The path from big data analytics capabilities to value in hospitals: a scoping review.

BACKGROUND: As the uptake of health information technologies increased, most healthcare organizations have become producers of big data. A growing number of hospitals are investing in the development of big data analytics (BDA) capabilities. If the promises associated with these capabilities are high, how hospitals create value from it remains unclear. The present study undertakes a scoping review of existing research on BDA use in hospitals to describe the path from BDA capabilities (BDAC) to value and its associated challenges. METHODS: This scoping review was conducted following Arksey and O'Malley's 5 stages framework. A systematic search strategy was adopted to identify relevant articles in Scopus and Web of Science. Data charting and extraction were performed following an analytical framework that builds on the resource-based view of the firm to describe the path from BDA capabilities to value in hospitals. RESULTS: Of 1,478 articles identified, 94 were included. Most of them are experimental research (n=69) published in medical (n=66) or computer science journals (n=28). The main value targets associated with the use of BDA are improving the quality of decision-making (n=56) and driving innovation (n=52) which apply mainly to care (n=67) and administrative (n=48) activities. To reach these targets, hospitals need to adequately combine BDA capabilities and value creation mechanisms (VCM) to enable knowledge generation and drive its assimilation. Benefits are endpoints of the value creation process. They are expected in all articles but realized in a few instances only (n=19). CONCLUSIONS: This review confirms the value creation potential of BDA solutions in hospitals. It also shows the organizational challenges that prevent hospitals from generating actual benefits from BDAC-building efforts. The configuring of strategies, technologies and organizational capabilities underlying the development of value-creating BDA solutions should become a priority area for research, with focus on the mechanisms that can drive the alignment of BDA and organizational strategies, and the development of organizational capabilities to support knowledge generation and assimilation.

Health capabilities and the determinants of infant mortality in Brazil, 2004-2015: an innovative methodological framework.

BACKGROUND: Despite the implementation of a set of social and health policies, Brazil has experienced a slowdown in the decline of infant mortality, regional disparities and persistent high death levels, raising questions about the determinants of infant mortality after the implementation of these policies. The objective of this article is to propose a methodological approach aiming at identifying the determinants of infant mortality in Brazil after the implementation of those policies. METHOD: A series of multilevel panel data with fixed effect nested within-clusters were conducted supported by the concept of health capabilities based on data from 26 Brazilian states between 2004 and 2015. The dependent variables were the neonatal, the infant and the under-five mortality rates. The independent variables were the employment rate, per capita income, Bolsa Família Program coverage, the fertility rate, educational attainment, the number of live births by prenatal visits, the number of health professionals per thousand inhabitants, and the access to water supply and sewage services. We also used different time lags of employment rate to identify the impact of employment on the infant mortality rates over time, and household income stratified by minimum wages to analyze their effects on these rates. RESULTS: The results showed that in addition to variables associated with infant mortality in previous studies, such as Bolsa Família Program, per capita income and fertility rate, other factors affect child mortality. Educational attainment, quality of prenatal care and access to health professionals are also elements impacting infant deaths. The results also identified an association between employment rate and different infant mortality rates, with employment impacting neonatal mortality up to 3 years and that a family income below 2 minimum wages increases the odds of infant deaths. CONCLUSION: The results proved that the methodology proposed allowed the use of variables based on aggregated data that could hardly be used by other methodologies.

How to Design a Remote Patient Monitoring System? A French Case Study.

BACKGROUND: Remote Patient Monitoring Systems (RPMS) based on e-health, Nurse Navigators (NNs) and patient engagement can improve patient follow-up and have a positive impact on quality of care (by limiting adverse events) and costs (by reducing readmissions). However, the extent of this impact depends on effective implementation which is often restricted. This is partly due to the lack of attention paid to the RPMS design phase prior to implementation. The content of the RPMS can be carefully designed at this stage and various obstacles anticipated. Our aim was to report on an RPMS design case to provide insights into the methodology required in order to manage this phase. METHODS: This study was carried out at Gustave Roussy, a comprehensive cancer centre, in France. A multidisciplinary team coordinated the CAPRI RPMS design process (2013-2015) that later produced positive outcomes. Data were collected during eight studies conducted according to the Medical Research Council (MRC) framework. This project was approved by the French National Data Protection Authorities. RESULTS: Based on the study results, the multidisciplinary team defined strategies for resolving obstacles prior to the implementation of CAPRI. Consequently, the final CAPRI design includes a web app with two interfaces (patient and health care professionals) and two NNs. The NNs provide regular follow-up via telephone or email to manage patients' symptoms and toxicity, treatment compliance and care packages. Patients contact the NNs via a secure messaging system. Eighty clinical decision support tools enable NNs to prioritise and decide on the course of action to be taken. CONCLUSION: In our experience, the RPMS design process and, more generally, that of any complex intervention programme, is an important phase that requires a sound methodological basis. This study is also consistent with the notion that an RPMS is more than a technological innovation. This is indeed an organizational innovation, and principles identified during the design phase can help in the effective use of a RPMS (e.g. locating NNs if possible within the care organization; recruiting NNs with clinical and managerial skills; defining algorithms for clinical decision support tools for assessment, but also for patient decision and orientation).

Impact of Synchronous Telemedicine Models on Clinical Outcomes in Pediatric Acute Care Settings: A Systematic Review.

OBJECTIVES: To evaluate the impact of synchronous telemedicine models on the clinical outcomes in pediatric acute care settings. DATA SOURCES: Citations from EBM Reviews, MEDLINE, EMBASE, Global Health, PubMed, and CINAHL. STUDY SELECTION: We identified studies that evaluated the impact of synchronous telemedicine on clinical outcomes between January 2000 and April 2018. All studies involving acutely ill children in PICUs, pediatric cardiac ICUs, neonatal ICUs, and pediatric emergency departments were included. Publication inclusion criteria were study design, participants characteristics, technology type, interventions, settings, outcome measures, and languages. DATA EXTRACTION: Two authors independently screened each article for inclusion and extracted information, including telecommunication method, intervention characteristics, sample characteristics and size, outcomes, and settings. DATA SYNTHESIS: Out of the 789 studies initially identified, 24 were included. The six main outcomes of interest published were quality of care, hospital and standardized mortality rate, transfer rate, complications and illness severity, change in medical management, and length of stay. The use of synchronous telemedicine results improved quality of care and resulted in a decrease in the transfer rate (31-87.5%) (four studies), a shorter length of stay (8.2 vs 15.1 d) (six studies), a change or reinforcement of the medical care plan, a reduction in complications and illness severity, and a low hospital and standardized mortality rate. Overall, the quality of the included studies was weak. CONCLUSIONS: Despite the broad recommendations found for using telemedicine in pediatric acute care settings, high-quality evidence of its impacts is still lacking. Further robust studies are needed to better determine the clinical effectiveness and the associated impacts of telemedicine in pediatric acute care settings.

Use of comparative performance indicators in rehabilitation.

BACKGROUND: The development of performance indicators that enable benchmarking between organizations is an important mechanism for accountability, organizational learning, and performance improvement. In the province of Quebec (Canada), 21 rehabilitation organizations developed a common set of performance indicators through interorganizational collaboration. PURPOSE: The aims of this study were to describe the rehabilitation organizations' use of a common set of performance indicators and to identify the factors influencing such use. APPROACH: A qualitative survey was performed. Individual semistructured interviews were conducted with executives (n = 18) working at 16 rehabilitation organizations using a common set of performance indicators. A thematic analysis of the factors of use was performed according to the Consolidated Framework for Implementation Research. The use of performance indicators was categorized as purposeful, political, or passive. FINDINGS: Our results showed that all organizations used the common set of performance indicators. Four factors were identified as important to all the rehabilitation organizations to explain their interest in comparative performance indicators: the need to develop their own performance indicators, the compatibility of performance information with organizational needs, complexity/simplicity of performance information, and the support offered by their common association. Sixty-three percent of rehabilitation organizations made purposeful or political use of performance indicators. Three main factors contributed to typify those organizations from the others: the perceived quality of the performance indicators, the leadership of decision makers, and the resources available. PRACTICE IMPLICATIONS: Our results showed that use of performance indicators can support the initiation of projects for improving the quality of care. Key recommendations are proposed to decision makers that may enhance performance indicators' use.

Keys to successful implementation of a French national quality indicator in health care organizations: a qualitative study.

BACKGROUND: Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice. METHOD: Seven ethnographic case studies in French HCOs combining in situ observations and 37 semi-structured interviews. RESULTS: A significant proportion of potential QAF users, such as anesthetists or other health professionals were often unaware of quality data. They were, however, involved in improvement actions to meet the QAF criteria. In fact, three intertwined factors influenced QAF appropriation by anesthesia teams and impacted practice. The first factor was the action of clinical managers (chief anesthetists and head of department) who helped translate public policy into local practice largely by providing legitimacy by highlighting the scientific evidence underlying QAF, achieving consensus among team members, and pointing out the value of QAF as a means of work recognition. The two other factors related to the socio-material context, namely the coherence of information systems and the quality of interpersonal ties within the department. CONCLUSIONS: Public policy tends to focus on the metrological validity of QIs and on ranking methods and overlooks QI implementation. However, effective QI implementation depends on local managerial activity that is often invisible, in interaction with socio-material factors. When developing national quality improvement programs, health authorities might do well to specifically target these clinical managers who act as invaluable mediators. Their key role should be acknowledged and they ought to be provided with adequate resources.

Ultimate journey of the terminally ill: Ways and pathways of hope.

OBJECTIVE: To better understand the role of hope among terminally ill cancer patients. DESIGN: Qualitative analysis. SETTING: A tertiary specialized cancer centre in Canada. PARTICIPANTS: Cancer patients in palliative care with an estimated remaining life expectancy of 12 months or less (N = 12) and their loved ones (N = 12) and treating physicians (N = 12). METHODS: Each patient underwent up to 3 interviews and identified a loved one who participated in 1 interview. Treating physicians were also interviewed. All interviews were fully transcribed and analyzed by at least 2 investigators. Interviews were collected until saturation occurred. MAIN FINDINGS: Seven attributes describe the experiences of palliative cancer patients and their caregivers: hope as an irrational phenomenon that is a deeply rooted, affect-based response to adversity; initial hope for miraculous healing; hope as a phenomenon that changes over time, evolving in different ways depending on circumstances; hope for prolonged life when there is no further hope for cure; hope for a good quality of life when the possibility of prolonging life becomes limited; a lack of hope for some when treatments are no longer effective in curbing illness progression; and for others hope as enjoying the present moment and preparing for the end of life. CONCLUSION: Approaches aimed at sustaining hope need to reflect that patients' reactions might fluctuate between despair and a form of acceptance that leads to a certain serenity. Clinicians need to maintain some degree of hope while remaining as realistic as possible. The findings also raise questions about how hope influences patients' perceptions and acceptance of their treatments.

Home telemonitoring for chronic disease management: an economic assessment.

OBJECTIVES: There have been very few assessments of the economics of home telemonitoring, and the quality of evidence has often been weakened by methodological flaws. This has made it difficult to compare telehomecare with traditional home care for the chronic diseases studied. This economic analysis is an attempt to address this gap in the literature. METHODS: We have analyzed the consumption of healthcare services by 95 patients with various chronic diseases over a 21-month period, that is, 12 months before, 4 months during home telemonitoring use, and over 5 months after withdraw of the technology. RESULTS: Our findings indicate significant benefits to the home telemonitoring program as evidenced by large reductions in number of hospitalizations, length of average hospital stay, and, to a lesser extent, number of emergency room visits. Contrary to expectations, however, the number of home visits by nurses increased both during and after the telemonitoring intervention. In terms of the financial analysis, the telehomecare program resulted in significant savings: the equivalent of over CAD1,557 per patient as calculated on an annualized basis. This represents a net gain of 41 percent as compared to traditional home care. CONCLUSIONS: While the present economic analysis led to positive results, additional assessments should be conducted to confirm the cost-effectiveness of this mode of care delivery.

Predicting the use of electronic prescribing among early adopters in primary care.

OBJECTIVE: To identify the factors that can predict physicians' use of electronic prescribing. DESIGN: All primary care physicians who practised in a single geographic region in Quebec were invited to use a free, advanced, research-based electronic prescribing and drug management system. This natural experiment was studied with an expansion of the Technology Acceptance Model (TAM), which was used to explain early adopters' use of this electronic prescribing technology. SETTING: Quebec city region. PARTICIPANTS: A total of 61 primary care physicians who practised in a single geographic region where there was no electronic prescribing. MAIN OUTCOME MEASURES: Actual use of electronic prescribing; physicians' perceptions of and intentions to use electronic prescribing; physician and practice characteristics. RESULTS: During the 9-month study period, 61 primary care physicians located in 26 practice sites used electronic prescribing to write 15 160 electronic prescriptions for 18 604 patients. Physician electronic prescribing rates varied considerably, from a low of 0 to a high of 75 per 100 patient visits, with a mean utilization rate of 30 per 100 patient visits. Overall, 34% of the variance in the use of electronic prescribing was explained by the expanded TAM. Computer experience (P=.001), physicians' information-acquisition style (P=.01), and mean medication use in the practice (P=.02) were significant predictors. Other TAM factors that generally predict new technology adoption (eg, intention to use, perceived ease of use, and perceived usefulness) were not predictive in this study. CONCLUSION: The adoption of electronic prescribing was a highly challenging task, even among early adopters. The insight that this pilot study provides into the determinants of the adoption of electronic prescribing suggests that novel physician-related factors (eg, information-acquisition style) and practice-related variables (eg, prevalence of medication use) influence the adoption of electronic prescribing.

Maintaining a medical institution in a context of materiality change: Lessons from a Canadian university hospital.

This research aimed to better understand how institutions are maintained, and the role of materiality in this institutional work. More specifically, the present qualitative case study analyzed how different actors in a large academic hospital in Canada worked together (i.e. accomplished institutional work) to maintain the institution of medical record keeping as a new clinical information system (computerized physician order entry-the material entity) was enacted. The study reveals that, to maintain the institution at stake, the intertwinement of processes of creating and maintaining institutions took place. In fact, different forms of institutional work interact Results also strongly suggest that the design of computerized physician order entry and its implementation (i.e. the materiality involved in this institutional change) played an important role in the maintenance of the institution of medical record keeping: on the one hand, it was particularly present in three types of institutional work, namely enabling, policing, and deterring; on the other hand, it appeared to be an essential component of the routinization of work by allowing a better fit between the new technology and the organization of work.

Evaluation of a national e-booking system for medical consultation in primary care in a universal health system.

PURPOSE: The Rendez-vous Santé Québec is a national online booking (e-booking) system of medical appointments in primary care rolled out in 2018 in Québec (Canada). The objectives of this study were to describe the adoption by targeted users, and analyze the facilitating and limiting factors at the technological, individual and organizational levels to inform policy makers. METHODS: A mixed methods evaluation was conducted involving interviews with key stakeholders (n = 40), audit logs of the system in 2019, and a population-based survey (n = 2 003). All data were combined to analyze facilitating and limiting factors, based on the DeLone and McLean framework. RESULTS: The RVSQ e-booking system had a low adoption across the province mainly because it was poorly aligned with the diversity of organizational and professional practices. The other commercial e-booking systems already used by clinics seemed better adapted to interdisciplinary care, patient prioritization and advanced access. e-Booking system was appreciated by patients, but has implications for the performance of primary care organization that goes beyond scheduling management issues, with potential detrimental consequences for care continuity and appropriateness. Further research is needed to define how e-booking systems could support a better alignment between primary care innovative practices and improve the fit between patients' needs and resources availability in primary care.

The effects of a regional telepathology project: a study protocol.

BACKGROUND: Telepathology, which is an emerging form of telemedicine in Canada, is defined as the electronic transmission of pathological images, usually derived from microscopes, from one location to another. There are various applications of telepathology, including case referral for an expert opinion, provision of an emergency service in the absence of a resident pathologist, and education. Until now, there has been relatively little use of telepathology for core diagnostic services in the absence of a local pathologist, but this practice is likely to increase in the future. The Laval University Integrated Health Network is in the process of deploying a telepathology system, primarily to provide an intraoperative frozen section service to small hospitals in sparsely populated areas which are experiencing a severe shortage of on-site pathologists. The telepathology project involves 17 hospitals located in five regions of eastern Quebec, Canada. This paper describes the study protocol that will be used to evaluate the benefits associated with the project. METHODS/DESIGN: A panel of experts was first assembled by Canada Health Infoway to agree on a set of benefits indicators that could be applied to all telepathology projects across Canada. Using the set of indicators as an input, we have developed a three-step study protocol. First, a survey questionnaire will be distributed to appraise the way pathologists, pathology technologists and surgeons perceive the telepathology system and its impacts. Second, a series of semi-structured interviews will be conducted with project leaders and telepathology users at sites that are representative of all the hospitals in the Laval University Integrated Health Network. The overall aim is to better understand the expected and unexpected effects of telepathology on health care professionals and patients as well as on the regional organization and delivery of care services. Finally, a pre-post design using secondary data is proposed to evaluate a wide array of tangible benefits to the patients, the health care providers, the hospitals, and the region as a whole. DISCUSSION: The Laval University Integrated Health Network's telepathology project is expected to yield positive and significant results that are relevant internationally. Our findings will provide valuable information on the nature and extent of benefits associated with telepathology systems intended to provide an intraoperative frozen section service to remote hospitals experiencing a shortage of specialists.

Users' perspectives of key factors to implementing electronic health records in Canada: a Delphi study.

BACKGROUND: Interoperable electronic health record (EHR) solutions are currently being implemented in Canada, as in many other countries. Understanding EHR users' perspectives is key to the success of EHR implementation projects. This Delphi study aimed to assess in the Canadian context the applicability, the importance, and the priority of pre-identified factors from a previous mixed-methods systematic review of international literature. METHODS: A three-round Delphi study was held with representatives of 4 Canadian EHR user groups defined as partners of the implementation process who use or are expected to use EHR in their everyday activity. These groups are: non-physician healthcare professionals, health information professionals, managers, and physicians. Four bilingual online questionnaire versions were developed from factors identified by the systematic review. Participants were asked to rate the applicability and the importance of each factor. The main outcome measures were consensus and priority. Consensus was defined a priori as strong (≥ 75%) or moderate (≥ 60-74%) according to user groups' level of agreement on applicability and importance, partial (≥ 60%) when participants agreed only on applicability or importance, or as no consensus (< 60%). Priority for decision-making was defined as factors with strong consensus with scores of 4 or 5 on a five-point Likert scale for applicability and importance. RESULTS: Three Delphi rounds were completed by 64 participants. Levels of consensus of 100%, 64%, 64%, and 44% were attained on factors submitted to non-physician healthcare professionals, health information professionals, managers, and physicians, respectively. While agreement between and within user groups varied, key factors were prioritized if they were classified as strong (≥ 75% from questionnaire answers of user groups), for decision-making concerning EHR implementation. The 10 factors that were prioritized are perceived usefulness, productivity, motivation, participation of end-users in the implementation strategy, patient and health professional interaction, lack of time and workload, resources availability, management, outcome expectancy, and interoperability. CONCLUSIONS: Amongst all factors influencing EHR implementation identified in a previous systematic review, ten were prioritized through this Delphi study. The varying levels of agreement between and within user groups could mean that users' perspectives of each factor are complex and that each user group has unique professional priorities and roles in the EHR implementation process. As more EHR implementations in Canada are completed it will be possible to corroborate this preliminary result with a larger population of EHR users.

[The Eastern Quebec telepathology network: a real collective project]. / Le réseau de télépathologie de l'Est du Québec - Un véritable projet collectif.

The aim of the Eastern Québec telepathology network is to provide uniform diagnostic telepathology services across a huge geographic region with a low population density. This project is intended to provide surgeons and pathologists with frozen section and second opinion services anywhere and at any time across the entire region, in order to avoid unnecessary patient transfer. The project has been implemented in 21 sites, each equipped with a whole slide scanner, a macroscopy station, a videoconferencing device and a viewer/case management and collaboration solution. Of the 21 sites, 6 are devoid of a pathology laboratory, two have no pathologist and 5 have only one pathologist on site. Signs of improvement of medical care in this region are already apparent since the Eastern Québec telepathology network has been implemented. However, it is important not to underestimate the challenges related to change management in the course of implementation of such a new technology.

Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review.

BACKGROUND: Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users. METHODS: Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users. RESULTS: Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities. CONCLUSIONS: This systematic review presents innovative research on the barriers and facilitators to EHR implementation. While important similarities between user groups are highlighted, differences between them demonstrate that each user group also has a unique perspective of the implementation process that should be taken into account.

Assessing task-technology fit in a PACS upgrade: do users' and developers' appraisals converge?

The purpose of this study was to measure users' perceived benefits of a picture archiving and communication system (PACS) upgrade, and compare their responses to those predicted by developers. The Task-Technology Fit (TTF) model served as the theoretical framework to study the relation between TTF, utilization, and perceived benefits. A self-administered survey was distributed to radiologists working in a university hospital undergoing a PACS upgrade. Four variables were measured: impact, utilization, TTF, and perceived net benefits. The radiologists were divided into subgroups according to their utilization profiles. Analysis of variance was performed and the hypotheses were tested with regression analysis. Interviews were conducted with developers involved in the PACS upgrade who were asked to predict impact and TTF. Users identified only a moderate fit between the PACS enhancements and their tasks, while developers predicted a high level of TTF. The combination of a moderate fit and an underestimation of the potential impact of changes in the PACS led to a low score for perceived net benefits. Results varied significantly among user subgroups. Globally, the data support the hypotheses that TTF predicts utilization and perceived net benefits, but not that utilization predicts perceived net benefits. TTF is a valid tool to assess perceived benefits, but it is important to take into account the characteristics of users. In the context of a technology that is rapidly evolving, there needs to be an alignment of what users perceive as a good fit and the functionality developers incorporate into their products.

Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases.

OBJECTIVE: To assess the impact of a home telemonitoring technology on patients with chronic obstructive pulmonary disease in terms of care satisfaction, patient empowerment, improved quality of life, and utilization of hospital and home care. DESIGN: A quasi-experimental retrospective and prospective design was developed with a matched control group to compare the effects of telemonitoring (the experimental group, n = 23) with the traditional homecare offering (the control group, n = 23). MEASUREMENTS: Satisfaction, patient empowerment, and quality of life were measured using validated Likert scales, whereas the data on care utilization were collected from the participating patients' medical record. RESULTS: Mixed results were observed. The clinical effects of home telemonitoring were very positive in terms of patients' satisfaction and empowerment. The perceptions of care providers as well as those of patients were congruent in this respect. Also, the study suggests that telemonitoring may have a positive effect on quality of life for patients with chronic obstructive pulmonary diseases. In contrast, the results were disappointing in terms of resource savings for the use of both homecare and hospital care. CONCLUSION: Capturing the full potential of these new technologies will require a much more fundamental reorganization of work than just a simple deployment of the technology.

The Determinants of Infant Mortality in Brazil, 2010-2020: A Scoping Review.

Despite the implementation of social and health policies that positively affected the health of the populations in Brazil, since 2009 the country has experienced a slower decline of infant mortality. After an economic and political crisis, Brazil witnessed increases in infant mortality that raised questions about what are the determinants of infant mortality after the implementation of such policies. We conducted a scoping review to identify and summarize those determinants with searches in three databases: LILACS, MEDLINE, and SCIELO. We included studies published between 2010 and 2020. We selected 23 papers: 83% associated infant mortality with public policies; 78% related infant mortality with the use of the health system and socioeconomic and living conditions; and 27% related to individual characteristics to infant mortality. Inequalities in the access to healthcare seem to have important implications in reducing infant mortality. Socioeconomic conditions and health-related factors such as income, education, fertility, housing, and the Bolsa Família. Program coverage was pointed out as the main determinants of infant mortality. Likewise, recent changes in infant mortality in Brazil are likely related to these factors. We also identified a gap in terms of studies on a possible association between employment and infant mortality.

Virtual organization of hospital medical imaging: a user satisfaction survey.

A virtual medical imaging department is an innovative and demanding organizational model, to the extent that the underlying goal is to achieve a continuous and advanced organizational integration of human and physical resources, clinical data, and clienteles. To better understand the kind of benefits offered, we conducted a survey of three groups of users--radiologists, radiological technologists, and medical specialists--working in a five-site virtual organization. We received 127 valid questionnaires, for an overall response rate of 66%. The assessments vary according to the use made of the system. The scores for system quality and the quality of the data produced were markedly higher for intra-hospital use (respectively 7.9 and 8.7 out of 10) than for inter-hospital use (5.4 and 7.0). Despite the negative assessments they made of inter-hospital use, users maintained a positive attitude toward some type of virtual organization of medical imaging. Indeed, the score for Overall satisfaction with the system was very high, 8.9 out of 10. Moreover, the scores for Intended future use of the system were very high for both intra-hospital use (8.9) and inter-hospital use (8.7). We also found significant differences in perceptions among user groups.

User-Centered Design for Promoting Patient Engagement in Chronic Diseases Management: The Development of CONCERTO.

Multimorbidity increases care needs among people with chronic diseases. In order to support communication between patients, their informal caregivers and their healthcare teams, we developed CONCERTO+, a patient portal for chronic disease management in primary care. A user-centered design comprising 3 iterations with patients and informal caregivers was performed. Clinicians were also invited to provide feedback on the feasibility of the solution. Several improvements were brought to CONCERTO+, and it is now ready to be implemented in real-life setting.