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2.
BMC Health Serv Res ; 19(1): 845, 2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31739783

RESUMO

BACKGROUND: Mathematical modelling has been a vital research tool for exploring complex systems, most recently to aid understanding of health system functioning and optimisation. System dynamics models (SDM) and agent-based models (ABM) are two popular complementary methods, used to simulate macro- and micro-level health system behaviour. This systematic review aims to collate, compare and summarise the application of both methods in this field and to identify common healthcare settings and problems that have been modelled using SDM and ABM. METHODS: We searched MEDLINE, EMBASE, Cochrane Library, MathSciNet, ACM Digital Library, HMIC, Econlit and Global Health databases to identify literature for this review. We described papers meeting the inclusion criteria using descriptive statistics and narrative synthesis, and made comparisons between the identified SDM and ABM literature. RESULTS: We identified 28 papers using SDM methods and 11 papers using ABM methods, one of which used hybrid SDM-ABM to simulate health system behaviour. The majority of SDM, ABM and hybrid modelling papers simulated health systems based in high income countries. Emergency and acute care, and elderly care and long-term care services were the most frequently simulated health system settings, modelling the impact of health policies and interventions such as those targeting stretched and under resourced healthcare services, patient length of stay in healthcare facilities and undesirable patient outcomes. CONCLUSIONS: Future work should now turn to modelling health systems in low- and middle-income countries to aid our understanding of health system functioning in these settings and allow stakeholders and researchers to assess the impact of policies or interventions before implementation. Hybrid modelling of health systems is still relatively novel but with increasing software developments and a growing demand to account for both complex system feedback and heterogeneous behaviour exhibited by those who access or deliver healthcare, we expect a boost in their use to model health systems.


Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Modelos Teóricos , Idoso , Assistência à Saúde/estatística & dados numéricos , Feminino , Programas Governamentais , Política de Saúde , Serviços de Saúde/estatística & dados numéricos , Humanos , Irlanda , Masculino , Assistência Médica , Análise de Sistemas
3.
BMC Health Serv Res ; 19(1): 833, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727073

RESUMO

BACKGROUND: Women and families experiencing socioeconomic and psychosocial adversity are the least likely to access health care but most likely to benefit. For health services to effectively meet the needs of individuals experiencing adversity, research involving the health services must be truly representative. However, individuals experiencing adversity are typically excluded from or underrepresented in health services research. This paper reports on the implementation of a quality improvement approach designed to support recruitment and retention of pregnant women experiencing adversity in a longitudinal, health services randomized controlled trial ("right@home"). METHODS: right@home recruited Australian women from 10 public maternity hospitals across the states of Victoria and Tasmania who were experiencing adversity (≥2 risk factors on screening survey). Regular follow-up assessments were conducted by phone or face-to-face to child age 2 years. Research processes were designed taking heed of previous research demonstrating effective strategies for recruiting and retaining minority groups (e.g. piloting the recruitment process; recruiting via the health service providing care to the subgroup; remunerating participants); however, we were concerned that important information was missing. Therefore, once recruitment began, we conducted a continuous evaluation of the research processes, testing and implementing changes to processes or new strategies to maximize recruitment and retention (e.g. using a suite of strategies to maintain contact with families, using flexible data collection methods, obtaining consent for data linkage for future health and education data). RESULTS: right@home enrolled a large cohort of women (N = 722) experiencing high levels of adversity according to socioeconomic status and psychosocial risk factors, and achieved excellent retention (83% completion at 2 years). Most strategies appeared to increase recruitment and retention. All required additional time from the research team to develop and test, and some required extra funding, which ranged from minor (e.g. printing) to substantial (e.g. salaries, remuneration). CONCLUSIONS: By taking a quality improvement approach, supported by sufficient resourcing and flexible research processes, it is possible to recruit and retain a large cohort of women experiencing adversity who are typically missed or lost from longitudinal research.


Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Serviços de Saúde Materna/organização & administração , Gestantes/psicologia , Feminino , Humanos , Estudos Longitudinais , Gravidez , Melhoria de Qualidade , Apoio Social , Populações Vulneráveis
4.
BMC Health Serv Res ; 19(1): 766, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665004

RESUMO

BACKGROUND: To address deficits in the delivery of acute services in Ireland, the National Acute Medicine Programme (NAMP) was established in 2010 to optimise the management of acutely ill medical patients in the hospital setting, and to ensure their supported discharge to primary and community-based care. NAMP aims to reduce inappropriate hospital admissions, reduce length of hospital stay and ensure patients receive timely treatment in the most appropriate setting. It does so primarily via the development of Acute Medical Assessment Units (AMAUs) for the rapid assessment and management of medical patients presenting to hospitals, as well as streamlining the care of those admitted for further care. This study will examine the impact of this programme on patient care and identify the factors influencing its implementation and operation. METHODS: We will use a multistage mixed methods evaluation with an explanatory sequential design. Firstly, we will develop a logic model to describe the programme's outcomes, its components and the mechanisms of change by which it expects to achieve these outcomes. Then we will assess implementation by measuring utilisation of the Units and comparing the organisational functions implemented to that recommended by the NAMP model of care. Using comparative case study research, we will identify the factors which have influenced the programme's implementation and its operation using the Consolidated Framework for Implementation Research to guide data collection and analysis. This will be followed by an estimation of the impact of the programme on reducing overnight emergency admissions for potentially avoidable medical conditions, and reducing length of hospital stay of acute medical patients. Lastly, data from each stage will be integrated to examine how the programme's outcomes can be explained by the level of implementation. DISCUSSION: This formative evaluation will enable us to examine whether the NAMP is improving patient care and importantly draw conclusions on how it is doing so. It will identify the factors that contribute to how well the programme is being implemented in the real-world. Lessons learnt will be instrumental in sustaining this programme as well as planning, implementing, and assessing other transformative programmes, especially in the acute care setting.


Assuntos
Doença Aguda/terapia , Cuidados Críticos/organização & administração , Pesquisa sobre Serviços de Saúde/métodos , Hospitais , Humanos , Irlanda , Programas Nacionais de Saúde , Avaliação de Programas e Projetos de Saúde
5.
BMJ ; 366: l4563, 2019 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-31405902

RESUMO

OBJECTIVE: To determine any changes in total hospital revisits within 30 days of discharge after a hospital stay for medical conditions targeted by the Hospital Readmissions Reduction Program (HRRP). DESIGN: Retrospective cohort study. SETTING: Hospital stays among Medicare patients for heart failure, acute myocardial infarction, or pneumonia between 1 January 2012 and 1 October 2015. PARTICIPANTS: Medicare fee-for-service patients aged 65 or over. MAIN OUTCOMES: Total hospital revisits within 30 days of discharge after hospital stays for medical conditions targeted by the HRRP, and by type of revisit: treat-and-discharge visit to an emergency department, observation stay (not leading to inpatient readmission), and inpatient readmission. Patient subgroups (age, sex, race) were also evaluated for each type of revisit. RESULTS: Our study cohort included 3 038 740 total index hospital stays from January 2012 to September 2015: 1 357 620 for heart failure, 634 795 for acute myocardial infarction, and 1 046 325 for pneumonia. Counting all revisits after discharge, the total number of hospital revisits per 100 patient discharges for target conditions increased across the study period (monthly increase 0.023 visits per 100 patient discharges (95% confidence interval 0.010 to 0.035)). This change was due to monthly increases in treat-and-discharge visits to an emergency department (0.023 (0.015 to 0.032) and observation stays (0.022 (0.020 to 0.025)), which were only partly offset by declines in readmissions (-0.023 (-0.035 to -0.012)). Increases in observation stay use were more pronounced among non-white patients than white patients. No significant change was seen in mortality within 30 days of discharge for target conditions (-0.0034 (-0.012 to 0.0054)). CONCLUSIONS: In the United States, total hospital revisits within 30 days of discharge for conditions targeted by the HRRP increased across the study period. This increase was due to a rise in post-discharge emergency department visits and observation stays, which exceeded the decline in readmissions. Although reductions in readmissions have been attributed to improvements in discharge planning and care transitions, our findings suggest that these declines could instead be because hospitals and clinicians have intensified efforts to treat patients who return to a hospital within 30 days of discharge in emergency departments and as observation stays.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Unidades de Observação Clínica/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Pesquisa sobre Serviços de Saúde/métodos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Medicare/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Alta do Paciente , Readmissão do Paciente/tendências , Pneumonia/epidemiologia , Pneumonia/terapia , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Estados Unidos/epidemiologia
6.
Yearb Med Inform ; 28(1): 208-217, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31419834

RESUMO

OBJECTIVE: We present a narrative review of recent work on the utilisation of Natural Language Processing (NLP) for the analysis of social media (including online health communities) specifically for public health applications. METHODS: We conducted a literature review of NLP research that utilised social media or online consumer-generated text for public health applications, focussing on the years 2016 to 2018. Papers were identified in several ways, including PubMed searches and the inspection of recent conference proceedings from the Association of Computational Linguistics (ACL), the Conference on Human Factors in Computing Systems (CHI), and the International AAAI (Association for the Advancement of Artificial Intelligence) Conference on Web and Social Media (ICWSM). Popular data sources included Twitter, Reddit, various online health communities, and Facebook. RESULTS: In the recent past, communicable diseases (e.g., influenza, dengue) have been the focus of much social media-based NLP health research. However, mental health and substance use and abuse (including the use of tobacco, alcohol, marijuana, and opioids) have been the subject of an increasing volume of research in the 2016 - 2018 period. Associated with this trend, the use of lexicon-based methods remains popular given the availability of psychologically validated lexical resources suitable for mental health and substance abuse research. Finally, we found that in the period under review "modern" machine learning methods (i.e. deep neural-network-based methods), while increasing in popularity, remain less widely used than "classical" machine learning methods.


Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Processamento de Linguagem Natural , Dados de Saúde Gerados pelo Paciente , Mídias Sociais , Bibliometria , Humanos , Saúde Pública/ética , Vigilância em Saúde Pública/métodos
7.
Health Policy Plan ; 34(8): 625-634, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424494

RESUMO

Standardized patients (SPs), i.e. mystery shoppers for healthcare providers, are increasingly used as a tool to measure quality of clinical care, particularly in low- and middle-income countries where medical record abstraction is unlikely to be feasible. The SP method allows care to be observed without the provider's knowledge, removing concerns about the Hawthorne effect, and means that providers can be directly compared against each other. However, their undercover nature means that there are methodological and ethical challenges beyond those found in normal fieldwork. We draw on a systematic review and our own experience of implementing such studies to discuss six key steps in designing and executing SP studies in healthcare facilities, which are more complex than those in retail settings. Researchers must carefully choose the symptoms or conditions the SPs will present in order to minimize potential harm to fieldworkers, reduce the risk of detection and ensure that there is a meaningful measure of clinical care. They must carefully define the types of outcomes to be documented, develop the study scripts and questionnaires, and adopt an appropriate sampling strategy. Particular attention is required to ethical considerations and to assessing detection by providers. Such studies require thorough planning, piloting and training, and a dedicated and engaged field team. With sufficient effort, SP studies can provide uniquely rich data, giving insights into how care is provided which is of great value to both researchers and policymakers.


Assuntos
Simulação de Paciente , Garantia da Qualidade dos Cuidados de Saúde/métodos , Países em Desenvolvimento , Feminino , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Masculino , Garantia da Qualidade dos Cuidados de Saúde/ética
8.
Surg Infect (Larchmt) ; 20(7): 527-529, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31335255

RESUMO

Background: The expert panel that conducted the Assessing Surgical Site Infection Surveillance Technologies (ASSIST) project elaborates on the key findings of the health technologies assessment (HTA) report in a series of articles addressing topics from workflow challenges to implementation strategies to new big data analytics tailored to incorporate serial patient-generated health data (PGHD). Conclusion: By reporting on the methodology, with an emphasis on stakeholder engagement, the ASSIST investigators provide the basis for a future deep dive into the next phase of PGHD integration into surgical site infection (SSI) surveillance.


Assuntos
Processamento Eletrônico de Dados , Monitoramento Epidemiológico , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Dados de Saúde Gerados pelo Paciente , Período Pós-Operatório , Infecção da Ferida Cirúrgica/diagnóstico , Humanos
9.
Surg Infect (Larchmt) ; 20(7): 588-591, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31347988

RESUMO

Background: Patients increasingly use mobile devices to send text messages and photographic data to surgeons. There is potential to harness this patient-generated health data (PGHD) for clinical and public health surveillance of surgical site infection (SSI). Leveraging PGHD collected via remote monitoring in the post-operative period has the potential to produce important benefits for patients, surgeons, care teams, and infection surveillance and prevention. Methods: We conducted a health technology assessment (HTA), drawing heavily on stakeholder engagement to better understand current and potential uses of PGHD in post-operative care. Stakeholder engagement activities included assembling an advisory board composed of stakeholder experts, interviewing key informants, and seeking out stakeholder guidance to synthesize evidence from interviews, literature review, and technical app review in order to develop recommendations on the use of PGHD in SSI surveillance. Results: We conducted a review of the published literature, a technical/market scan of available apps for capturing post-operative PGHD, and two rounds of key informant interviews with stakeholders. In addition, we held a day-long workshop to solicit stakeholder feedback on initial findings of the project and to guide additional work. These activities culminated in an HTA report that provides guidance and recommendations on the use of PGHD in SSI surveillance, including practice, research, and public health surveillance, and identifies open issues on post-operative use of PGHD for which additional evidence and experience are needed to optimize application of those data for clinical and public health purposes. Conclusion: Stakeholders, individuals with direct experience, or interest in a given topic are critical to the HTA process. They provide insight to guide the work conducted, ensure that the topics addressed are relevant and important, and that products of the work are accessible and meaningful to the individuals who will be most impacted.


Assuntos
Monitoramento Epidemiológico , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Dados de Saúde Gerados pelo Paciente , Participação do Paciente/métodos , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Processamento Eletrônico de Dados , Humanos , Período Pós-Operatório , Participação dos Interessados
10.
Value Health ; 22(7): 808-815, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277828

RESUMO

BACKGROUND: Machine learning is increasingly used to predict healthcare outcomes, including cost, utilization, and quality. OBJECTIVE: We provide a high-level overview of machine learning for healthcare outcomes researchers and decision makers. METHODS: We introduce key concepts for understanding the application of machine learning methods to healthcare outcomes research. We first describe current standards to rigorously learn an estimator, which is an algorithm developed through machine learning to predict a particular outcome. We include steps for data preparation, estimator family selection, parameter learning, regularization, and evaluation. We then compare 3 of the most common machine learning methods: (1) decision tree methods that can be useful for identifying how different subpopulations experience different risks for an outcome; (2) deep learning methods that can identify complex nonlinear patterns or interactions between variables predictive of an outcome; and (3) ensemble methods that can improve predictive performance by combining multiple machine learning methods. RESULTS: We demonstrate the application of common machine methods to a simulated insurance claims dataset. We specifically include statistical code in R and Python for the development and evaluation of estimators for predicting which patients are at heightened risk for hospitalization from ambulatory care-sensitive conditions. CONCLUSIONS: Outcomes researchers should be aware of key standards for rigorously evaluating an estimator developed through machine learning approaches. Although multiple methods use machine learning concepts, different approaches are best suited for different research problems.


Assuntos
Mineração de Dados/métodos , Pesquisa sobre Serviços de Saúde/métodos , Aprendizado de Máquina , Demandas Administrativas em Assistência à Saúde , Tomada de Decisão Clínica , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Modelos Econômicos , Modelos Estatísticos , Indicadores de Qualidade em Assistência à Saúde
11.
Value Health ; 22(7): 816-821, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277829

RESUMO

BACKGROUND AND OBJECTIVES: Common health state valuation methodology, such as time tradeoff (TTO) and standard gamble (SG), is typically applied under several descriptively invalid assumptions, for example, related to linear quality-adjusted life years (QALYs) or expected utility (EU) theory. Hence, the current use of results from health state valuation exercises may lead to biased QALY weights, which may in turn affect decisions based on economic evaluations using such weights. Methods have been proposed to correct responses for the biases associated with different health state valuation techniques. In this article we outline the relevance of prospect theory (PT), which has become the dominant descriptive alternative to EU, for health state valuations and economic evaluations. METHODS AND RESULTS: We provide an overview of work in this field, which aims to remove biases from QALY weights. We label this "the corrective approach." By quantifying PT parameters, such as loss aversion, probability weighting, and nonlinear utility, it may be possible to correct TTO and SG responses for biases in an attempt to produce more valid estimates of preferences for health states. Through straightforward examples, this article illustrates the effects of this corrective approach and discusses several unresolved issues that currently limit the relevance of corrected weights for policy. CONCLUSIONS: Suggestions for research addressing these issues are provided. Nonetheless, if validly corrected health state valuations become available, we argue in favor of using these in economic evaluations.


Assuntos
Custos de Cuidados de Saúde , Pesquisa sobre Serviços de Saúde/métodos , Indicadores Básicos de Saúde , Nível de Saúde , Modelos Teóricos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Tomada de Decisão Clínica , Análise Custo-Benefício , Pesquisa sobre Serviços de Saúde/economia , Humanos , Modelos Econômicos , Formulação de Políticas , Resultado do Tratamento
12.
BMC Med Ethics ; 20(1): 49, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311525

RESUMO

BACKGROUND: An ethics reflection group (ERG) is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments. METHODS: The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. RESULTS: The implementation process was influenced by both structural factors and factors related to clinicians having different values, interests and experiences. Structural barriers and promotors in the process to implement ERG included the following sub-categories: Organizational factors, recruitment and training of ethics facilitators, the deliberation model, planning and recruitment of participants to the ERGs, the support of the ward managers and the project group. Barriers and promotors found among clinicians included the following sub-categories: Expectations and pre-understandings of ERGs, understandings of a physician's job, challenges experienced by ethics facilitators. At the end of the study, when it was decided that the ERGs should be continued, the implementation strategies were remodeled by the participants to meet new challenges. CONCLUSION: The study of ERG implementation identified important structural and professional barriers and promotors that are likely to be relevant to anyone wanting to implement ethics support services across various types of healthcare services.


Assuntos
Comitês de Ética Clínica/organização & administração , Pesquisa sobre Serviços de Saúde/métodos , Ética Clínica , Grupos Focais , Pesquisa sobre Serviços de Saúde/organização & administração , Departamentos Hospitalares/ética , Departamentos Hospitalares/organização & administração , Humanos , Entrevistas como Assunto , Desenvolvimento de Programas
13.
PLoS Negl Trop Dis ; 13(6): e0007514, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31242194

RESUMO

BACKGROUND: The current World Health Organization (WHO) target for the three major soil-transmitted helminth (STH) infections is to reduce prevalence of moderate-to-heavy infections to below 1% by 2020. In terms of monitoring and evaluation (M&E), the current WHO guidelines for control of STHs recommend evaluation of infection levels in school-age children (SAC) after five to six years of preventive chemotherapy (PC), using the standard Kato-Katz faecal smear. Here, we assess the predictive performance of various sampling designs for the evaluation of the morbidity target. METHODOLOGY/PRINCIPAL FINDINGS: Using two mathematical models for STH transmission and control, we simulate how the number of villages and SAC sampled affect the ability of survey results in sentinel villages to predict the achievement of the morbidity target in PC implementation units (e.g. districts). As PC is stopped when the prevalence of infection in SAC in sentinel villages is less than 1%, we estimate the positive predictive value (PPV) of this indicator for meeting the morbidity target in the whole district. The PPV varies by species and PC strategy, and it is generally higher in areas with lower pre-control prevalence. Sampling a fixed number of SAC spread out over 10 instead of 5 sentinel villages may increase the PPV by up to 20 percentage points. If every SAC in a village is tested, a higher number of villages may increase the PPV by up to 80 percentage points. Increasing the proportion of SAC tested per village does not result in a relevant increase of PPV. CONCLUSIONS/SIGNIFICANCE: Although the WHO guidelines provide a combined strategy to control the three STH species, the efficacy of PC strategies clearly differs by species. There is added value in considering more villages within implementation units for M&E of morbidity targets, the extent varying by STH species. A better understanding of pre- and post-control local STH prevalence levels is essential for an adequate M&E strategy including the definition of morbidity targets at the appropriate geographical scale.


Assuntos
Anti-Helmínticos/uso terapêutico , Quimioprevenção/métodos , Controle de Doenças Transmissíveis/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Pesquisa sobre Serviços de Saúde/métodos , Helmintíase/diagnóstico , Helmintíase/prevenção & controle , Adolescente , Criança , Pré-Escolar , Feminino , Helmintíase/epidemiologia , Humanos , Masculino
14.
Nurse Educ Pract ; 38: 59-65, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31176910

RESUMO

A period of re-negotiation is expected when introducing a new teaching and learning approach in a Bachelor of Nursing course. This study, underpinned by a social constructivist framework, used action research to uncover the interactions, challenges and outcomes when implementing an inquiry-based learning approach to support the development of students' clinical reasoning and capability to think like a nurse. Data collection involved non-participant observation of 32 tutorial groups (600 first-year students and 8 teachers) over the first two weeks of semester. Analysis was informed by Charmaz's social constructivist approach. The findings revealed three interconnected constructs: Opting in and out (students), Driving and reframing (teachers) and Creating and realising new understandings (both students and teachers). Introducing a new approach necessitated conscious planning and deliberate behaviour change on behalf of the teacher and student. Use of an inquiry-based learning approach which embedded clinical reasoning, investigative prompts and learning scaffolds in the form of case exemplars assisted students to 'think like a nurse'.


Assuntos
Bacharelado em Enfermagem/métodos , Estudantes de Enfermagem/psicologia , Pensamento , Currículo , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Aprendizagem , Aprendizagem Baseada em Problemas/métodos , Pesquisa Qualitativa , Pesquisa
15.
Osteoporos Int ; 30(9): 1779-1788, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31190123

RESUMO

The purpose of this study was to assess the performance of our Fracture Liaison Service (FLS) over a period of 2 years. Osteoporosis medication was prescribed for 243 patients, and zoledronic acid was the main drug prescribed (60.2%). INTRODUCTION: A Fracture Liaison Service (FLS) was implemented at Lille University Hospital in 2016. The main purpose of this study was to assess the performance of the FLS using criteria proposed by the International Osteoporosis Foundation (IOF). METHODS: The criteria used were patient identification, patient evaluation, post-fracture assessment timing, vertebral-fracture identification, blood and bone mineral density (BMD) testing, falls prevention, multifaceted health and lifestyle risk-factor assessment, and medication initiation and review. RESULTS: Between January 2016 and January 2018, 736 patients (≥ 50 years old) with a recent history of fragility fracture (≤ 12 months) were identified. The identification rate for hip fractures was 74.2%. However, patient evaluation for all type of fractures was quite low (30.3%) since many patients failed to attend the FLS unit. The reasons for non-attendance were refusal, agreed but subsequently failed to attend, and still waiting to be seen. In all, 256 patients (76.6% female, mean (SD) age 74.3 (11.0) years) were seen at the FLS. Mean (SD) post-fracture assessment timing was 13.3 (9.3) weeks. Of the 139 patients seen for a non-vertebral fracture, 103 were assessed for vertebral fractures, and at least one new vertebral fracture was found in 45 of them (43.7%). Osteoporosis medication was prescribed for 243 (94.9%) patients. The main osteoporosis drug prescribed was zoledronic acid (60.2%). CONCLUSIONS: Secondary prevention of osteoporotic fractures has improved since the implementation of the FLS. However, patient identification, patient evaluation, and post-fracture assessment timing still need to be improved.


Assuntos
Fraturas por Osteoporose/prevenção & controle , Prevenção Secundária/métodos , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/uso terapêutico , Comunicação , Procedimentos Clínicos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/normas , Feminino , França/epidemiologia , Pesquisa sobre Serviços de Saúde/métodos , Hospitais Universitários/organização & administração , Hospitais Universitários/normas , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Pacientes não Comparecentes/estatística & dados numéricos , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Medição de Risco/métodos , Prevenção Secundária/organização & administração , Prevenção Secundária/normas
16.
Womens Health Issues ; 29 Suppl 1: S121-S130, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31253236

RESUMO

INTRODUCTION: Sex- and gender-specific science is essential to inform patient-centered, evidence-based care. Developing such evidence requires adequate inclusion of both women and men in trials. We sought to describe study participation of women and men in Department of Veterans Affairs Health Services Research and Development trials. METHODS: We identified recent health services research trials from one Health Services Research and Development Center of Innovation and compared the participation of women and men from trial recruitment to study completion. We also calculated the participation to prevalence ratio (PPR) by sex for each trial. RESULTS: We included eight trials that started recruitment between 2011 and 2014. Only one study purposefully attempted to boost the recruitment of women. Overall, the PPR for women ranged from 0.2 to 4.5, with seven studies having a PPR of greater than 1, indicating that women participated in these trials at proportions greater than their prevalence in the disease population within the Department of Veterans Affairs. The PPR for men ranged from 0.8 to 1.1. Retention was best with those studies that used administrative data for final outcomes assessment. No studies provided results stratified by sex or conducted analyses to explore treatment effect by sex. CONCLUSIONS: At a single site, women participated in Health Services Research and Development trials at similar or greater rates to men without cross-study efforts to enrich the recruitment or retention of women. Adding strategic recruitment approaches could further boost the proportion of women in Department of Veterans Affairs trials and enable adequately powered sex-based analyses.


Assuntos
Ensaios Clínicos como Assunto/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde/métodos , Seleção de Pacientes , Adulto , Feminino , Humanos , Masculino , Fatores Sexuais , Estados Unidos , United States Department of Veterans Affairs , Adulto Jovem
17.
PLoS One ; 14(5): e0216303, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31042782

RESUMO

OBJECTIVES: To identify a broad range of research priorities to inform the studies seeking to improve population health outcomes based on the engagement of diverse stakeholders. METHODS: A multi-step, participatory and mixed-methods approach was adopted to solicit and structure the investigative themes from diverse stakeholders. The priority setting exercise involved four key phases: (1) feedback from community leadership; (2) interim ranking survey and focus group discussions during the population health symposium; (3) individual in-depth interviews with stakeholders in the community; and (4) synthesis of the research priorities from the multistep process. RESULTS: Diverse stakeholders in Singapore, comprising community partnership leaders, health care and social service providers, users of population health services, patients and caregivers, participated in the research priority setting exercise. Initial 14 priorities were identified from six community leadership feedback, 42 survey responses, two focus groups (n = 16) and 95 in-depth interviews. The final integrated research agenda identified six priorities: empower residents and patients to take charge of their health; improve care transition and management through relationship building and communication; enhance health-social care interface; improve respite care services for long-term caregivers; develop primary care as a driving force for care integration; and capacity building for service providers. Selected research questions in each priority area were also generated to develop novel models of care, foster collaboration, implement optimal services and enhance understanding of the end users' care needs. CONCLUSIONS: This study illuminates that greater community engagement in research priority setting for population health can facilitate the formulation of evidence-based research agendas that matter to the care providers and service users in the community. The outcomes derived from this exercise will help focus researchers' efforts through which meaningful gains can be made for population health.


Assuntos
Serviços de Saúde Comunitária/métodos , Prioridades em Saúde , Pesquisa sobre Serviços de Saúde/métodos , Saúde da População , Grupo com Ancestrais do Continente Asiático , Grupos Focais , Humanos , Singapura , Inquéritos e Questionários
20.
Top Stroke Rehabil ; 26(5): 399-404, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31038012

RESUMO

Stroke caregivers represent a distinct population and require unique considerations when conducting intervention research. Unfortunately, there are few published recommendations for conducting intervention trials with stroke caregivers. Thus, the goal of this paper is to provide foundational guidance for stroke caregiving researchers. We describe lessons learned from three trials of the RESCUE intervention to illustrate methodological issues in stroke caregiver research. We identify challenges encountered while conducting a clinical demonstration project, pilot study, and multi-site randomized controlled trial of a problem-solving and skills-building stroke caregiver intervention. We use our research experiences to exemplify or enhance understanding of each issue and describe the strategies we employed to overcome these obstacles. We present issues related to and recommendations for study design, theoretical frameworks, eligibility criteria, recruitment and retention, human subjects protection, intervention design, treatment fidelity, outcome measures, and qualitative methods. Identifying approaches to circumvent methodological challenges can help advance research on and implementation of stroke caregiver programs.


Assuntos
Cuidadores/psicologia , Depressão/terapia , Pesquisa sobre Serviços de Saúde , Psicoterapia/normas , Projetos de Pesquisa , Estresse Psicológico/terapia , Acidente Vascular Cerebral/enfermagem , Adulto , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/normas , Humanos , Projetos Piloto , Guias de Prática Clínica como Assunto/normas , Projetos de Pesquisa/normas
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