The integration of human and non-human actors to advance healthcare delivery: unpacking the role of actor-network theory, a systematic literature review.

BACKGROUND: There is an increasing public, societal and policy imperative for effective integration of healthcare delivery systems. Central to integration in healthcare is a focus on people-centred health, access, patient empowerment, interprofessional teamwork and collaboration between all healthcare stakeholders - difficult to achieve in current silo-driven bureaucratic health organisations. Therefore, actor-network theory (ANT) offers a theoretical approach to understanding the complexities of healthcare delivery by unpacking the type of actor's interplay between social elements and immaterial objects, their interactions, interdependencies and power dynamics. AIMS: The first of its type, this systematic review aims to identify, synthesise, and appraise extant literature on the use and application of ANT in healthcare contexts. METHODS: This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO. The authors generated a search strategy utilising 31 Boolean terms, conducting electronic searches of MEDLINE, CINAHL Complete, SCOPUS, PubMed, APA PsycINFO, Business Source Complete and Academic Search Complete. The studies obtained were evaluated for inclusion based on their alignment with the specified inclusion and exclusion criteria. Studies were independently evaluated by the authors, with all data synthesised using a thematic analysis. RESULTS: From an initial 2,533 studies, the systematic review included 103 studies which utilised ANT within a healthcare context. The analysis of the studies identified trends in the application of ANT across healthcare which we categorised into four themes: healthcare delivery systems, technology and data, integrated care, and innovation management. The findings demonstrated variability and fragmentation in the application of ANT, often diverging from its fundamental principles. CONCLUSIONS: Decluttering the literature suggests three dimensions for understanding the relationships of actors, unidimensional ANT - based on single actors, bi-dimensional ANT, the relationship between two actors and multi-dimensional ANT, where human and non-human actors interact to impact healthcare outcomes. The limited number of studies on the use of ANT for integrated healthcare research highlights both its importance to the topic and the considerable research gap that must be addressed.

Teleradiology in Saudi Arabia: a national survey and retrospective review of associated MRI reports.

BACKGROUND: Due to the recent evolution of telecommunications, it is now acknowledged that digital communication provides essential services for remote areas. Teleradiology allows the ability to obtain images at one site, send them over a distance, and view them remotely for diagnostic or consultation purposes. AIM: The highlighted objectives include (a) the added value of the service, (b) user satisfaction, and (c) quality assurance according to global best practices and national quality standards. METHODS: This study utilised an eight-part online self-report survey distributed among employees of the Ministry of Health (MOH) who use the national teleradiology platform. The survey sections were designed to gather comprehensive data, including participant demographics, levels of satisfaction with the service, awareness of security measures, communication effectiveness, perceived advantages and disadvantages, quality assurance, technical challenges, IT support, and future perceptions of teleradiology services. Additionally, a total of 212 MRI reports from patients who underwent brain and spine MRI examinations between 2018 and 2020 were collected from the platform to strengthen the analysis. RESULTS: Most survey respondents (78%) were males, with a significant majority (96.2%) affirming that teleradiology sufficiently addresses clinical inquiries. Furthermore, 90% expressed satisfaction with the service, and 93% endorsed the standardization of MR imaging procedures across Ministry of Health (MOH) hospitals. Notably, 92.4% recognised teleradiology as a transformative strategy for healthcare facilities in Saudi Arabia, concurring with its benefits. The analysis of the MRI reports revealed structural inconsistencies; compared with structured templates, the average number of incorporated elements was reduced, and essential elements were frequently absent. Intriguingly, reports delineating normal cases included a higher incidence of clinical impressions relative to those describing abnormalities, yet the latter contained a more comprehensive array of elements. Variability in report composition was correlated with the years of experience of the reporters. Teleradiology users perceived enhancements in the quality of radiological reporting and the daily operational workflow. Nonetheless, certain limitations were identified, necessitating focused improvements by service providers. CONCLUSION: Despite teleradiology being a subspecialisation, it can reduce the role of local radiologists. Further research is needed on data security, confidentiality, and archiving options, as well as the cost-effectiveness of teleradiology services.

Exploring health worker absenteeism at public healthcare facilities in Chhattisgarh, India.

AIM: This study aims to assess the health worker absenteeism and factors associated with it in a high-focus district in Chhattisgarh, India. BACKGROUND: Human resources for health are among the key foundations to build resilient healthcare systems. Chhattisgarh is a high-focus Indian state with a severe shortage of health care workers, and absenteeism further aggravates the shortage. METHODS: This study was conducted as a mixed-methods study employing sequential explanatory design. Absenteeism was defined as the absence of health worker in the designated position without a formal leave or official reason in two different unannounced visits. A facility survey across all the public healthcare facilities in Jashpur district, Chhattisgarh, was conducted through random, unannounced visits employing a checklist developed based on Indian Public Health Standards. Twelve participants were purposively sampled and interviewed from healthcare facilities to explore factors associated with absenteeism. Survey data were analysed descriptively, and thematic analysis was employed to analyse qualitative interviews. FINDINGS: Among all the positions filled at primary health centre level (n = 339), close to 8% (n = 27) were absent, whereas among the positions filled at community health centre level (n = 285), only 1.14% (n = 4) were absent. Absenteeism was not found in the district hospital. Qualitative interviews reveal that macro-level (geographical location and lack of connectivity), meso-level (lack of equipment and amenities, makeshift health facilities, doctor shortage, and poor patient turnover), and micro-level (unmet expectations) factors contribute to health worker absenteeism. CONCLUSION: Health worker absenteeism was more at PHC level. Systemic challenges, human resource shortages, and infrastructural shortcomings contributed to health worker absenteeism.

Project Vayoraksha: Implementation of novel mHealth technology for healthcare delivery during COVID-19 in geriatric population of Kerala.

Background & objectives mHealth technologies, with their potential in improving public health, have recently gained considerable interest in India, offering an opportunity to deliver tailored and low cost interventions to the selected populations, especially in resource-poor settings. Project Vayoraksha aimed at developing and pilot testing mHealth technology-assisted strategies (Vayoraksha mobile application and field Vayoraksha network) to improve healthcare delivery and reverse quarantine at the field level among the geriatric population. Methods This field operational research study was implemented in Pathanamthitta, Kerala, from October 2020 to July 2021. The Vayoraksha mobile phone application for the geriatric users and a web interface used by healthcare workers involved in the field Vayoraksha network was developed with multisectoral expertise. Vayoraksha had facilities for symptom surveillance, teleconsultation and assessment of needs and included a community-based system to monitor and meet their needs that can help in reverse quarantine of the geriatric population. Results The project was implemented using the field Vayoraksha campaign involving frontline health workers and community volunteers. A baseline survey of 4782 geriatric population in the study area was conducted in Phase I, and 2383 (49.8%) had access to a smartphone facility to use Vayoraksha. Of these, 1257 (52.7%) were covered under the 'field Vayoraksha campaign' using intersectoral coordination and community participation. A total of 750 (59.6%) geriatric individuals downloaded the application of whom, 452 (60.3%) used the services of Vayoraksha. Needs were registered by 56 (12.3%) individuals of which 46 (82.1%) were medical needs related to the management of chronic diseases. More than 70 per cent of the needs were met through the Vayoraksha field network under the local primary health centre. More than 80 per cent of the geriatric individuals reported symptoms related to COVID-19 during the intervention period. Compliance with quarantine was observed in 77.7 per cent of the geriatric populations. Among those who used Vayoraksha, 26 (5.7%) availed tele-counselling services, and 3 (0.6%) used teleconsultation facilities. It was observed that Vayoraksha users had a higher proportion of the geriatric population who were young, educated, having chronic morbidity and living with family. Regular symptom surveillance was done within this group; only 12 (2.6%) of them tested positive for COVID-19 during this study. Interpretation & conclusions Results of this pilot study are promising, with 60 per cent of the geriatric population downloading and using Vayoraksha within a short time. Technology-assisted interventions can supplement the existing system for improved healthcare delivery among the vulnerable groups and have good potential for scale-up in the near future in developing countries.

Perceptions and attitudes toward artificial intelligence among frontline physicians and physicians' assistants in Kansas: a cross-sectional survey.

Objective: This survey aims to understand frontline healthcare professionals' perceptions of artificial intelligence (AI) in healthcare and assess how AI familiarity influences these perceptions. Materials and Methods: We conducted a survey from February to March 2023 of physicians and physician assistants registered with the Kansas State Board of Healing Arts. Participants rated their perceptions toward AI-related domains and constructs on a 5-point Likert scale, with higher scores indicating stronger agreement. Two sub-groups were created for analysis to assess the impact of participants' familiarity and experience with AI on the survey results. Results: From 532 respondents, key concerns were Perceived Communication Barriers (median = 4.0, IQR = 2.8-4.8), Unregulated Standards (median = 4.0, IQR = 3.6-4.8), and Liability Issues (median = 4.0, IQR = 3.5-4.8). Lower levels of agreement were noted for Trust in AI Mechanisms (median = 3.0, IQR = 2.2-3.4), Perceived Risks of AI (median = 3.2, IQR = 2.6-4.0), and Privacy Concerns (median = 3.3, IQR = 2.3-4.0). Positive correlations existed between Intention to use AI and Perceived Benefits (r = 0.825) and Trust in AI Mechanisms (r = 0.777). Perceived risk negatively correlated with Intention to Use AI (r = -0.718). There was no difference in perceptions between AI experienced and AI naïve subgroups. Discussion: The findings suggest that perceptions of benefits, trust, risks, communication barriers, regulation, and liability issues influence healthcare professionals' intention to use AI, regardless of their AI familiarity. Conclusion: The study highlights key factors affecting AI adoption in healthcare from the frontline healthcare professionals' perspective. These insights can guide strategies for successful AI implementation in healthcare.

The Importance of Honoring Family Caregiver Burden: Challenges in Mental Health Care Delivery.

There is growing recognition of the profound mental health challenges faced by the 53 million U.S. family caregivers, and the need for increased access to psychosocial care for this vulnerable population. Family caregivers are increasingly seeking support from hospital-based counseling centers. This trend-combined with a public policy landscape that promotes the delivery of caregiver-specific supports and services-highlights challenges faced by mental health professionals to provide and bill for psychosocial care to family caregivers. In this paper, we discuss three interrelated challenges that mental health professionals face in providing care to family caregivers and which our field needs to confront as healthcare transfers more responsibilities onto the shoulders of family caregivers: (1) caregiver burden is not recognized as a formal diagnosis; (2) current documentation for caregivers is typically linked to patient encounters; and (3) support for family caregivers occurs within larger systematic barriers to mental health integration. By accurately describing and documenting caregiver burden and advocating for increased parity in mental health coverage, we hope that the field can bridge the gap between emerging research, momentum in policy, and available psychosocial services for this vulnerable population.

Preparing early economic evaluations for the development and management of health service interventions.

OBJECTIVES: We draw from the Health Technology Assessment (HTA) literature to propose how hospitals and local health networks can prepare the key components of early economic evaluations to support the development and management of health service interventions. METHODS: Using the case example of a proposed intervention for older people in the Emergency Department (ED), a conceptual logic model of a new health service intervention is articulated to inform the structuring and population of a decision-analytic model using observed data on the existing care comparator and structured elicitation exercise of initial stakeholder expectations of intervention effects. RESULTS: The elicited patient pathway probabilities and lengths of stay quantities profile which of the existing types of patients are expected to avoid the ED and how this impacts the lengths of stay across the system. The exercise also quantifies the stakeholders' uncertainty and disagreement, with qualitative insights into why. The elicitation exercise participants draw upon the rationale for how the intervention is expected to affect a change within the local context, as captured within the logic model, together with the descriptive analyses of the characteristics and utilization of their target population. Feedback indicates the methods are acceptably robust yet pragmatic enough for healthcare delivery settings. CONCLUSIONS: As proposed in this paper, HTA methods can be used to capture how key stakeholders initially expect a service intervention to affect a change within their local context. The example results can be used in a decision-analytic model to guide the development and management of an intervention.

Parent and adolescent perspectives on a novel transdisciplinary model of healthcare delivery for type 1 diabetes.

Objective: We aimed to obtain pre-adolescent/adolescent and parent input on a proposed transdisciplinary model for routine type 1 diabetes (T1D) healthcare in which an advanced practice nurse, dietitian, and psychologist with expertise in T1D and extensive cross-discipline training co-deliver care during quarterly T1D care visits using a family-focused approach. Methods: Participants were 17 parent-youth dyads plus one additional adolescent who responded to open-ended questions about the structure and format of the proposed transdisciplinary care model via an online, private social network. A six-member coding team developed and revised a codebook, coded question responses through iterative cycles of inductive coding, and distilled major recurring themes to obtain perspectives on the transdisciplinary care model and feedback on improving the model. Results: We identified nine themes regarding reactions to our proposed transdisciplinary care model, which fell into three broad categories: 1) General Perceptions of Transdisciplinary Care (e.g., Transdisciplinary Care may facilitate improved communication and collaboration among providers and result in more holistic care); 2) Perceptions about Transdisciplinary Care Providers (e.g., Perspectives on the inclusion of dietitians and psychologists as members of the transdisciplinary care team were mixed); and 3) Suggestions for Improving the Transdisciplinary Care Model (e.g., Ensure care is patient/family centered and holistic). Conclusions: The present findings provided important feedback to modify our transdisciplinary care model and on parent and youth preferences for T1D healthcare delivery.

Addressing the barrier of transport costs in accessing headache care in Sub-Saharan Africa.

The article by Leone et al. (2024) highlights the significant barrier of transport costs in accessing headache care for HIV-positive patients in Malawi, a concern that resonates with challenges observed in opioid agonist therapy (OAT) in Taiwan. This letter draws parallels between the findings of Leone et al. and the Taiwanese experience, where distance to treatment centers has been shown to influence patients' choice of OAT. The discussion underscores the importance of expanding healthcare service availability and exploring telemedicine as potential solutions to mitigate geographical barriers. Integrating these approaches could improve patient retention and treatment outcomes in both regions. This commentary emphasizes the broader implications of transport-related barriers in healthcare access, advocating for strategic interventions to enhance healthcare delivery in resource-limited settings.

Cystic fibrosis foundation position paper: Redefining the CF care model.

Specialized care is provided to people with cystic fibrosis (pwCF) by interdisciplinary teams nested within the CF Foundation's accredited care center network. This network allows for standardization of the care model, implementation of clinical care guidelines, efficient communication, and outcomes reporting. Recent developments have impacted this care model. Increased access to CFTR modulator therapies has improved overall health for many, although not all pwCF. The COVID-19 pandemic resulted in a rapid adoption of telemedicine and remote monitoring to ensure continuity of CF care. A collaboration of care providers, pwCF, and parent caregivers reevaluated key aspects of the current care model and considered potential modifications based on a widening range of needs. Available evidence was used to evaluate components of routine clinical practice and identify potential adaptations to care. The review included identification of patient characteristics warranting intensive monitoring, while embracing patient-centric care, and emphasizing the integration of telemedicine and at-home health technologies. Despite the changing landscape, the importance of the relationship between pwCF, their support system, and the care team was confirmed as a timeless and foundational aspect of the care model. Shared decision making, partnership, and coproduced care plans between pwCF and their CF care teams guide the best adaptations of the care model to support individual priorities and wellbeing. As health care advances and pwCF age, further research is needed to understand the impact of the care model on long-term health outcomes and to identify best practices that support pwCF to live longer healthier lives.

Adapting the cystic fibrosis care model: Perspectives from people with CF, caregivers, and members of CF care teams.

BACKGROUND: Rapidly emerging clinical trends offer the opportunity to amend guidance on issues pertaining to CF care delivery. A national survey was conducted to gather perspectives on CF care including potential adaptations to the care model to best meet the needs of this population. METHODS: A survey instrument was developed to capture perspectives on CF care. People with CF (pwCF), including those post lung transplant, caregivers and care teams were surveyed. Descriptive statistics were calculated to characterize respondents and responses. RESULTS: In-person, routine visits with the CF care teams were valued by survey respondents. However, reduced in-person visit frequency from the standard three-month interval was supported for individuals in a stable state of health. This was particularly true for pwCF ages two or older and on a modulator. Lung function, pulmonary exacerbation frequency, and transition periods were noted to influence preference for visit frequency. Integrating telehealth with remote monitoring in between visits was broadly supported. For shared care between CF teams and other medical providers (transplant teams and primary care providers (PCP)), good communication, easily accessible health records, and convenient locations were important. CONCLUSIONS: Survey findings support adapting CF care based on individual needs and life transitions. Themes identified can inform future areas of study and resource development to support successful modification of the CF care model and shared decision-making between patients and their care providers.

Exploring Innovative U.S. School Health Delivery Models: A Narrative Review.

School health services have been described as the "hidden healthcare" system because of their isolation within schools and from other healthcare providers. This isolation may inhibit innovations in school healthcare delivery. Hence, there is a need to identify and characterize various delivery models. This review examines models to identify innovative approaches and formulate suggestions for public health departments, local and state educational agencies, and policymakers. Toward this goal, published and gray literature were studied and synthesized, identifying three delivery models: the traditional model of school-based nursing and two alternative models: school-based health centers and community partnerships. Mechanisms of delivery included telehealth, mobile clinics, and system-level care. Although no innovative, comprehensive approaches to school health services models were found, innovation generally focused on improving equitable delivery to vulnerable populations. Policies must be formulated and funded to integrate such innovations into a comprehensive, preventative approach, including improved care coordination and data sharing.

Perceptions and Satisfaction of E-Health Applications: An Analytical Cross-Sectional Study in a Rural Health Center at Tiruvallur District, Tamil Nadu.

Introduction E-health, defined as the utilization of information and communication technologies for health services, has become integral in enhancing healthcare delivery and accessibility. This study focuses on user satisfaction and perceptions of e-health applications in rural health centers, with special focus on Tamil Nadu, India. E-health technologies have proven to be effective in addressing challenges to healthcare accessibility and improving patient outcomes, at reduced costs. Despite these benefits, there is a need to understand user experiences in rural settings to optimize the implementation of e-health solutions. Methods A cross-sectional study was conducted among 383 patients registered in a non-communicable disease (NCD) clinic and specialty clinic in the rural health center of a tertiary care hospital in Tiruvallur district. Participants were selected using a consecutive sampling method from the NCD and specialty clinic registers. A semi-structured questionnaire was used to collect data on their perception and satisfaction with e-health applications. Data was entered in (Microsoft) MS Excel (Microsoft Corporation, Redmond, Washington, United States) and analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Results The overall mean age was 49.45 ± 7 years. Among the study participants, females constituted 57.3% compared to males who constituted 42.7%. 58.3% of the participants had comorbid conditions. More than half of the study participants were educated up to the high school level. According to BG Prasad's classification, 86.9 % of the participants belonged to middle class and below. Among the study participants, more than half of them use their smartphones as devices for internet access to use e-health applications. The study participants who had no co-morbid conditions were 3.3 times the odds of having poor perception and satisfaction when compared to the other categories (OR = 3.3, CI = 2.1 - 5.1) in using e-health applications, and this difference was found to be statistically significant (p = 0.01). Conclusion This study's findings reveal that gender, socio-economic status, occupation, and the presence of comorbid illnesses play significant roles in shaping users' perceptions and satisfaction levels. This study's findings underscore the importance of tailored e-health interventions to address these barriers and enhance healthcare delivery in rural areas.

Knowledge, attitude and practices of surgeons regarding venous thromboembolism prophylaxis in tertiary healthcare hospitals of the Rawalpindi Districts.

Objective: To assess doctors' knowledge, attitudes and practices regarding venous thromboembolism prophylaxis. METHODS: The cross-sectional study was conducted from April to September 2021 in three public-sector hospitals affiliated with the Rawalpindi Medical University: Holy Family Hospital, Benazir Bhutto Hospital and Rawalpindi District Headquarters Hospital, Rawalpindi, Pakistan, and comprised physicians of either gender who were actively involved in patient care. Data was collected using a predesigned questionnaire regarding venous thromboembolism. Data was analysed using SPSS 25. RESULTS: All the 220(100%) subjects approached responded positively to the study questionnaire. There were 144(65.45%) general surgeons, 50(22.72%) gynaecologists and 26(11.81%) orthopaedic surgeons. Overall, there were 26(11.81%) senior consultants, 65(29.54%) postgraduate residents and 129(58.63%) house officers. There were 150(68.2%) doctors who reported having witnessed deep-vein thrombosis in their patients, and 113(51.4%) had witnessed deaths related to pulmonary embolism. Among the methods employed for DVT diagnosis, the use of clinical criteria was the most common 136(36.1%), while venography was the least common technique used by 8(2.2%). While 210(95.5%) subjects expressed the desire for adopting an institute-wide regimen for venous thromboembolism prophylaxis, only 66(30%) were currently following such a regimen.

Healthcare failure mode and effect analysis combined service blueprint - Mitigating mass casualty triage in emergency units: A qualitative study.

INTRODUCTION: The 24-hour operation of medical emergency units involves crucial first-hand information and medical treatments, which could involve potential complications and disputes if not handled with the utmost professionalism. Effective logistical support and timely activation are crucial in mass casualty triage to prevent systematic treatment issues and chaos. OBJECTIVE: This study explores the integration of Healthcare Failure Mode and Effect Analysis (HFMEA) with a service blueprint to mitigate medical risks and enhance mass casualty triage efficiency in emergency units. METHOD: An expert team analyzed emergency unit standard operating procedure cases using a service blueprint to visually represent mass casualty triage scenarios. The HFMEA identified potential hazards and failure risks in healthcare service delivery during mass casualty triage. RESULTS: Fifteen high-risk hazard indexes exceeding the standard score of eight were identified among three main processes and thirty-one potential failure reasons. The initial operational time for mass casualty triage was approximately 104 min, significantly reduced to 34 min after process revision (p = 0.043, <0.05). CONCLUSIONS: This study demonstrates effective time management in mass casualty triage, potentially saving up to an hour. Improved operational efficiency allows for focused resuscitation efforts, alleviating concerns about timely patient flow initiation.

Adoption of telemedicine for obesity treatment during the COVID-19 pandemic achieved comparable outcomes to in-person visits.

Background: During the COVID-19 pandemic, weight loss programs rapidly transitioned to a virtual model, replacing in-person clinic visits. We sought to compare the observed weight loss and adherence to treatment between patients referred for intensive behavioral therapy (IBT) who were treated via telemedicine and those treated in person. Methods: After IRB approval, we conducted a retrospective observational study of patients referred for clinical bariatric IBT between January 2019 and June 2021 who were followed in person or via telemedicine. The primary endpoint was the percentage of excess BMI loss (EBL%); secondary endpoints included treatment adherence, duration of follow-up, and number of completed visits. Results: During the study period, 139 patients were seen for at least one IBT session for weight management: 62 were followed up in person (IP) and 77 via telemedicine (TM). The mean age, baseline BMI, and follow-up duration between the groups were similar. In the IP and TM groups, the EBL% was -24.7 ± 24.7 and -22.7 ± 19.5 (P = 0.989) and loss to follow-up after the first visit was 27.4% and 19.5% (P = 0.269), respectively. Conclusion: For the management of obesity, weight loss programs delivered via telemedicine can achieve similar outcomes to those provided via classical in-person visits. This study suggests that the integration of telecare into clinical practice in bariatric medicine should be considered in the future. Emerging technologies may allow adequate patient follow-up in multiple scenarios, specifically non-critical chronic disorders, and bring unanticipated benefits for patients and healthcare providers.

Acceptance of the Internet-Based Sharing Nursing Service among caregivers of elderly with chronic diseases.

BACKGROUND: In China, Internet-Based Sharing Nursing Service (IBSNS) is a new mode of nursing service delivery that has been in practice for over five years, which enables nurses to provide care at clients' home. However, the acceptance and associated factors of IBSNS among caregivers of elderly with chronic diseases who are the major clients of the service were unclear. AIM: To explore the acceptance of IBSNS and its associated factors among Chinese caregivers of elderly patient with chronic diseases based on the modified Technology Acceptance Model (mTAM). METHODS: A cross-sectional study was conducted from February 2023 to March 2023. Caregivers of hospitalized elderly with chronic diseases were recruited using convenience sampling method from three hospitals in Beijing, China. Data were obtained from self-reports of participants. Structural equation modeling was used to analyze data. RESULTS: A total of 65.1% of the caregivers had neutral to weakly positive behavioral intention of IBSNS use. The mTAM model was supported with good model fit. Perceived ease of use was positively associated with perceived usefulness. Both perceived usefulness and perceived security were positively associated with attitude, consequently, attitude was associated with behavioral intention. CONCLUSIONS: Improving the ease of use, security, and usefulness may be helpful to increase the positive attitude towards IBSNS and behavioral intention of using IBSNS, which provides valuable insights that can help healthcare providers improve the integration of technology in patient care, ultimately leading to better health outcomes and more efficient healthcare systems.

Navigation Support during Transitions in Care for Persons with Complex Care Needs: A Systematic Review.

Persons with complex care needs that arise due to chronic health conditions, serious illness, or social vulnerability are at increased risk of adverse health outcomes during transitions in care. To inform the development of a best practice guideline, a systematic review was conducted to examine the effect that navigation support has during transitions in care on quality of life, emergency department visits, follow-up visits, patient satisfaction, and readmission rates for persons with complex care needs. Eight databases were searched from 2016 to 2023. Studies were appraised using validated tools and data were extracted and presented narratively. The GRADE approach was used to assess the certainty of the evidence. Seventeen studies were included and the majority focused on transitions from hospital to home. Navigation support was provided for one month to one year following a transition. Results weakly indicate that providing navigation support during transitions in care may increase follow-up visits, reduce readmissions within 30 days, and increase patient satisfaction for persons with complex care needs. There were no important differences for quality of life and emergency department visits within 30 days of a transition. The certainty of the evidence was very low. Providing navigation support during transitions in care may improve outcomes for persons with complex needs; however, there remains uncertainty regarding the effectiveness of this intervention and more high-quality research is needed.