Development and evaluation of the Family Needs Questionnaire for Pediatric Rehabilitation.

PURPOSE: To develop the Family Needs Questionnaire-Pediatric Rehabilitation (FNQ-PR) version and evaluate the reliability and concurrent validity of this self-report measure for caregivers of children with disabilities who receive pediatric rehabilitation services. MATERIALS/METHODS: The 39-item FNQ-PR was developed through a modified Delphi Technique. For test-retest evaluation, parents completed the FNQ-PR twice through an online REDCap survey, 1-3 weeks apart. Concurrent validity data (parent-report Impact on Family Scale [IFS-15] and Measure of Processes of Care [MPOC-20]) were collected at baseline. Reliability analyses included ICCs (95%CI) and internal consistency evaluation. RESULTS: Twenty-five caregivers of children ages 2-18 years (mean age 12.2 years) with a disability completed the FNQ-PR at baseline, and 21 completed the retest. FNQ-PR total score demonstrated excellent test-retest reliability (ICC = 0.84); internal consistency was high. The FNQ-PR total score was strongly negatively associated with IFS-15 total score (r = -0.62) and showed fair to strong association with MPOC subscale scores (0.45 ≤ r ≤ 0.70). Participants did not identify issues with the online format or FNQ-PR item rating. CONCLUSIONS: The FNQ-PR demonstrated excellent overall reliability and strong evidence of validity. It fills a gap in clinical care of families of children with disabilities, providing a systematic way for families to identify the extent to which their needs are perceived to have been met. Clinicians can use this tool to target unmet needs that are most important to families. FNQ-PR use in future research will support exploration of the impact of specific child and family factors on family needs.

Propuesta de acciones para eliminar mudas en la gestión de los procesos en instituciones de salud cubanas / Proposal of Actions to Eliminate Changes in the Management of Processes in Cuban Health Institutions

Introducción: El conocimiento y desarrollo de habilidades relacionadas con la gestión por procesos en los profesionales sanitarios son vitales para mejorar la calidad de los servicios. Objetivo: Proponer acciones para la eliminación de las mudas en la gestión de los procesos en instituciones de salud cubanas. Métodos: Investigación descriptiva, transversal entre enero-junio 2020 centrada en la búsqueda del conocimiento sobre los procesos en 35 instituciones de salud. Se indagó a partir de preguntas realizadas a los participantes sobre los procesos que realizaban en sus instituciones, sus desperdicios y propuestas de mejora. Se aplicó del enfoque Lean a los procesos estudiados. Resultados: Se identificaron las siguientes mudas: demoras en los tiempos de espera; duplicidad de documentos y exámenes complementarios, exceso de modelajes, traslados innecesarios del personal, errores en la planificación de las acciones de promoción y utilización de recursos humanos en actividades no vinculadas a su formación. Se propusieron para su mejora las siguientes acciones: programación de consultas por horarios escalonados, distribución del modelaje según tipo de institución, utilización de las tecnologías de la información y las comunicaciones, control gerencial de los procesos. Conclusiones: La aplicación del enfoque Lean en la gestión de procesos en instituciones sanitarias permite identificar mudas en su flujo y proponer acciones de mejoras fundamentalmente de tipo organizativo y de control gerencial(AU)

Introduction: The knowledge and development of skills related to process management in health professionals are vital for improving the quality of services. Objective: To propose actions for the elimination of changes in the processes management in Cuban health institutions. Methods: This is a descriptive, cross-sectional research from January to June 2020 focused on the search for knowledge about the processes in 35 health institutions. It was examined from questions asked to the participants about the processes they carried out in their institutions, their waste and proposals for improvement. The Lean approach was applied to the processes studied. Results: The following changes were identified: delays in waiting times; duplication of documents and complementary exams, excessive modeling, unnecessary transfers of personnel, errors in the planning of promotion actions and use of human resources in activities not related to their training. The following actions were proposed for improvement: scheduling of consultations by staggered hours, distribution of modeling according to the type of institution, use of information and communication technologies, managerial control of processes. Conclusions: The application of the Lean approach in the management of processes in health institutions makes it possible to identify their flow changes and propose improvement actions, fundamentally of an organizational and managerial control nature(AU)

The Australian living guidelines for the clinical care of people with COVID-19: What worked, what didn't and why, a mixed methods process evaluation.

INTRODUCTION: The Australian National COVID-19 Clinical Evidence Taskforce is producing living, evidence-based, national guidelines for treatment of people with COVID-19 which are updated each week. To continually improve the process and outputs of the Taskforce, and inform future living guideline development, we undertook a concurrent process evaluation examining Taskforce activities and experience of team members and stakeholders during the first 5 months of the project. METHODS: The mixed-methods process evaluation consisted of activity and progress audits, an online survey of all Taskforce participants; and semi-structured interviews with key contributors. Data were collected through five, prospective 4-weekly timepoints (beginning first week of May 2020) and three, fortnightly retrospective timepoints (March 23, April 6 and 20). We collected and analysed quantitative and qualitative data. RESULTS: An updated version of the guidelines was successfully published every week during the process evaluation. The Taskforce formed in March 2020, with a nominal start date of March 23. The first version of the guideline was published two weeks later and included 10 recommendations. By August 24, in the final round of the process evaluation, the team of 11 staff, working with seven guideline panels and over 200 health decision-makers, had developed 66 recommendations addressing 58 topics. The Taskforce website had received over 200,000 page views. Satisfaction with the work of the Taskforce remained very high (>90% extremely or somewhat satisfied) throughout. Several key strengths, challenges and methods questions for the work of the Taskforce were identified. CONCLUSIONS: In just over 5 months of activity, the National COVID-19 Clinical Evidence Taskforce published 20 weekly updates to the evidence-based national treatment guidelines for COVID-19. This process evaluation identified several factors that enabled this achievement (e.g. an extant skill base in evidence review and convening), along with challenges that needed to be overcome (e.g. managing workloads, structure and governance) and methods questions (pace of updating, and thresholds for inclusion of evidence) which may be useful considerations for other living guidelines projects. An impact evaluation is also being conducted separately to examine awareness, acceptance and use of the guidelines.

Práticas de avaliação na gestão da Atenção Básica à Saúde / Evaluation practices in Primary Health Care management

Resumo Neste estudo, investigamos efeitos das práticas de avaliação na Atenção Básica à Saúde no município de Belo Horizonte, na perspectiva de gestores de diversos níveis. É uma pesquisa qualitativa, de caráter descritivo. O foco deste artigo foi a análise do uso de dois instrumentos de avaliação, o Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) e o Gestão do Cuidado no Território (GCT), de abrangência municipal. As análises apontaram uma tendência dos entrevistados em realçar mais os aspectos positivos dos instrumentos de avaliação estudados, já que servem prioritariamente aos processos de gestão. Além disso, mostraram as diferenças entre os dois instrumentos, tanto em natureza quanto em efeitos. O PMAQ-AB recebeu críticas específicas de problemas identificados em sua operacionalização. Por sua vez, o grau de sucesso da GCT depende do nível de engajamento e participação dos atores locais.

Abstract In this study, we investigate the effects of assessment practices in Primary Health Care in the city of Belo Horizonte, from the perspective of managers at different levels. It is a qualitative, descriptive research. The focus of this article was the analysis of the use of two assessment instruments, the National Program for Improving Access and Quality of Primary Care (PMAQ-AB) and the Management of Care in the Territory (GCT), with municipal coverage. The analyzes indicated a tendency of the interviewees to emphasize more the positive aspects of the studied assessment instruments, as they primarily serve the management processes. Furthermore, they showed the differences between the two instruments, both in nature and in effects. The PMAQ-AB received specific criticisms of problems identified in its operation. In turn, the degree of success of the GCT depends on the level of engagement and participation of local actors.

Identificación de procesos de salud por maestrantes de la Escuela Nacional de Salud Pública / Identification of health processes by teachers of the National School of Public Health

Introducción: En los programas académicos de las especialidades, maestrías y cursos que se imparten en la Escuela Nacional de Salud Pública se inserta el estudio de los procesos y la gestión por procesos, tecnología que puede ser implementada para la mejora de la calidad en los servicios de salud en Cuba. Objetivo: Identificar los procesos vinculados al desempeño de los maestrantes en las instituciones de salud. Métodos: Investigación descriptiva de corte transversal entre enero y marzo de 2020, centrada en la búsqueda del conocimiento acerca del tema de procesos en los estudiantes de las maestrías de Atención Primaria de Salud y de Promoción y Educación para la Salud. Se solicitó la identificación de cinco procesos vinculados a su labor según la definición de la variable procesos y la selección de un proceso para la construcción colectiva de un diagrama de flujos y una ficha de procesos. Resultados: Se identificaron errores gramaticales y en la identificación de procesos en 13 maestrantes, se eliminaron aquellos que se repetían. Los procesos se agruparon y clasificaron en operativos, de apoyo y estratégicos. Se confeccionó un diagrama de flujos y una ficha del proceso más identificado por los maestrantes. Conclusiones: Los procesos operativos se identificaron con más frecuencia que los de apoyo y los estratégicos. La construcción de un diagrama de flujos y una ficha de proceso permitió una mayor visibilidad de las actividades y tareas que se desarrollan durante el proceso de atención médica por el equipo básico de salud en el consultorio médico de la familia(AU)

Introduction: The academic programs of specialties, master's degrees and courses taught at the National School of Public Health include the study of processes and process management, a technology that can be implemented to improve the quality of health services in Cuba. Objective: To identify the processes linked to the performance of master's courses students in health institutions. Methods: Cross-sectional and descriptive research carried out between January and March 2020, focused on the search for knowledge about the topic of processes in students of the master's degree courses of Primary Health Care and Health Promotion and Education. The identification of five processes linked to their work was requested according to the definition of the variable process and the selection of a process for the collective construction of a flow diagram and a process file. Results: Grammatical errors and errors in the identification of processes were observed in thirteen master's degree students, while those repeated were eliminated. The processes were grouped and classified into operational, supportive and strategic. A flow chart and a file of the process most identified by the master's degree students were made. Conclusions: Operational processes were identified more frequently than supportive and strategic ones. The construction of a flow chart and a process sheet allowed greater visibility of the activities and tasks developed during the medical care process by the basic health team in the family medical office(AU)

SMaRT Assessment Tool: An Innovative Approach for Objective Assessment of Flap Designs.

SUMMARY: The teaching and assessment of ideal surgical markings for local flaps required for optimal aesthetic and functional outcomes remain a challenge in the present era of competency-based surgical education. The authors utilized the bilobed flap for nasal reconstruction as a proof of concept for the development of an innovative objective assessment tool based on statistical shape analysis, with a focus on providing automated, evidence-based, objective, specific, and practical feedback to the learner. The proposed tool is based on Procrustes statistical shape analysis, previously used for the assessment of facial asymmetry in plastic surgery. For performance boundary testing, a series of optimal and suboptimal designs generated in deliberate violation of the established ideals of optimal bilobed flap design were evaluated, and a four-component feedback score of Scale, Mismatch, Rotation, and Translation (SMaRT) was generated. The SMaRT assessment tool demonstrated the capacity to proportionally score a spectrum of designs (n = 36) ranging from subtle to significant variations of optimal, with excellent computational and clinically reasonable performance boundaries. In terms of shape mismatch, changes in SMaRT score also correlated with intended violations in designs away from the ideal flap design. This innovative educational approach could aid in incorporating objective feedback in simulation-based platforms in order to facilitate deliberate practice in flap design, with the potential for adoption in other fields of plastic surgery to automate assessment processes.

The implementation, use and sustainability of a clinical decision support system for medication optimisation in primary care: A qualitative evaluation.

BACKGROUND: The quality and safety of prescribing in general practice is important, Clinical decision support (CDS) systems can be used which present alerts to health professionals when prescribing in order to identify patients at risk of potentially hazardous prescribing. It is known that such computerised alerts may improve the safety of prescribing in hospitals but their implementation and sustainable use in general practice is less well understood. We aimed to understand the factors that influenced the successful implementation and sustained use in primary care of a CDS system. METHODS: Participants were purposively recruited from Clinical Commissioning Groups (CCGs) and general practices in the North West and East Midlands regions of England and from the CDS developers. We conducted face-to-face and telephone-based semi-structured qualitative interviews with staff stakeholders. A selection of participants was interviewed longitudinally to explore the further sustainability 1-2 years after implementation of the CDS system. The analysis, informed by Normalisation Process Theory (NPT), was thematic, iterative and conducted alongside data collection. RESULTS: Thirty-nine interviews were conducted either individually or in groups, with 33 stakeholders, including 11 follow-up interviews. Eight themes were interpreted in alignment with the four NPT constructs: Coherence (The purpose of the CDS: Enhancing medication safety and improving cost effectiveness; Relationship of users to the technology; Engagement and communication between different stakeholders); Cognitive Participation (Management of the profile of alerts); Collective Action (Prescribing in general practice, patient and population characteristics and engagement with patients; Knowledge);and Reflexive Monitoring (Sustaining the use of the CDS through maintenance and customisation; Learning and behaviour change. Participants saw that the CDS could have a role in enhancing medication safety and in the quality of care. Engagement through communication and support for local primary care providers and management leaders was considered important for successful implementation. Management of prescribing alert profiles for general practices was a dynamic process evolving over time. At regional management levels, work was required to adapt, and modify the system to optimise its use in practice and fulfil local priorities. Contextual factors, including patient and population characteristics, could impact upon the decision-making processes of prescribers influencing the response to alerts. The CDS could operate as a knowledge base allowing prescribers access to evidence-based information that they otherwise would not have. CONCLUSIONS: This qualitative evaluation utilised NPT to understand the implementation, use and sustainability of a widely deployed CDS system offering prescribing alerts in general practice. The system was understood as having a role in medication safety in providing relevant patient specific information to prescribers in a timely manner. Engagement between stakeholders was considered important for the intervention in ensuring prescribers continued to utilise its functionality. Sustained implementation might be enhanced by careful profile management of the suite of alerts in the system. Our findings suggest that the use and sustainability of the CDS was related to prescribers' perceptions of the relevance of alerts. Shared understanding of the purpose of the CDS between CCGS and general practices particularly in balancing cost saving and safety messages could be beneficial.

Reflection on the Fly: Development of the Team Reflection Behavioral Observation (TuRBO) System for Acute Care Teams.

PURPOSE: Acute care teams work in dynamic and complex environments and must adapt to changing circumstances. A team process that helps teams process information and adapt is in-action team reflection (TR), defined as concurrent collective reflection on group objectives, strategies, or processes during an ongoing care event. However, the health care field lacks a means for systematically observing and ultimately training in-action TR in acute care teams. To bridge this gap, the authors developed a theoretically and empirically informed framework, Team Reflection Behavioral Observation (TuRBO), for measuring in-action TR. METHOD: In 2018 at ETH, Zurich, Switzerland, the authors developed a theoretical framework based on the literature and theory. They then conducted exploratory reviews of preexisting videos of acute care teams training simulated emergencies. The authors adapted observation codes using an iterative approach. Using the developed coding framework, they coded 23 video recordings of acute care teams and provided validity evidence from the 3 sources: content, internal structure (interrater reliability), and relations to other variables. RESULTS: The final TuRBO framework consists of 3 general dimensions-seeking information, evaluating information, and planning-that are further specified in 7 subcodes. Interrater agreement of the coding was substantial (κ = 0.80). As hypothesized, the data showed a positive relationship between in-action TR and team performance. Also, physicians spent significantly more time on in-action TR than nurses. CONCLUSIONS: The TuRBO framework for assessing in-action TR in acute care teams provides positive validity evidence of the data. TuRBO integrates different team communication and calibration processes under the overarching concept of in-action TR and provides descriptive behavioral markers. TuRBO taps into powerful cultural and normative components of patient safety. This tool can augment team training that allows all team members to serve as an important resource for flexible, resilient, and safer patient care.

Procesos y capacidades en la Estrategia Alto a la Tuberculosis Valle del Cauca - Colombia / Processes and capacities in the Stop TB Strategy, Valle del Cauca - Colombia

Introducción: Pese a los esfuerzos, las metas de control de la tuberculosis no han sido alcanzadas debido, en gran parte, a problemas de gestión de los programas de tuberculosis. El año 2015 fue un hito en la lucha contra la tuberculosis en Colombia. Objetivo: Evaluar los procesos y las capacidades de la Estrategia Alto a la Tuberculosis en el Valle del Cauca-Colombia para generar conocimiento útil para la toma de decisiones estratégicas y operativas para todos sus actores. Métodos: El estudio se enmarca dentro de lo que se denomina investigación evaluativa. El diseño de la evaluación general fue un abordaje mixto (cualitativo-cuantitativo), y en particular, el componente de procesos y capacidades tuvo un abordaje cualitativo. El periodo de análisis fue 2008-2014 y la información se recolectó en 2015-2016 y se analizó en 2016-2017. Resultados: Se evidenciaron avances en la inclusión de la Estrategia en los planes territoriales e institucionales, así como en el desarrollo de herramientas para el seguimiento, pero bajos niveles de articulación interprogramática e institucionalización de la gestión de medicamentos. Se observó una escasa adaptación de estrategias de prevención, captación, detección y seguimiento de pacientes a las realidades locales, así como bajo grado de articulación entre instituciones y comunidad, de alianzas estratégicas y escasos procesos de gestión del conocimiento. Conclusiones: Se observa un encadenamiento de debilidades que explican un bajo desempeño local y departamental. Cada institución cumple con lo que establece la norma, haciendo lo que puede con lo que tiene, con un bajo enfoque estratégico de abordaje tanto a nivel territorial como institucional(AU)

Introduction: Despite the efforts, the tuberculosis control goals have not been achieved due, in large part, to problems of management of the tuberculosis programs. 2015 was a milestone in the fight against tuberculosis in Colombia. Objective: To evaluate the processes and capacities of the Stop Tuberculosis Strategy in Valle del Cauca, Colombia to generate useful knowledge for making strategic and operational decisions for all stakeholders. Methods: The study is framed within what is called evaluative research. The design of the general evaluation was a mixed approach (qualitative-quantitative), and in particular, the processes and capabilities component had a qualitative approach. The analysis period was 2008-2014 and the information was collected in 2015-2016 and analyzed in 2016-2017. Results: Progress was evident in the inclusion of the Strategy in territorial and institutional plans, as well as in the development of monitoring tools, but low levels of inter-program coordination and institutionalization of drug management. Scant adaptation of strategies was observed for prevention, recruitment, detection and monitoring of patients to local realities, as well as a low degree of articulation of strategic alliances between institutions and the community, and few knowledge management processes. Conclusions: There is a chain of weaknesses that explains poor local and departmental performance. Each institution complies with what is established in the norm, doing what they can with what they have, with a low strategic approach to tactic both at the territorial and institutional level(AU)

Family-centeredness of services for young children with Down syndrome: an observational study from Turkey

Background/aim: Physicians require information on the family centeredness of services for children with Down syndrome, one of the most frequently encountered disabilities in childhood. We aimed to determine the family-centeredness of services for young children with Down syndrome and using a bioecological theory framework we hypothesized that child, family and service-related factors would be associated with such services. Materials and methods: In a crosssectional design, children with Down syndrome seen at Ankara University Developmental Pediatrics Division (AUDPD) between February 2020 and June 2020 were included if they had received services in the community for at least 12 months. Mothers responded to the measure of process of care-20 (MPOC-20) used to measure family centeredness. Results: All 65 eligible children were included; 57% were boys and median age was 25.0 (IQR: 18.5­38.0) months. The MPOC-20 subscale scores were highest for the "respectful and supportive care (RSC)" (median 6.0; IQR: 4.8­6.8) and lowest for the "providing specific information" (median 3.0; IQR: 4.4­6.5) subscales. On univariate analyses, maternal education

Employing computational linguistics techniques to identify limited patient health literacy: Findings from the ECLIPPSE study.

OBJECTIVE: To develop novel, scalable, and valid literacy profiles for identifying limited health literacy patients by harnessing natural language processing. DATA SOURCE: With respect to the linguistic content, we analyzed 283 216 secure messages sent by 6941 diabetes patients to physicians within an integrated system's electronic portal. Sociodemographic, clinical, and utilization data were obtained via questionnaire and electronic health records. STUDY DESIGN: Retrospective study used natural language processing and machine learning to generate five unique "Literacy Profiles" by employing various sets of linguistic indices: Flesch-Kincaid (LP_FK); basic indices of writing complexity, including lexical diversity (LP_LD) and writing quality (LP_WQ); and advanced indices related to syntactic complexity, lexical sophistication, and diversity, modeled from self-reported (LP_SR), and expert-rated (LP_Exp) health literacy. We first determined the performance of each literacy profile relative to self-reported and expert-rated health literacy to discriminate between high and low health literacy and then assessed Literacy Profiles' relationships with known correlates of health literacy, such as patient sociodemographics and a range of health-related outcomes, including ratings of physician communication, medication adherence, diabetes control, comorbidities, and utilization. PRINCIPAL FINDINGS: LP_SR and LP_Exp performed best in discriminating between high and low self-reported (C-statistics: 0.86 and 0.58, respectively) and expert-rated health literacy (C-statistics: 0.71 and 0.87, respectively) and were significantly associated with educational attainment, race/ethnicity, Consumer Assessment of Provider and Systems (CAHPS) scores, adherence, glycemia, comorbidities, and emergency department visits. CONCLUSIONS: Since health literacy is a potentially remediable explanatory factor in health care disparities, the development of automated health literacy indicators represents a significant accomplishment with broad clinical and population health applications. Health systems could apply literacy profiles to efficiently determine whether quality of care and outcomes vary by patient health literacy; identify at-risk populations for targeting tailored health communications and self-management support interventions; and inform clinicians to promote improvements in individual-level care.

When dispatcher assistance is not saving lives: assessment of process compliance, barriers and outcomes in out-of-hospital cardiac arrest in a metropolitan city in China.

BACKGROUND: Several Chinese cities have implemented dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), although out-of-hospital cardiac arrest (OHCA) survival rates remain low. We aimed to assess the process compliance, barriers and outcomes of OHCA in one of the earliest implemented (DA-CPR) programmes in China. METHODS: We retrospectively reviewed OHCA emergency dispatch records of Suzhou emergency medical service from 2014 to 2015 and included adult OHCA victims (>18 years) with a bystander-witnessed atraumatic OHCA that was subsequently confirmed by on-site emergency physician. The circumstances and DA-CPR process related to the OHCA event were analysed. Dispatch audio records were reviewed to identify potential barriers to implementation during the DA-CPR process. RESULTS: Of the 151 OHCA victims, none survived. The median time from patient collapse to call for emergency services and that from call to provision of cardiopulmonary resuscitation instructions was 30 (IQR 20-60) min and 115 (IQR 90-153) s, respectively. Only 110 (80.3%) bystanders/rescuers followed the dispatcher instructions; of these, 51 (46.3%) undertook persistent chest compressions. Major barriers to following the DA-CPR instructions were present in 104 (68.9%) cases, including caller disconnection of the call, distraught mood or refusal to carry out either compressions or ventilations. CONCLUSIONS: The OHCA survival rate and the DA-CPR process were far from optimal. The zero survival rate is disproportionally low compared with survival statistics in high-income countries. The prolonged delay in calling the emergency services negated and rendered futile any DA-CPR efforts. Thus, efforts targeted at developing public awareness of OHCA, calling for help and competency in DA-CPR should be increased.

Ferramentas para a organização do processo de trabalho na segurança do paciente / Herramientas para organizar el proceso de trabajo en seguridad del paciente / Tools to organize the work process in patient safety

RESUMO Objetivo discutir acerca da utilização das ferramentas de Análise de Modo e Efeitos de Falha e sua aplicação na assistência à saúde. Método trata-se de um artigo de reflexão visando à apresentação do formato próprio de aplicação de ambas as ferramentas seguida das suas diferenças de execução nos processos de trabalho. Resultados ambos os modelos possuem a mesma finalidade, sendo direcionados para a detecção de falhas antes mesmo da sua manifestação, auxiliando diretamente na promoção da segurança. A análise do erro, com a participação das equipes e a geração de índices de falhas, repercute no planejamento e na implementação de ações práticas voltadas à segurança do paciente. Conclusão e implicações para a prática embora semelhantes, existem, entre eles, distinções quanto à priorização das falhas para elencar ações práticas corretivas, principalmente no cálculo do Índice de Prioridade de Risco relacionado à gravidade, na probabilidade de ocorrência e na detecção das falhas. Ambas as ferramentas se mostram como importantes aliadas dos gestores de saúde para a detecção de falhas graves que colocam em risco a assistência livre de eventos adversos.

RESUMEN Objetivo discutir el uso de las herramientas de Análisis de Modos y Efectos de Falla y su aplicación en la atención médica. Método este es un artículo de reflexión, con el objetivo de presentar el formato propio de aplicación adecuado para ambas herramientas, seguido de sus diferencias de ejecución en los procesos de trabajo. Resultados ambos modelos tienen el mismo propósito, dirigidos a la detección de fallas incluso antes de su manifestación, ayudando directamente en la promoción de la seguridad. El análisis del error con la participación de los equipos y la generación de tasas de fracaso tiene repercusiones en la planificación e implementación de acciones prácticas dirigidas a la seguridad del paciente. Conclusión e implicaciones para la práctica aunque son similares, existen distinciones con respecto a la priorización de fallas para enumerar acciones correctivas prácticas, principalmente en el cálculo del Índice de Prioridad de Riesgo relacionado con la gravedad, la probabilidad de ocurrencia y la detección de fallas. Se ha demostrado que ambas herramientas son aliadas importantes para los gerentes de salud para la detección de fallas graves que ponen en riesgo la atención libre de eventos adversos.

ABSTRACT Objective to discuss the use of Failure Mode and Effects Analysis tools and their application in health care. Method this is a reflection article, aiming at presenting the proper application format for both tools, followed by their differences in execution in the work processes. Results both models have the same purpose, being directed to the detection of failures even before their manifestation, directly assisting in the promotion of safety. The analysis of the error with the participation of the teams and the generation of failure rates has repercussions on the planning and implementation of practical actions aimed at patient safety. Conclusion and implications for the practice although similar, there are distinctions regarding the prioritization of failures to list practical corrective actions, mainly in the calculation of the Risk Priority Index related to severity, probability of occurrence and failure detection. Both tools are shown to be important allies to health managers for the detection of serious failures that put care free from adverse events at risk.

Practical Tools to Monitor and Evaluate Transition.

The success of transition for children and youth with neurological disorders depends on leadership from the pediatric neurology team to encourage and support the patient's firm knowledge base of the medical condition, gradual acceptance of self-management skills and confident self-advocacy. While the foundations of effective medical transition have been effectively outlined, the challenge remains to translate from principles to practice. The Child Neurology Foundation has published open source, practical guides which are designed to facilitate the ability to structure and monitor the process through adolescence as well as to insure an effective transfer of care to adult providers. In addition, this article provides one hospital;'s efforts to integrate the transition process into the electronic medical record.

Assessing the scalability of innovations in primary care: a cross-sectional study.

BACKGROUND: Canadian health funding currently prioritizes scaling up for evidence-based primary care innovations, but not all teams prepare for scaling up. We explored scalability assessment among primary care innovators in the province of Quebec to evaluate their preparedness for scaling up. METHODS: We performed a cross-sectional survey from Feb. 18 to Mar. 18, 2019. Eligible participants were 33 innovation teams selected for the 2019 Quebec College of Family Physicians' Symposium on Innovations. We conducted a Web-based survey in 2 sections: innovation characteristics and the Innovation Scalability Self-administered Questionnaire. The latter includes 16 criteria (scalability components) grouped into 5 dimensions: theory (1 criterion), impact (6 criteria), coverage (4 criteria), setting (3 criteria) and cost (2 criteria). We classified innovation types using the International Classification of Health Interventions. We performed a descriptive analysis using frequency counts and percentages. RESULTS: Out of 33 teams, 24 participated (72.7%), with 1 innovation each. The types of innovation were management (15/24), prevention (8/24) and therapeutic (1/24). Most management innovations focused on patient navigation (9/15). In order of frequency, teams had assessed theory (79.2%) and impact (79.2%) criteria, followed by cost (77.1%), setting (59.7%) and coverage (54.2%). Most innovations (16/24) had assessed 10 criteria or more, including 10 management innovations, 5 prevention innovations and 1 therapeutic innovation. Implementation fidelity was the least assessed criterion (6/24). INTERPRETATION: The scalability assessments of a primary care innovation varied according to its type. Management innovations, which were the most prevalent and assessed the most scalability components, appear to be most prepared for primary care scale-up in Canada.

Process Mining-Supported Emergency Room Process Performance Indicators.

Emergency room processes are often exposed to the risk of unexpected factors, and process management based on performance measurements is required due to its connectivity to the quality of care. Regarding this, there have been several attempts to propose a method to analyze the emergency room processes. This paper proposes a framework for process performance indicators utilized in emergency rooms. Based on the devil's quadrangle, i.e., time, cost, quality, and flexibility, the paper suggests multiple process performance indicators that can be analyzed using clinical event logs and verify them with a thorough discussion with clinical experts in the emergency department. A case study is conducted with the real-life clinical data collected from a tertiary hospital in Korea tovalidate the proposed method. The case study demonstrated that the proposed indicators are well applied using the clinical data, and the framework is capable of understanding emergency room processes' performance.

Implementing a transdiagnostic sleep and circadian intervention in a community mental health setting: A qualitative process evaluation with community stakeholders.

The implementation of evidence-based psychological treatments (EBPTs) may be particularly challenging to accomplish in community mental health settings for individuals with severe mental illness (SMI). Transdiagnostic treatments, or treatments that target a mechanism that underpins multiple mental health problems, may be particularly well-suited to community mental health settings. This study examines community stakeholder perspectives (N = 22) of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) implemented in a community mental health setting in the context of a randomized controlled trial of TranS-C for SMI. The present study aimed to identify barriers and facilitators to the implementation of TranS-C for SMI in a community mental health setting using (1) a deductive theory-based process based on the Framework for Dissemination in Health Services Intervention Research and (2) an inductive thematic analysis process. All deductive themes were identified as both barriers and facilitators to the implementation of EBPTs and TranS-C in this community mental health setting. Seven additional themes were identified through the inductive thematic analysis. A discussion of how the findings are related to prior research, other EBPT implementation, and future TranS-C implementation are included.

Automatic Process Comparison for Subpopulations: Application in Cancer Care.

Processes in organisations, such as hospitals, may deviate from the intended standard processes, due to unforeseeable events and the complexity of the organisation. For hospitals, the knowledge of actual patient streams for patient populations (e.g., severe or non-severe cases) is important for quality control and improvement. Process discovery from event data in electronic health records can shed light on the patient flows, but their comparison for different populations is cumbersome and time-consuming. In this paper, we present an approach for the automatic comparison of process models that were extracted from events in electronic health records. Concretely, we propose comparing processes for different patient populations by cross-log conformance checking, and standard graph similarity measures obtained from the directed graph underlying the process model. We perform a user study with 20 participants in order to obtain a ground truth for similarity of process models. We evaluate our approach on two data sets, the publicly available MIMIC database with the focus on different cancer patients in intensive care, and a database on breast cancer patients from a Dutch hospital. In our experiments, we found average fitness to be a good indicator for visual similarity in the ZGT use case, while the average precision and graph edit distance are strongly correlated with visual impression for cancer process models on MIMIC. These results are a call for further research and evaluation for determining which similarity or combination of similarities is needed in which type of process model comparison.

The Intervention Scalability Assessment Tool: a pilot study assessing five interventions for scalability.

OBJECTIVES: This study tested the utility of the Intervention Scalability Assessment Tool (ISAT) with real-world interventions considered for scale-up in the Australian context. We explored user perceptions of the usefulness of the ISAT in making scalability decisions and conducted an analysis of completed ISATs. Type of program/service: The ISAT was designed to assist policy makers/practitioners to make structured and reflective assessments of the potential scalability of their interventions. METHODS: Participants (n = 26) were invited via email and needed to be considering a population intervention for scale-up, to be able to pilot the ISAT, and to be willing to complete an online survey to provide feedback. Survey data and completed ISATs were collated and common responses were identified, with exceptions noted. RESULTS: Thirteen participants accepted the invitation to pilot the ISAT; six completed ISATs and returned surveys and five of each were included in the final analysis. The process by which participants completed the ISAT varied, some involving up to six stakeholders in the process and others only one. The time taken to complete the ISAT ranged from 2 hours to 3 days. Interventions considered for scalability were public health interventions and all but one involved a potential statewide scale-up. In terms of outcome, scalability scores across interventions varied, however, all but one intervention was recommended for scale-up. The remaining intervention was deemed to be promising but further information was required before assessing scalability. LESSONS LEARNT: The ISAT was perceived as a useful tool to assess the scalability of real-world health programs, with participants noting only minor limitations and challenges. The ISAT can be applied to a variety of population health interventions and identifies strengths and weaknesses in the evidence base for scale-up. This study revealed that decisions to scale up are often made despite potential weaknesses highlighted through the ISAT. This is likely a reflection of the critically influential role of contextual factors in decisions to scale up, whereby decision makers may balance a variety of considerations, of which evidence of scalability is only one factor.

Facilitating implementation of an evidence-based method to assess the mental health of 3-5-year-old children at Child Health Clinics: A mixed-methods process evaluation.

BACKGROUND: A number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed. METHODS: The mixed-methods process evaluation was guided by Moore et al.'s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses' opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS: Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77-91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period. CONCLUSION: The facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families.