and financing of pediatric health policies.


O objetivo deste artigo foi identificar a utilização de tecnologias e estimar o custo direto da atenção hospitalar de crianças e adolescentes com condições crônicas complexas em um hospital público federal especializado na assistência de alta complexidade a pacientes pediátricos. O trabalho foi realizado concomitantemente com um estudo de coorte durante o período de um ano e incluiu 146 pacientes com condições complexas crônicas e 37 pacientes não-crônicos. A análise identificou que a maioria dos pacientes com condições complexas crônicas internou em média duas vezes em um ano e que tinham doenças com o envolvimento de pelo menos dois sistemas orgânicos. O uso de drenos e cateteres e a gastrostomia foram as tecnologias de maior utilização. Na comparação com os pacientes não-crônicos, o custo direto mediano dos pacientes com condições complexas crônicas foi superior quando se comparou a utilização de tecnologias. O estudo indica um elevado custo da atenção hospitalar para esses pacientes. Documentar a utilização de tecnologias e o custo da atenção hospitalar permite subsidiar os gestores e contribuir para a tomada de decisões de planejamento, gestão e financiamento das políticas de saúde na área pediátrica.


Asunto(s)
Tecnología Biomédica/estadística & datos numéricos , Costos de Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Adolescente , Tecnología Biomédica/economía , Niño , Preescolar , Enfermedad Crónica , Estudios de Cohortes , Hospitalización/economía , Humanos , Lactante , Recién Nacido , Estudios Retrospectivos
17.
Healthc Policy ; 15(1): 95-106, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31629459

RESUMEN

INTRODUCTION: A recent pan-Canadian survey of 48 health organizations concluded that structures, processes, factors and information used to support funding decisions on new non-drug health technologies (NDTs) vary within and across jurisdictions in Canada. METHODS: A self-administered survey was used to determine demographic and financial characteristics of organizations, followed by in-depth interviews with senior leadership of consenting organizations to understand the processes for making funding decisions on NDTs. RESULTS: Seventy-three and 48 organizations completed self-administered surveys and telephone interviews, respectively (with 45 participating in both ways). Fifty-five different processes were identified, the majority of which addressed capital equipment. Most involved multidisciplinary committees (with medical and non-medical representation), but the types of information used to inform deliberations varied. Across all processes, decision-making criteria included local considerations such as alignment with organizational priorities. CONCLUSIONS: NDT decision-making processes vary in complexity, depending on characteristics of the healthcare organization and context.


Asunto(s)
Tecnología Biomédica/organización & administración , Tecnología Biomédica/estadística & datos numéricos , Administración Hospitalaria , Invenciones/estadística & datos numéricos , Terapias en Investigación/estadística & datos numéricos , Adulto , Canadá , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
18.
BMC Health Serv Res ; 19(1): 648, 2019 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-31492139

RESUMEN

BACKGROUND: Commissioning innovative health technologies is typically complex and multi-faceted. Drawing on the negotiated order perspective, we explore the process by which commissioning organisations make their decisions to commission innovative health technologies. The empirical backdrop to this discussion is provided by a case study exploring the commissioning considerations for a new photoplethysmography-based diagnostic technology for peripheral arterial disease in primary care in the UK. METHODS: The research involved an empirical case study of four Clinical Commissioning Groups (CCGs) involved in the commissioning of services in primary and secondary care. Semi-structured in-depth interviews (16 in total) and two focus groups (a total of eight people participated, four in each group) were conducted with key individuals involved in commissioning services in the NHS including (i) senior NHS clinical leaders and directors (ii) commissioners and health care managers across CCGs and (iii) local general practitioners. RESULTS: Commissioning of a new diagnostic technology for peripheral arterial disease in primary care involves high levels of protracted negotiations over funding between providers and commissioners, alliance building, conflict resolution and compromise of objectives where the outcomes of change are highly contingent upon interventions made across different care settings. Our evidence illustrates how reconfigurations of inter-organisational relations, and of clinical and related work practices required for the successful implementation of a new technology could become the major challenge in commissioning negotiations. CONCLUSIONS: Innovative health technologies such as the diagnostic technology for peripheral arterial disease are commissioned in care pathways where the value of such technology is realised by those delivering care to patients. The detail of how care pathways are commissioned is complex and involves high degrees of uncertainty concerning such issues as prioritisation decisions, patient benefits, clinical buy-in, value for money and unintended consequences. Recent developments in the new care models and integrated care systems (ICSs) in the UK offer a unique opportunity for the successful commissioning arrangements of innovative health technologies in primary care such as the new diagnostic technology for peripheral arterial disease.


Asunto(s)
Tecnología Biomédica/estadística & datos numéricos , Medicina General/estadística & datos numéricos , Invenciones , Tecnología Biomédica/organización & administración , Difusión de Innovaciones , Grupos Focales , Medicina General/organización & administración , Médicos Generales/organización & administración , Médicos Generales/estadística & datos numéricos , Administración de los Servicios de Salud , Humanos , Negociación , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/estadística & datos numéricos , Medicina Estatal
19.
JMIR Mhealth Uhealth ; 7(9): e12861, 2019 09 11.
Artículo en Inglés | MEDLINE | ID: mdl-31512582

RESUMEN

BACKGROUND: Due to the adoption of electronic health records (EHRs) and legislation on meaningful use in recent decades, health systems are increasingly interdependent on EHR capabilities, offerings, and innovations to better capture patient data. A novel capability offered by health systems encompasses the integration between EHRs and wearable health technology. Although wearables have the potential to transform patient care, issues such as concerns with patient privacy, system interoperability, and patient data overload pose a challenge to the adoption of wearables by providers. OBJECTIVE: This study aimed to review the landscape of wearable health technology and data integration to provider EHRs, specifically Epic, because of its prevalence among health systems. The objectives of the study were to (1) identify the current innovations and new directions in the field across start-ups, health systems, and insurance companies and (2) understand the associated challenges to inform future wearable health technology projects at other health organizations. METHODS: We used a scoping process to survey existing efforts through Epic's Web-based hub and discussion forum, UserWeb, and on the general Web, PubMed, and Google Scholar. We contacted Epic, because of their position as the largest commercial EHR system, for information on published client work in the integration of patient-collected data. Results from our searches had to meet criteria such as publication date and matching relevant search terms. RESULTS: Numerous health institutions have started to integrate device data into patient portals. We identified the following 10 start-up organizations that have developed, or are in the process of developing, technology to enhance wearable health technology and enable EHR integration for health systems: Overlap, Royal Philips, Vivify Health, Validic, Doximity Dialer, Xealth, Redox, Conversa, Human API, and Glooko. We reported sample start-up partnerships with a total of 16 health systems in addressing challenges of the meaningful use of device data and streamlining provider workflows. We also found 4 insurance companies that encourage the growth and uptake of wearables through health tracking and incentive programs: Oscar Health, United Healthcare, Humana, and John Hancock. CONCLUSIONS: The future design and development of digital technology in this space will rely on continued analysis of best practices, pain points, and potential solutions to mitigate existing challenges. Although this study does not provide a full comprehensive catalog of all wearable health technology initiatives, it is representative of trends and implications for the integration of patient data into the EHR. Our work serves as an initial foundation to provide resources on implementation and workflows around wearable health technology for organizations across the health care industry.


Asunto(s)
Recolección de Datos/tendencias , Registros Electrónicos de Salud/tendencias , Dispositivos Electrónicos Vestibles/tendencias , Tecnología Biomédica/estadística & datos numéricos , Tecnología Biomédica/tendencias , Recolección de Datos/métodos , Registros Electrónicos de Salud/estadística & datos numéricos , Humanos , Dispositivos Electrónicos Vestibles/estadística & datos numéricos
20.
Int J Med Inform ; 130: 103948, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31442846

RESUMEN

With the emergence of an always-on culture and the private smartphones always within reach, professional and recreational contexts overlap. Little empirical knowledge is available on prevailing online habits among healthcare personnel and whether gender matters in this context. To investigate health technology-related preferences, we conducted an online survey among a purposive sample of employees and students at the Medical University of Vienna, Austria. In total, 905 participants (59.0%, 540/905, females) provided self-reported information on use of online services and mobile health applications (apps) as well as respective gender-specific internal and external apperceptions. Mann-Whitney U tests and binary regression analysis assessed respective gender differences. The structured German questionnaire was validated by principal component analysis. The study found a moderate familiarity with health technologies. As for gender differences, prevailing health app use was high among both male and female participants (39, 141/365, and 42%, 229/540, respectively), with apps for tracking activity and nutrition habits most commonly used. Approval for monitoring health and lifestyle parameters, eHealth and telemedicine knowledge levels, and online health information retrieval predicted health app use, whereas gender did not. Socio-demographic attributes including gender influence not only private online habits of users, but might also affect acceptance of health technologies and their professional use in a clinical setting. Thus, addressing the gender dimension already in concept stages of digital devices and services for healthcare and lifestyle could speed up private and public adoption of health technologies.


Asunto(s)
Tecnología Biomédica/estadística & datos numéricos , Monitores de Ejercicio/estadística & datos numéricos , Cuerpo Médico/psicología , Aplicaciones Móviles/estadística & datos numéricos , Teléfono Inteligente/estadística & datos numéricos , Estudiantes/psicología , Adulto , Austria , Estudios Transversales , Femenino , Humanos , Masculino , Factores Sexuales , Encuestas y Cuestionarios , Telemedicina/estadística & datos numéricos , Universidades
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