Stakeholders' Involvement in Health Technology Assessment in Kazakhstan, Poland and Bulgaria.

Background: In recent years, involvement of healthcare stakeholders in health technology assessment (HTA) has been discussed as helping the inclusion of social values in the decision-making process. The aim of our research was to identify and compare details from Kazakhstan, Poland and Bulgaria on their stakeholders' involvement in the HTA process. Information was sought on their identification, responsibilities, and regulation. Methods: We conducted a survey of seven types of stakeholders in the healthcare systems of Kazakhstan, Poland, and Bulgaria. They included patients and the public, providers, purchasers, payers, policy makers, product makers, and principal investigators. They were questioned on their involvement in the HTA process, and on the objectives of their participation. Results: Levels of involvement of different kinds of stakeholder varied between countries, reflecting political and administrative developments. There was full or partial agreement on the objectives of stakeholder participation. All respondents agreed that representatives of the ministry of health should be involved in selection of stakeholders for HTA. Conclusion: Progress has been made in the involvement of stakeholders, with interest in further development in all three countries.

Patients' Use of Telemedicine Mobile Application During COVID-19 Restrictions.

Telemedicine is being used in an increasing number of countries as an alternative to face-to-face traditional healthcare, to reduce the chances of spreading COVID-19. Although the use and benefits of telemedicine have been increasingly demonstrated for a long time, we do not know much about its adoption and use during the COVID-19 pandemic, when the community is confined by the social distancing restrictions. The main aim of this research is to study the factors affecting the adoption and use of telemedicine in patients during the period of COVID-19 restrictions. We also want to investigate the benefits of telemedicine for patients. We used a qualitative approach in this study. We interviewed six patients who used telemedicine during the COVID-19 restrictions. We find that telemedicine applications offered an overall positive experience for patients as a viable alternative way of medical care when physical attendance was restricted.

Validation of 4D Components for Measuring Quality of the Public Health Data Collection Process: Elicitation Study.

BACKGROUND: Identification of the essential components of the quality of the data collection process is the starting point for designing effective data quality management strategies for public health information systems. An inductive analysis of the global literature on the quality of the public health data collection process has led to the formation of a preliminary 4D component framework, that is, data collection management, data collection personnel, data collection system, and data collection environment. It is necessary to empirically validate the framework for its use in future research and practice. OBJECTIVE: This study aims to obtain empirical evidence to confirm the components of the framework and, if needed, to further develop this framework. METHODS: Expert elicitation was used to evaluate the preliminary framework in the context of the Chinese National HIV/AIDS Comprehensive Response Information Management System. The research processes included the development of an interview guide and data collection form, data collection, and analysis. A total of 3 public health administrators, 15 public health workers, and 10 health care practitioners participated in the elicitation session. A framework qualitative data analysis approach and a quantitative comparative analysis were followed to elicit themes from the interview transcripts and to map them to the elements of the preliminary 4D framework. RESULTS: A total of 302 codes were extracted from interview transcripts. After iterative and recursive comparison, classification, and mapping, 46 new indicators emerged; 24.8% (37/149) of the original indicators were deleted because of a lack of evidence support and another 28.2% (42/149) were merged. The validated 4D component framework consists of 116 indicators (82 facilitators and 34 barriers). The first component, data collection management, includes data collection protocols and quality assurance. It was measured by 41 indicators, decreased from the original 49% (73/149) to 35.3% (41/116). The second component, data collection environment, was measured by 37 indicators, increased from the original 13.4% (20/149) to 31.9% (37/116). It comprised leadership, training, funding, organizational policy, high-level management support, and collaboration among parallel organizations. The third component, data collection personnel, includes the perception of data collection, skills and competence, communication, and staffing patterns. There was no change in the proportion for data collection personnel (19.5% vs 19.0%), although the number of its indicators was reduced from 29 to 22. The fourth component, the data collection system, was measured using 16 indicators, with a slight decrease in percentage points from 18.1% (27/149) to 13.8% (16/116). It comprised functions, system integration, technical support, and data collection devices. CONCLUSIONS: This expert elicitation study validated and improved the 4D framework. The framework can be useful in developing a questionnaire survey instrument for measuring the quality of the public health data collection process after validation of psychometric properties and item reduction.

Understanding cancer patients' use and perceptions of inpatient portal: A case study at a tertiary hospital in Saudi Arabia.

BACKGROUND: Inpatient portals have been introduced into tertiary hospitals to meet patients' information and communication needs, to increase their awareness of health care, and to facilitate their transition after discharge. However, there is inadequate knowledge about hospitalised oncology patients' use and perceptions of these technologies. OBJECTIVE: To explore cancer patients' use and perceptions of an inpatient portal in a tertiary hospital and to identify the main benefits and barriers for patients in using the portal. METHOD: A qualitative case study was conducted in a tertiary hospital in Riyadh, Saudi Arabia. Only cancer patients were invited to participate. Twenty-two semi-structured interviews were conducted in the patient's room in a cancer care centre in January 2020. Interviews were audio-recorded, fully transcribed, and analysed using a thematic analysis method. RESULTS: Most patients used the portal for the first time. The most used features were entertainment, watching fall prevention videos and viewing medication lists. Although the majority of patients were positive towards the portal, and considered it to be useful and easy to use, only a small number of them used the key clinical feature of the system such as pain assessment, health education, and discharge preparation. The patients would like to see further improvement in usability of the portal, appropriate user training, adding further information, and incorporating more services and features in the portal. CONCLUSION: The introduction of the inpatient portal is successful in improving cancer patients' hospitalisation experience. It helped cancer patients to acquire knowledge about their own health, to actively engage in their care processes, and to request and acquire electronic services, in addition to providing entertainment. Future research on which factors inspire patients' use of the portal and how the influence is achieved is needed for the successful integration of the portal into the patients' hospital care process.

Application of a four-dimensional framework to evaluate the quality of the HIV/AIDS data collection process in China.

OBJECTIVE: To qualitatively evaluate the quality of the data collection process used by the Chinese national HIV/AIDS data repository (CRIMS), using a four-dimensional (4D) framework. The process is vital for the acquisition of high-quality data for ending the HIV/AIDS epidemic in China. METHODS: The study was carried out in China from September 2014 to April 2015. Stratified convenient sampling was conducted to recruit 28 study participants including health administrators, public health professionals and clinicians. Data were collected through semi-structured interviews with the participants and from field observations in six hospitals. Content analysis was conducted following the 4D Framework. RESULTS: 61 percent of the facilitators and 74 percent of the barriers of the 4D Framework were confirmed in the CRIMS data collection process. The CRIMS achieved better-quality data collection management. The perceived gaps primarily included: impractical data collection protocol and invalid quality assessment mechanism for data collection management; weak leadership and unsupportive organizational policy for data collection environment; poor communication and job fatigue for data collection personnel; and inflexibility and inaccessibility of data collection system. Areas for improvement included: engaging frontline staff in the design of data collection protocol, standardizing quality assurance procedures, strengthening leadership, recognizing data collector's contributions, and meeting end-users' needs for the CRIMS. CONCLUSION: The findings generated knowledge about the quality of the CRIMS data collection process. The 4D Framework has potential as an evaluation tool for decision-makers on the improvement of the public health data collection process.

Trend in data errors after the implementation of an electronic medical record system: A longitudinal study in an Australian regional Drug and Alcohol Service.

OBJECTIVES: To investigate trends in data errors over the 40 months after the implementation of an electronic medical record (eMR) system in an Australian regional Drug and Alcohol (D&A) Service. METHODS: One hundred and twenty three error reports and data on occasions of service were obtained from the D&A Service. Statistical analysis was conducted to describe types of errors, to compare distribution of error types among different documentation forms, D&A Service sites and job roles. Error rates were also analysed. RESULTS: In the 40 months after the implementation, a total of 18,549 errors occurred. These errors were grouped into four types: mismatched data fields (54.5 %), duplicate medical record (1.8 %), date/time error (8.2 %) and blank field (35.4 %). The distribution of error types differed in the forms being completed, the sites and the job roles. Quarterly error rate increased from 28.8 errors per 100 occasions of service in Year 1 Quarter 1-40.6 in Quarter 3, then decreased to 18.1 in Quarter 4. It dropped to 6.6 in Year 2 Quarter 2 and continued to decrease to 2.5 in Year 4 Quarter 1. Monthly error rate was the highest at 44.6 in Month 8, fell to the lowest at 1.0 in Month 18 and remained at under 7.3 from Month 19 to Month 40. CONCLUSIONS: After the implementation of the eMR system, the error rate increased in the first three quarters before decreasing. It reached stability about one and a half years after implementation. There were significant differences in the error distribution among the documentation forms, sites and job roles. The findings of this study could be used by eMR trainers to tailor training sessions for specific sites and job roles. These findings might also be useful for managers of other D&A Services to plan for the implementation of new electronic documentation systems.

The contribution of electronic health records to risk management through accreditation of residential aged care homes in Australia.

BACKGROUND: The Australian government has implemented a compulsory aged care accreditation system to guide and monitor the risk management approach in registered residential aged care (RAC) homes. This research assessed the contribution of electronic health records (EHR) to risk management in RAC homes in relation to the extent that aged care accreditation fulfils its role. METHODS: A convenience sample of 5560 aged care accreditation reports published from 2011 to 2018 was manually downloaded from the Accreditation Agency web site. A mixed-method approach of text data mining and manual content analysis was used to identify any significant differences in failure to meet accreditation outcomes among the RAC homes. This took account of whether EHR or paper records were used, year of accreditation, and size and location of the homes. RESULTS: It appears that aged care accreditation was focused on structure and process, with limited attention to outcome. There was a big variation between homes in their use of measurement indicators to assess accreditation outcomes. No difference was found in outcomes between RAC homes using EHR and those using paper records. Only 3% of the RAC homes were found to have failed some accreditation outcomes. Failure in monitoring mechanism was the key factor for failing many accreditation outcomes. The top five failed outcomes were Human Resource Management, Clinical Care, Information Systems, Medication Management and Behavioural Management. CONCLUSIONS: Sub-optimal outcomes have limited the effectiveness of accreditation in driving and monitoring risk management for care recipient safety in RAC homes. Although EHR is an important structure and process component for RAC services, it made a limited contribution to risk management for accreditation in Australian RAC homes. Either EHR was not effective, or the accreditation process was not robust enough to recognize its influence. Aged care accreditation in Australia needs to develop further outcome-based measures that are supported by robust data infrastructure and clear guidance.

Identification of the essential components of quality in the data collection process for public health information systems.

This study identifies essential components in the data collection process for public health information systems based on appraisal and synthesis of the reported factors affecting this process in the literature. Extant process assessment instruments and studies of public health data collection from electronic databases and the relevant institutional websites were reviewed and analyzed following a five-stage framework. Four dimensions covering 12 factors and 149 indicators were identified. The first dimension, data collection management, includes data collection system and quality assurance. The second dimension, data collector, is described by staffing pattern, skill or competence, communication and attitude toward data collection. The third, information system, is assessed by function and technology support, integration of different data collection systems, and device. The fourth dimension, data collection environment, comprises training, leadership, and funding. With empirical testing and contextual analysis, these essential components can be further used to develop a framework for measuring the quality of the data collection process for public health information systems.

Hospital-based Health Technology Assessment in Kazakhstan: 3 years' experience of one unit.

OBJECTIVES: The aim of this study was to describe the development and activities of the Hospital-Based Health Technology Assessment (HB-HTA) Unit in the Hospital of the President's Affairs Administration, one of the first examples of the implementation of HB-HTA into the practice of Kazakhstani hospitals. METHODS: Details of the development of the Unit were obtained from the hospital's administrative records. The Unit's own records were used to describe the reports prepared and the clinical areas that were covered. Responses to recommendations in the Unit's reports were obtained from hospital administration and individual departments. Estimates of savings and payback periods were based on data from the hospital information system, and data submitted by manufacturers and distributors of medical equipment. RESULTS: Fifty-one rapid- and mini-HTA reports were prepared by the Unit from 2015 to 2017. Seventeen health technologies (33 percent) were not recommended for implementation in hospital practice. Refusal to implement sixteen of these technologies saved approximately 1,053,500 USD. Of the thirty-four recommended health technologies, twenty-four were implemented to treat or diagnose 1,376 patients, and eight others were included in plans for 2018-20. Of the twenty-four implemented health technologies, twelve did not require additional investments. The payback period of investments for the other twelve implemented technologies is not more than 3 years for six, less than 5 years for four, and more than 10 years for two technologies. CONCLUSIONS: Establishment of the HB-HTA Unit in the hospital created the basis for making informed managerial decisions; identifying key directions for strategic development; and improving hospital management.

Medication administration process in a residential aged care home: An observational study.

AIMS: To understand the medication administration process in residential aged care homes. BACKGROUND: Understanding actual processes that nurses follow is critical to guide improvement efforts and to develop robust systems to ensure safety in medication administration. METHODS: Seven nurses were observed for 12 morning medication rounds at two units of a residential aged care home in Australia. Observations were guided by an activity theoretical framework. RESULTS: Nurses followed a common work process to administer medication. This process included actions from preparing medication trolley, locating a resident, preparing and administering medication to this person, documenting the administration, to finally checking medication charts to ensure all residents received medication. We identified 15 process deviations that may hinder safe medication administration. Electronic medication administration records appeared to be able to prevent a deviation associated with the paper-based documentation process. CONCLUSIONS: This study elaborated the medication administration process in a residential aged care home and identified process deviations. It suggests a safety checklist that can be used to evaluate nursing practice and improve medication administration process. IMPLICATION FOR NURSING MANAGEMENT: To develop robust systems for medication safety, nursing managers need to understand the actual nursing process, identify process deviations, and investigate the context in which these deviations occur.

Text Data Mining of Aged Care Accreditation Reports to Identify Risk Factors in Medication Management in Australian Residential Aged Care Homes.

This study aimed to identify risk factors in medication management in Australian residential aged care (RAC) homes. Only 18 out of 3,607 RAC homes failed aged care accreditation standard in medication management between 7th March 2011 and 25th March 2015. Text data mining methods were used to analyse the reasons for failure. This led to the identification of 21 risk indicators for an RAC home to fail in medication management. These indicators were further grouped into ten themes. They are overall medication management, medication assessment, ordering, dispensing, storage, stock and disposal, administration, incident report, monitoring, staff and resident satisfaction. The top three risk factors are: "ineffective monitoring process" (18 homes), "noncompliance with professional standards and guidelines" (15 homes), and "resident dissatisfaction with overall medication management" (10 homes).

Precision of EMR Data: The Case for a Drug and Alcohol Service.

Error-laden data can negatively affect clinical and operational decision making, research findings and funding allocation. This study examined the number and types of data errors in an electronic medical record (EMR) system in a Drug and Alcohol service. Specifically, errors in service data were examined. Three months after the implementation of the EMR system, 9,379 errors were identified from ten error reports generated between March 2015 and May 2016. The errors were grouped into four types: mismatched data fields (60.5%), duplicate medical record error (3.2%), date/time error (8.8%) and blank field error (27.4%). The errors can be prevented by adding functions, such as alert messages in the EMR system. How and why the errors occur need to be investigated in future studies.

Data Quality of the Chinese National AIDS Information System: A Critical Review.

Thirty-nine electronic English and Chinese articles on data quality assessment of the Chinese AIDS information system were critically reviewed. Some performance assessment related indicators of data quality have improved since the system was launched in 2008. After a thematic analysis of the factors that may affect data quality, four domains were identified. They are data management, data collector, information system, and data collection environment. The findings are useful to guide data quality improvement effort.

The Impact of Electronic Health Records on Risk Management of Information Systems in Australian Residential Aged Care Homes.

To obtain indications of the influence of electronic health records (EHR) in managing risks and meeting information system accreditation standard in Australian residential aged care (RAC) homes. The hypothesis to be tested is that the RAC homes using EHR have better performance in meeting information system standards in aged care accreditation than their counterparts only using paper records for information management. Content analysis of aged care accreditation reports from the Aged Care Standards and Accreditation Agency produced between April 2011 and December 2013. Items identified included types of information systems, compliance with accreditation standards, and indicators of failure to meet an expected outcome for information systems. The Chi-square test was used to identify difference between the RAC homes that used EHR systems and those that used paper records in not meeting aged care accreditation standards. 1,031 (37.4%) of 2,754 RAC homes had adopted EHR systems. Although the proportion of homes that met all accreditation standards was significantly higher for those with EHR than for homes with paper records, only 13 RAC homes did not meet one or more expected outcomes. 12 used paper records and nine of these failed the expected outcome for information systems. The overall contribution of EHR to meeting aged care accreditation standard in Australia was very small. Risk indicators for not meeting information system standard were no access to accurate and appropriate information, failure in monitoring mechanisms, not reporting clinical incidents, insufficient recording of residents' clinical changes, not providing accurate care plans, and communication processes failure. The study has provided indications that use of EHR provides small, yet significant advantages for RAC homes in Australia in managing risks for information management and in meeting accreditation requirements. The implication of the study for introducing technology innovation in RAC in Australia is discussed.

A PROCESS OF PRIORITIZING TOPICS FOR HEALTH TECHNOLOGY ASSESSMENT IN KAZAKHSTAN.

OBJECTIVES: The aim of this study was to develop criteria for the prioritization of topics for health technology assessment (HTA) in the healthcare system of Kazakhstan. METHODS: Initial proposals for criteria were suggested through consultation with Ministry of Health (MoH) policy areas. These were refined through a workshop attended by HTA department staff, persons from medical universities and research institutes, and MoH policy makers. The workshop included discussion on methods used in international HTA practice. Opinions of participants on selection of criteria from those specified in a review of prioritization processes were used to define a list for inclusion in an instrument for routine use. A scoring system was established in later discussion. RESULTS: Selected criteria for HTA prioritization were burden of disease, availability of alternative technology, clinical effectiveness, economic efficiency, budget impact, and ethical, legal, and/or psychosocial aspects. For each criterion, a health technology under consideration is given a score from 3 (High) to 1 (Low). The total score determines whether the technology is of high to medium priority or of low priority. Determination of priorities for assessment, using the instrument, should be carried out by an expert group appointed by the MoH. The process was applied in 2014 to a selection of topics, and three health technologies were chosen for full assessments. CONCLUSIONS: Criteria for prioritization have evolved with development of the HTA program in Kazakhstan. A method for HTA prioritization has been developed that is easy to apply, requires comparatively few resources, and is compatible with processes required by the MoH.

IMPLEMENTATION OF HEALTH TECHNOLOGY ASSESSMENT WORK IN A HOSPITAL IN KAZAKHSTAN.

OBJECTIVES: The aim of this study was to implement health technology assessment (HA) in the First General City Hospital in Astana, Kazakhstan. METHODS: We organized trainings to familiarize hospital staff with the purpose and details of HTA. An HTA committee was established, with representation from hospital physicians and managers, and criteria for prioritization of health technologies determined. Clinical departments of the hospital were asked to prepare applications for new technologies for their services. RESULTS: The HTA committee reviewed five applications and selected a technology from one of these, on single incision laparoscopic surgery (SILS), for assessment. A short HTA report on SILS was prepared, covering its safety, clinical effectiveness, and cost effectiveness. The report was used to support a request to the Department of Health for additional funding to implement this technology within the hospital. This funding was approved and SILS was established in several hospital departments. CONCLUSIONS: This successful initial experience with HTA has paved the way for its routine use by the hospital for informing decisions on the procurement and use of new health technologies.

INFLUENCE OF HEALTH TECHNOLOGY ASSESSMENT AND ITS MEASUREMENT.

OBJECTIVES: The aim of this study was to obtain information on methods used to measure health technology assessment (HTA) influence, decisions that were influenced, and outcomes linked to HTA. METHODS: Electronic databases were used to locate studies in which HTA influence had been demonstrated. Inclusion criteria were studies that reliably reported consideration by decision makers of HTA findings; comparative studies of technology use before and after HTA; and details of changes in policy, health outcomes, or research that could be credibly linked to an HTA. RESULTS: Fifty-one studies were selected for review. Settings were national (24), regional (12), both national and regional (3) hospitals (9), and multinational (3). The most common approach to appraisal of influence was review of policy or administrative decisions following HTA recommendations (51 percent). Eighteen studies (35 percent) reported interview or survey findings, thirteen (26 percent) reviewed administrative data, and six considered the influence of primary studies. Of 142 decisions informed by HTA, the most common types were on routine clinical practice (67 percent of studies), coverage (63 percent), and program operation (37 percent). The most frequent indications of HTA influence were on decisions related to resource allocation (59 percent), change in practice pattern (31 percent), and incorporation of HTA details in reference material (18 percent). Few publications assessed the contribution of HTA to changing patient outcomes. CONCLUSIONS: The literature on HTA influence remains limited, with little on longer term effects on practice and outcomes. The reviewed publications indicated how HTA is being used in different settings and approaches to measuring its influence that might be more widely applied, such as surveys and monitoring administrative data.

Nursing staff work patterns in a residential aged care home: a time-motion study.

Objective Residential aged care services are challenged by an increasing number of residents and a shortage of nursing staff. Developing strategies to overcome this challenge requires an understanding of nursing staff work patterns. The aim of the present study was to investigate the work processes followed by nursing staff and how nursing time is allocated in a residential aged care home. Methods An observational time-motion study was conducted at two aged care units for 12 morning shifts. Seven nurses were observed, one per shift. Results In all, there were 91h of observation. The results showed that there was a common work process followed by all nurse participants. Medication administration, documentation and verbal communication were the most time-consuming activities and were conducted most frequently. No significant difference between the two units was found in any category of activities. The average duration of most activities was less than 1min. There was no difference in time utilisation between the endorsed enrolled nurses and the personal carers in providing nursing care. Conclusion Medication administration, documentation and verbal communication were the major tasks in morning shifts in a residential aged care home. Future research can investigate how verbal communication supports nursing care. What is known about the topic? The aging population will substantially increase the demand for residential aged care services. There is a lack of research on nurses' work patterns in residential aged care homes. What does this paper add? The present study provides a comprehensive understanding of nurses' work patterns in a residential aged care home. There is a common work process followed by nurses in providing nursing care. Medication administration, verbal communication and documentation are the most time-consuming activities and they are frequently conducted in the same period of time. Wound care, physical review and documentation on desktop computers are arranged flexibly by the nurses. What are the implications for practitioners? When developing a task reallocation strategy to improve work efficiency, effort can be put into tasks that can be arranged more flexibly.

Factors influencing nursing time spent on administration of medication in an Australian residential aged care home.

AIMS: To examine nursing time spent on administration of medications in a residential aged care (RAC) home, and to determine factors that influence the time to medicate a resident. BACKGROUND: Information on nursing time spent on medication administration is useful for planning and implementation of nursing resources. METHODS: Nurses were observed over 12 morning medication rounds using a time-motion observational method and field notes, at two high-care units in an Australian RAC home. RESULTS: Nurses spent between 2.5 and 4.5 hours in a medication round. Administration of medication averaged 200 seconds per resident. Four factors had significant impact on medication time: number of types of medication, number of tablets taken by a resident, methods used by a nurse to prepare tablets and methods to provide tablets. CONCLUSION: Administration of medication consumed a substantial, though variable amount of time in the RAC home. Nursing managers need to consider the factors that influenced the nursing time required for the administration of medication in their estimation of nursing workload and required resources. IMPLICATIONS FOR NURSING MANAGEMENT: To ensure safe medication administration for older people, managers should regularly assess the changes in the factors influencing nursing time on the administration of medication when estimating nursing workload and required resources.