Smart homes: pioneering age-friendly environments in China for enhanced health and quality of life.

Traditionally, China has been more reliant on a model of care that ensures older adults are cared for by family members. Whilst promoting the idea of older adults ageing in their own homes is essential, the provision of in-home care must shift from primarily relying on family caregivers to a model that places greater emphasis on gerontechnologies and enhanced healthcare service delivery. In this perspective article we argue for the adoption of a 'smart home' model in aged care in China. The smart home model argues for innovative technologies to older adult care, such as virtual support groups, video-conferencing, and electronic health records; assistive technologies that can safely maintain independence and assist with daily living such as sensors, wearables, telehealth, smart home technologies as well as interactive robotic technologies for mobility and cognitive support such as humanoid robots, rehabilitation robots, service/companion robots. The adoption and implementation of gerontechnologies have been slow, with only a handful of solutions demonstrating proven effectiveness in supporting home care. The utilisation of such digital technologies to support and enable older adults in China to age-in-place can bring a significant contribution to healthy ageing. Nonetheless, it's crucial to focus on co-creating with end-users, incorporating their values and preferences, and enhancing training to boost the adoption of these gerontechnologies. Through a smart home model of care, China can age-in-place more effectively, leading to significant contributions to healthy ageing.

Process mining and customer journey mapping in healthcare: Enhancing patient-centred care in stroke rehabilitation.

Background: Patient-centred care and enhancing patient experience is a priority across Australia. Stroke rehabilitation has multiple consumer touchpoints that would benefit from a better understanding of customer journeys, subsequently impacting better patient-centred care, and contributing to process improvements and better patient outcomes. Customer journey mapping through process mining extracts process data from event logs in existing information systems discovering patient journeys, which can be utilized to monitor guideline compliance and uncover nonconformance. Methodology: Utilizing process mining and variant analysis, customer journey maps were developed for 130 stroke rehabilitation patients from referral to discharge. In total, 168 cases from the Australasian Rehabilitation Outcomes Centre dataset were matched with 6291 cases from inpatient stroke data. Variants were explored for age, gender, outcome measures, length of stay and functional independence measure (FIM) change. Results: The study illustrated the process, process variants and patient journey map in stroke rehabilitation. Process characteristics of stroke rehabilitation patients were extracted and represented utilizing process mining and results highlighted process variation, attributes, touchpoints and timestamps across stroke rehabilitation patient journeys categorized by patient demographics and outcome variables. Patients demonstrated a mean and median duration of 49.5 days and 44 days, respectively, across the patient journeys. Nine variants were discovered, with 78.46% (n = 102) of patients following the expected sequence of activities in their stroke rehabilitation patient journey. Relationships involving age, gender, length of stay and FIM change along the patient journeys were evident, with four cases experiencing stroke rehabilitation journeys of more than 100 days, warranting further investigation. Conclusion: Process mining can be utilized to visualize and analyse patient journeys and identify gaps in service quality, thus contributing to better patient-centred care and improved patient outcomes and experiences in stroke rehabilitation.

Development of an evidence-informed governance and stewardship framework for elderly healthcare in Iran: A qualitative study.

Background: The ageing population poses significant challenges to healthcare systems, necessitating the establishment of high-functioning, integrated frameworks for elderly healthcare. This study aimed to explore the key challenges associated with the stewardship of elderly care in Iran and to develop a holistic stewardship framework. Methods: For this qualitative study, thirty semi-structured interviews were conducted with key Iranian healthcare stakeholders, utilizing purposive and snowball sampling during 2021-2022. Inductive open coding was utilized to generate new concepts related to key stewardship challenges. The World Health Organization's conceptual framework, outlining the three stewardship tasks, served as the basis for crafting a tailored framework for elderly healthcare stewardship in Iran. Results: Fourteen main challenges and 38 sub-challenges were identified for elderly healthcare stewardship in Iran, categorized according to the WHO framework's three stewardship tasks. Challenges related to WHO stewardship task 1, involving health policy formulation and vision definition, included challenges in vision definition, planning, policymaking, and intergovernmental institutional superiority. Challenges related to WHO stewardship task 2, delineating governance and stewardship through control and regulation, encompassed issues such as support for the elderly, system responsiveness, behavior of healthcare providers, organizational structure, and cross-sectoral leadership challenges. Challenges associated with WHO stewardship task 3, about the use of collective intelligence, explored stakeholder collaboration, information for decision-making, and challenges within the elderly information system, covering data documentation, reporting, analysis, accessibility, distribution, and circulation. Subsequently, a framework was developed, covering areas like defining the vision and direction of health policy, managing information systems, evidence-informed policymaking, and delivering elderly health services with a holistic approach. Conclusion: The present framework shows how a management information system, guided by evidenced-informed policymaking and the formulation of customized health policies, can facilitate the provision of elderly health services based on identified needs. It presents a governance and stewardship pathway that can be adopted by Iranian health policymakers and similar middle-income countries facing analogous challenges in ageing and aged care system stewardship, serving as a model for developing their own frameworks.

Quality Improvement in Stroke Rehabilitation: A Scoping Review.

Background: Quality improvement interventions are used extensively in health care, aiming to improve delivery and promote best practice. The impact of quality improvement interventions implemented in stroke rehabilitation remains unclear. Objective: The aim of this scoping review is to examine the different types of published quality improvement interventions in stroke rehabilitation and their impact on improving the quality of care. Materials and Methods: A scoping review was performed in the PubMed, Embase and CINAHL databases. QI studies evaluating interventions for stroke rehabilitation patients that were published up to August 2020 were included. The review looked at the types of quality improvement interventions that have been evaluated as well as the improvements/impacts reported for quality improvement interventions for stroke patients in rehabilitation. Results: We reviewed 1580 studies, twelve quality improvement interventions met inclusion criteria and were included in the current study. Six studies involved organizational change, three studies involved provider education and audit-feedback and three studies involved provider education. Of the twelve quality improvement interventions that have been included, >90% reported improvements (91.6%). In the majority of cases, improvements were noted through implementation of a myriad of interventions. Several facilitators and barriers were noted during implementation and contributed to success or failure of the intervention. Conclusion: There is paucity of full-text peer-reviewed published research investigating quality improvement interventions for improving the quality of care in stroke rehabilitation. The current review offers value to healthcare providers in terms of key success factors, contextual factors, barriers and facilitators associated with improvements in stroke rehabilitation.

Verifying alternative measures of healthcare service quality.

PURPOSE: The purpose of this paper is to determine the best measure among several alternatives (SERVQUAL, weighted SERVQUAL, SERVPERF, weighted SERVPERF) and develop a scale which healthcare providers can use for measurement of healthcare service quality. DESIGN/METHODOLOGY/APPROACH: The study involved two phases. The first phase was through a series of in-depth interviews with experts and patients followed by a pilot study. Subsequently, the second phase involved a quantitative phase through surveys with 384 patients. Alternative measures were analyzed using coefficient (Cronbach) α, composite reliability, factor analysis and logistic regression analysis. FINDINGS: Findings confirmed "Weighted SERVPERF" using an interactive methodology as the most appropriate for measurement of healthcare service quality. ORIGINALITY/VALUE: Using the model and scale developed, healthcare providers will be able to measure healthcare service quality and identify areas of shortfall and act accordingly to improve delivery through allocating resources in service areas that would generate the greatest returns in customer satisfaction. Enhancing satisfaction will ultimately generate patient loyalty and positive recommendation behavior.