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Cohort profile for the creation of the SAIL MELD-B e-cohort (SMC) and SAIL MELD-B children and Young adult e-cohort (SMYC) medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-22 Roberta Chiovoloni, Jakub Dylag, Nisreen A Alwan, Ann Berrington, Michael Boniface, Nic Fair, Emilia Holland, Rebecca B Hoyle, Mozhdeh Shiranirad, Sebastian Stannard, Zlatko Zlatev, Rhiannon K Owen, Simon DS Fraser, Ashley Akbari
Purpose We have established the SAIL MELD-B electronic cohort (e-cohort SMC) and the SAIL MELD-B children and Young adults e-cohort (SMYC) as a part of the Multidisciplinary Ecosystem to study Lifecourse Determinants and Prevention of Early-onset Burdensome Multimorbidity (MELD-B) project. Each cohort has been created to investigate and develop a deeper understanding of the lived experience of the
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Exploring the Effectiveness of PAC Rehabilitation for the Patients with Traumatic Brain Injury: A Retrospective Study medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-21 Ju-Lan Yang, Ying-Lin Hsu, Chih-Ming Lin, Ruoh-Lih Lei
Background According to a report from the World Health Organization, traumatic brain injury (TBI) will surpass many diseases by 2020 and become the main cause of death and disability. Therefore, post-acute care (PAC) is immediately given active integrated care during the golden period of post-acute care to restore its function, which will reduce the medical expenses of subsequent rehospitalization
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An analysis of humanitarian and health aid harmonisation over a decade (2011-2019) of the Syrian conflict medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-19 Munzer Alkhalil, Abdulkarim Ekzayez, Kristen Meagher, Maher Alaref, Rim Turkmani, Aula Abbara, Zedoun Alzoubi, Nassim El Achi, Preeti Patel
Introduction Aid harmonisation is a key component of donor efforts to make aid more effective by improving coordination and simplifying and sharing information to avoid duplication. This study evaluates the harmonisation of health and humanitarian aid in Syria during acute humanitarian and health crises from 2011 to 2019.
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Enhancing system empathy within a UK Emergency Department: A feasibility interprofessional priority setting exercise medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-16 Jeremy Howick, Andy Ward, Charlotte Grantham, Amber Bennett-Weston
Background System-level barriers inhibit empathy in healthcare, and this can harm patients and practitioners. The barriers include burnout-inducing administrative workloads, burdensome protocols, lack of wellbeing spaces, un-empathic leadership, and not emphasising empathy as an institutional value. A workshop aimed at enhancing empathic systems was successfully delivered in Canada but has not been
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The Development of a Brain Injury Survivor Patient and Public Involvement Group by a Brain Injury Survivor medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-16 James Piercy, Colin Hamilton, Robert Runcie, Christi Deaton, Alexis J Joannides
Background Patient and public involvement (PPI) in research is seen as key to ensuring applicability and impact. Undertaking PPI in people after brain injury has long been seen to be a challenge. In 2020 The NIHR Brain Injury MedTech Cooperative developed a programme with the aim of improving PPI involvement, impact and diversity in this population.
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Socioeconomic and demographic patterning of family uptake of a paediatric electronic patient portal innovation medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-15 Ameenat Lola Solebo, Lisanne Horvat-Gitsels, Christine Twomey, Siegfried Karl Wagner, Jugnoo S Rahi
Introduction Patient portals allowing access to electronic health care records and services can inform and empower, but may widen existing sociodemographic inequities. We aimed to describe associations between activation of a paediatric patient portal and patient race/ethnicity, socioeconomic status and markers of previous engagement with health care.
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The development of the gynecologic oncology pathway “VivaPathway GT“ – a qualitative study about the transformation from an implicit to an explicit, evidence-based clinical pathway in a Berlin-based tertiary care hospital medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-15 Anne Büscher, Nicolle Reinhold, Joachim Kugler
Introduction Standardization in healthcare is crucial for comprehensive patient care, as emphasized by the WHO and quality management principles. Clinical pathways offer a structured approach to describing essential processes, particularly relevant in gynecologic oncology care. Despite their proven benefits, pathways remain underutilized, highlighting the need for explicit translation of implicit pathways
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Stage-aware Brain Graph Learning for Alzheimer’s Disease medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-15 Ciyuan Peng, Mujie Liu, Chenxuan Meng, Sha Xue, Kathleen Keogh, Feng Xia
Current machine learning-based Alzheimer’s disease (AD) diagnosis methods fail to explore the distinctive brain patterns across different AD stages, lacking the ability to trace the trajectory of AD progression. This limitation can lead to an oversight of the pathological mechanisms of AD and suboptimal performance in AD diagnosis. To overcome this challenge, this paper proposes a novel stage-aware
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Resources to Aid Ethical Review of Clinical Studies: An Exploratory Scoping Review Identifying Gaps and Opportunities medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-15 Merle-Marie Pittelkow, Daniel Strech
Background Research Ethics Committees (RECs) review the ethical, legal, and methodological standard of clinical research. However, complying with all requirements and professional expectations while maintaining the necessary scientific and ethical standards can be challenging for applicants and members of the REC alike. There is a need for accessible guidelines and resources to help medical researchers
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A health systems analysis of non-compliance to the maternity referral system by health facilities in Uganda: Findings from a mixed-methods study medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-09 Henry Zakumumpa, Caroline Kyozira, Martin Bulamu, Remmy Buhuguru
Introduction A fully functional referral system is central to achieving quality maternal and newborn care. In 2018, Uganda established Kawempe National Referral hospital (KRNH) as the highest level of care for maternity services. There is a dearth of data examining if the referral function for which it was established has been met. The objectives of this study were two fold; i) to assess the appropriateness
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“It’s not about the money, money” - Well, actually it is. Divergent views on drivers of early phase clinical trial participation among ethnically diverse potential trial participants in the United Kingdom: A Mixed Methods Study medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-05 Pilar Artiach Hortelano, Neil Morton, Paul Wicks, Michael Young, Rebecca Burdell, Duncan Richards
Background Novel therapeutics should always be tested in a sample representative of the population in need of treatment. Initial efforts of drug development take place in early phase trials (phase-I and -II), setting the direction for late-stage studies (phase-III and -IV). However, study samples in early phase trials typically fail to recruit Black, Asian and minority ethnic groups, which might produce
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DOES QUALITY OF COUNSELING AND EXPOSURE TO FAMILY PLANNING MESSAGES INFLUENCE THE USE OF MODERN CONTRACEPTIVES AMONG WOMEN IN NORTHERN NIGERIA? medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-03 Matthew Alabi, Leanne Dougherty, Eno-Obong Etim, Adebola Adedimeji
Background Family Planning Counselling (FPC) involves information exchange on contraceptive methods between a provider and client and providing appropriate support in choosing a method that best suits the client’s needs. Access to sexual and reproductive health information enables women to make informed health decisions. However, the low modern contraceptive prevalence among women in northern Nigeria
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A simple mathematical model and physical device to estimate a woman-specific probability of skilled birth assistance and associated benefit of maternity waiting home stay medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-03 Jérémie Gallien, George Chen, Yi Zhang, Yuhang Du, Jody Lori, Joseph Sieka, Bentoe Tehoungue
This paper presents a simple mathematical model and an associated physical device to predict (i) the risk that a woman’s active labor will begin without a skilled birth attendant based on her parity and anticipated time to access skilled care; and (ii) the extent to which that risk may be reduced by moving to a maternity waiting home some time before her expected due date. This tool is designed to
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Addressing unmet social needs using a health navigator for patients at a major metropolitan hospital in Australia: a mixed-methods feasibility study medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-03 K Neadley, C Shoubridge, A Smith, S Martin, M Boyd, C Hocking
Introduction Integrating health and social care to address unmet social needs is an emerging priority for health systems worldwide. Screening and referral interventions for unmet social needs in healthcare settings have shown promising results. Most screening and referral interventions are implemented in primary care, despite evidence that disadvantaged populations face substantial barriers to accessing
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Maternal health in rural Pakistan: An analysis of knowledge and practices of antenatal care using the socio-ecological model medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-04-01 Nadia Agha, Rahim Dad Rind, Shoukat Ali Mahar, Moomal Mendhri Channa, Fizza Ansar, Sadiq Bhanbhro
Background Pakistan carries a heavy burden of maternal and child health vulnerabilities. Maternal health can be prevented with culturally specific interventions and women’s enhanced access to healthcare facilities, yet women in rural areas in Pakistan are deprived of such interventions. In this study, we assessed the prevalent knowledge and practices of antenatal care and the impact of low- income
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Through the patients’ eyes - Psychometric evaluation of the 64-item version of the Experienced Patient-Centeredness Questionnaire (EPAT-64) medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-29 Eva Christalle, Stefan Zeh, Hannah Führes, Alica Schellhorn, Pola Hahlweg, Jördis Zill, Martin Härter, Carsten Bokemeyer, Jürgen Gallinat, Christoffer Gebhardt, Christina Magnussen, Volkmar Müller, Katharina Schmalstieg-Bahr, André Strahl, Levente Kriston, Isabelle Scholl
Background Patient-reported experience measures (PREMs) are valuable tools for evaluating patient-centeredness (PC) from the patients’ perspective. Despite their utility, a comprehensive PREM addressing PC has been lacking. To bridge this gap, we developed the preliminary version of the Experienced Patient-Centeredness Questionnaire (EPAT), a disease-generic tool based on the integrative model of PC
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Understanding the impact of antenatal care policies in Georgia (USA) and Scotland (UK): A textual synthesis medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-22 Joanna Shim, Valery Burnett, Marlo Vernon, Fiona Work, Ivie Uwaifo, Chadburn Ray, Preethi Reddi
Objectives: This study aims to (1) understand the role of policy in maternal health outcomes, and (2) establish any differences or similarities between health systems, providing benchmarks for future maternal and infant care policies in Georgia and Scotland. Methods: Guided by JBI methodology, a textual review of policies and public health interventions that have influenced the antenatal care process
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Implementation of Virtual Reality Pain Alleviation Therapeutic into Routine Pediatric Clinical Care: Experience and Perspectives of Stakeholders medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-21 Helen Girin, Megan Armstrong, Kim A. Bjorklund, Christopher Murphy, Julie B. Samora, Jonathan Chang, Daniel J. Scherzer, Henry Xiang
Aims To determine the feasibility of implementing virtual reality (VR) in three pediatric clinical environments during brief, painful procedures outside of research.
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The role of telemedicine towards improved sustainability in health care and societal productivity in Turkey medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-21 Figen Özen, Alptug H. Kaynar, A. Kubilay Korkut, Melike Elif Teker Açıkel, Z. Dilsun Kaynar, A. Murat Kaynar
The COVID-19 pandemic increased utilization of telemedicine for diagnosis and treatment. While telemedicine is not the panacea for the increasing health care burden, it can alleviate the problem. Here, the hypothetical impact of delivering telehealth care to patients in a busy tertiary cardio-vascular clinic in Istanbul, Turkey, is examined. Additionally, the potential environmental and societal ramifications
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“…but I know something’s not right here”: Exploring the diagnosis and disclosure experiences of persons living with ALS medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-19 Kathleen M. Foldvari, Paul Stolee, Elena Neiterman, Veronique M. Boscart, Catherine Tong
Background: Amyotrophic Lateral Sclerosis (ALS), an incurable motor neuron disease, primarily affects those between the ages of 60-79, and has an approximate post-diagnosis life--expectancy of only two to five years. The condition has an unpredictable but ultimately terminal trajectory that poses a number of challenges for patients, caregivers and healthcare providers. While the diagnosis and disclosure
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A Survey on Optimization and Machine -learning-based Fair Decision Making in Healthcare medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-18 Zequn Chen, Wesley J. Marrero
Background. Unintended biases introduced by optimization and machine learning (ML) models are of great interest to medical professionals. Bias in healthcare decisions can cause patients from vulnerable populations (e.g., racially minoritized, low-income) to have lower access to resources, exacerbating societal unfairness. Purpose. This review aims to identify, describe, and categorize literature regarding
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Identifying barriers and potential solutions to improve equitable access to community eye services in central Kenya: a rapid exploratory sequential mixed methods study medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-15 Luke Allen, Sarah Karanja, Michael Gichangi, Cosmas Bunywera, Emmaculate Muturi, Dickson Gachobi, Purity Kathure, Elizabeth Mutile Muasa, Lorna Mutwiri, Lorna Kajuju, Faith Kagwiria, Benjamin Ntabathia, Hillary Rono, David Macleod, Min Jung Kim, Malebogo Tlhajoane, Matthew J Burton, Jacqueline Ramke, Nigel M Bolster, Andrew Bastawrous
Background: Recent research has found that less than half of people identified with an eye problem in Meru countys screening programme were able to access care, with younger adults being the least likely to receive the care they needed. We aimed to interview and survey members of this "left-behind" group to explore barriers and identify potential solutions using a rapid mixed-methods approach. Methods:
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Comparison of causes of stillbirth and child deaths as determined by verbal autopsy and minimally invasive tissue sampling medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-14 Nega Assefa, Anthony Scott, Lola Madrid, Merga Dheresa, Gezahegn Mengesha, Shabir Mahdi, Sana Mahtab, Ziyaad Dangor, Nellie Myburgh, Lesego Kamogelo Mothibi, Samba O. Sow, Karen L. Kotloff, Milagritos D. Tapia, Uma U. Onwuchekwa, Mahamane Djiteye, Rosauro Varo, Inacio Mandomando, Ariel Nhacolo, Charfudin Sacoor, Elisio Xerinda, Ikechukwu Ogbuanu, Solomon Samura, Babatunde Duduyemi, Alim Swaray-Deen
Background: In resource-limited settings where vital registration and medical death certificates are unavailable or incomplete, verbal autopsy (VA) is often used to attribute causes of death (CoD), identify the distribution and trends of diseases, and prioritize resource allocation and interventions. However, VA findings can be non-specific, as this tool is based on family members’ recall of symptoms
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The PRIME-NL study: evaluating a complex healthcare intervention for people with Parkinson's disease in a dynamic environment medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-13 Bart R. Maas, Robin van den Bergh, Sanne W. van den Berg, Eveline Hulstein, Niek Stadhouders, Patrick P.T. Jeurissen, Nienke M. de Vries, Bastiaan R. Bloem, Marten Munneke, Yoav Ben-Shlomo, Sirwan K.L. Darweesh
Background: An innovative, integrative care model for people with Parkinson (PRIME Parkinson) has gradually been implemented in a selected region of the Netherlands since 2021. A prospective evaluation of this model (PRIME-NL study) was initiated in parallel, spanning the year prior to implementation (baseline) and the implementation period. Following publication of the original study protocol, the
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Effectiveness of a chatbot in improving the mental wellbeing of health workers in Malawi during the COVID-19 pandemic: A randomized, controlled trial medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-11 Eckhard Kleinau, Tilinao Lamba, Wanda Jaskiewicz, Katy Gorentz, Ines Hungerbuehler, Donya Rahimi, Demoubly Kokota, Limbika Maliwichi, Edister Jamu, Alex Zumazuma, Mariana Negrao, Raphael Mota, Yasmine Khouri, Michael Kapps
We conducted a randomized, controlled trial (RCT) to investigate our hypothesis that the interactive chatbot, Vitalk, is more effective in improving mental wellbeing and resilience outcomes of health workers in Malawi than the passive use of Internet resources. For our 2-arm, 8-week, parallel RCT (ISRCTN Registry: trial ID ISRCTN16378480), we recruited participants from 8 professional cadres from public
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Factors supporting the primary care physicians' performance in Benin: a multiple case study medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-09 Kefilath Bello, Jan De Lepeleire, Djimon Marcel Zannou, Bart Criel
Introduction In Benin, as in many African countries, there is a gradual increase in physicians practising at the primary care level. A literature review showed that these primary care physicians (PCPs) have great potential for improving the quality of care. However, several conditions are necessary for this potential to be unlocked and for the PCPs to contribute effectively to strengthen their local
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Identifying barriers and potential solutions to improve equitable access to community eye services in Botswana, India, Kenya, and Nepal: a rapid exploratory sequential mixed methods study protocol medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-08 Luke Allen, Sarah Karanja, Michael Gichangi, Sailesh Kumar Mishra, Shalinder Sabherwal, Keneilwe Motlhatlhedi, Oathokwa Nkomazana, David Macleod, Min Kim, Jacqueline Ramke, Bakgaki Ratshaa, Malebogo Tlhajoane, Ari Ho-Foster, Nigel M. Bolster, Abhishek Roshan, Mohd Javed, Matthew J. Burton, Andrew Bastawrous
Introduction Evidence suggests that certain groups face substantial barriers to accessing eye care services. This study seeks to explore barriers and potential solutions as perceived by members of the population groups who are least able to access care in the context of four national eye screening programmes. We aim to use rapid yet robust mixed methods that allow us to identify generalisable findings
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Shared Medical Appointments in Heart Failure For Post-hospitalization Follow-up: A Randomized Controlled Trial medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-07 Tracey H Taveira, Lisa B. Cohen, Sharon LaForest, Karen Oliver, Melanie Parent, Renee Hearns, Sherry Ball, sandesh dev, Wen-Chih Wu
Background: Shared medical appointments (SMAs) in heart failure (HF) are medical visits where several patients with HF meet with multidisciplinary providers at the same time for efficient and comprehensive care. It is unknown whether HF-SMAs can improve overall and cardiac health status for high-risk patients discharged with HF. Methods: A 3-site, open-label, randomized-controlled-trial was conducted
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Assessing Patient Satisfaction in Ibadan South-west Region of Oyo State, Nigeria medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-06 Abel Chukwuemeka, Folahanmi Akinsolu, Marylyn Adekola, Mobolaji Olagunju, Olunike Abodunrin, Ifeoluwa Adewole, Oluwabukola Ola, Oliver Ezechi
Introduction Patient satisfaction plays a critical role in healthcare service delivery. Despite growing studies, patient satisfaction levels are still widely under-reported in Nigeria. This study assessed patient satisfaction among patients in primary and secondary healthcare facilities in Ibadan Southwest local government area of Oyo State, Nigeria. Method and Materials In this cross-sectional study
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A protocol for the comparison of telephone and in-person interview modalities: duration, richness, and costs in the context of exploring determinants of equitable access to community health services in Meru, Kenya medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-03-04 Luke N Allen, Sarah Karanja, Malebogo Tlhajoane, John Tlhakanelo, David Macleod, Andrew Bastawrous
Background: Our research team is conducting phenomenological interviews with people who have not been able to access health services in Meru County, Kenya, aiming to explore the barriers they face and their perceptions of how we could modify our community outreach services to improve accessibility. We plan to conduct an embedded study that compares in-person and telephone interview modalities in terms
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Protocol for an individual-level, two arm, superiority RCT within an adaptive platform trial: Enhanced patient counselling and SMS reminder messages to improve access to community-based eye care services in Meru, Kenya medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-29 Luke Allen, Min Kim, Michael Gichangi, David Macleod, James Carpenter, Malebogo Tlhajoane, Sarah Karanja, Nigel Bolster, Matthew Burton, Andrew Bastawrous
Background The Vision Impact Project (VIP) is a major community-based eye screening programme running in Kenya with the aim of promoting eye health for all. Previous studies embedded within the programme in Meru County have found that a third of people who are screened require care for an eye problem, however only half of these people manage to access outreach treatment clinics. Access varies between
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A Novel Artificial Intelligence Platform to Automate Clinical Consultation Notes and Enhance Diagnostic Efficiency in the Outpatient Clinic: Proposal of a Protocol for a Multi-Center, Multi-Disciplinary, Prospective Randomized Controlled Trial medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-29 Karanvir Gill, Giovanni Cacciamani, Jamal Nabhani, Joshua Corb, Tom Buchanan, Daniel Park, Virinder Bhardwaj, Onkarjit Marwah, Moses Kim, Deepak Kapoor, Alexander Kutikov, Robert Uzzo, Inderbir Gill
Presented herein is a proposal for a protocol for a multi-center, multi-disciplinary randomized controlled trial (RCT) to evaluate a novel artificial intelligence (AI)-based technology that automates the construction of the clinical consultation note (CCN) and enhances diagnostic assessments in the outpatient clinic setting. This innovative tech-platform automatically generates the CCN and presents
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Assessment of Technical Efficiency in the Moroccan Public Hospital Network: Using the DEA Method medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-29 Er-Rays Youssef, M’dioud Meriem
Background The public hospital network in Morocco plays a crucial role in providing healthcare services. However, this network faces challenges in terms of technical efficiency in healthcare management.
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Healthcare Consumers’ Perceptions of Incentive-Linked Prescribing: A Scoping Review of Research medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-28 Muhammad Naveed Noor, Haider Safdar Abbasi, Nina Van Der Mark, Zahida Azizullah, Janice Linton, Afifah Rahman-Shepherd, Amna Rehana Siddiqui, Mishal S. Khan, Rumina Hasan, Sadia Shakoor
Incentive-linked prescribing (ILP) is considered a controversial practice universally. If incentivised, physicians may prioritise meeting pharmaceutical sales targets through prescriptions, rather than considering patients' health and wellbeing. Despite the potential harms of ILP to patients and important stakeholders in the healthcare system, healthcare consumers (HCCs) which include patients and
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Reconsider photoplethysmogram signal quality assessment in the free living environment medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-28 Yan-Wei Su, Chia-Cheng Hao, Gi-Ren Liu, Yuan-Chung Sheu, Hau-Tieng Wu
Background: Assessing signal quality is crucial for biomedical signal processing, yet a precise mathematical model for defining signal quality is often lacking, posing challenges for experts in labeling signal qualities. The situation is even worse in the free living environment. Method: We advocate a reconsideration of the concept of signal quality. Result: We demonstrate the necessity of this reconsideration
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Open Science Practices Among Authors Published in Complementary, Alternative, and Integrative Medicine Journals: An International, Cross-Sectional Survey medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-27 Jeremy Y. Ng, Brenda Lin, Liliane Kreuder, Holger Cramer, David Moher
Background: Open science practices aim to increase transparency in research and increase research availability through open data, open access platforms, and public access. Due to the increasing popularity of complementary, alternative, and integrative medicine (CAIM) research, our study aims to explore current open science practices and perceived barriers among CAIM researchers in their own respective
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Telemedicine's Impact on Diabetes Care during the COVID-19 Pandemic: A Cohort Study in a Large Integrated Healthcare System medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-27 Reysha Patel, Jie Huang, Loretta Hsueh, Anjali Gopalan, Andrea Millman, Isabelle Franklin, Mary Reed
Introduction To examine if patients exposed to primary care telemedicine (telephone or video) early in the COVID-19 pandemic had higher rates of downstream HbA1c measurement and improved HbA1c levels in the second year of the pandemic. Research Design and Methods In a cohort of 242, 848 Kaiser Permanente Northern California patients with diabetes, we examined associations between early-pandemic patient-initiated
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A systematic scoping review of studies describing human factors, human-centered design, and usability of sensor-based digital health technologies medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-24 Animesh Tandon, Bryan Cobb, Jacob Centra, Elena Izmailova, Nikolay V Manyakov, Samantha McClenahan, Smit Patel, Emre Sezgin, Srinivasan Vairavan, Bernard Vrijens, Jessie P Bakker
Background: Increasing adoption of sensor-based digital health technologies (sDHTs) in recent years has cast light on the many challenges in implementing these tools into clinical trials and patient care at scale across diverse patient populations; however, the methodological approaches taken towards sDHT usability evaluation have varied markedly. Objective: To elucidate the current landscape of studies
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Implementation of a shared decision making process for severe stroke-a mixed methods study medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-23 Akila Visvanathan, Sarah Morton, Allan MacRaild, Polly Black, Sophie Gilbert, Mark Barber, Martin Dennis, Richard O'Brien, Gillian E Mead
Clinical decisions made early after stroke can make the difference between survival with disability or death. We aimed to develop, implement and evaluate a new Shared decision making (SDM) process for severe stroke into a regional 36 bedded stroke unit. We developed the process through four coproduction workshops, attempted its implementation then its impact on death at 6 months, discharge destination
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Factors Influencing Smartwatch Use and Comfort with Health Data Sharing: A Sequential Mixed-Methods Study Protocol medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-23 Anthony J Goodings, Kayode Philip Fadahunsi, Derjung Mimi Tarn, Patrick Henn, Frances Shiely, John O'Donoghue
Introduction Smartwatches have become ubiquitous for tracking health metrics. These data sets hold substantial potential for enhancing healthcare and public health initiatives; it may be used to track chronic health conditions, detect previously undiagnosed health conditions, and better understand public health trends. By first understanding the factors influencing one's continuous use of the device
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Evaluating the Financial Factors Influencing Maternal, Newborn, and Child Health in Africa medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-23 Youssef Er-Rays, Meriem M'dioud
The study investigated the impact of healthcare system efficiency on the delivery of maternal, newborn, and child services in Africa. Data Envelopment Analysis and Tobit regression were employed to assess the efficiency of 46 healthcare systems across the continent, utilizing the Variable Returns to Scale model with Input orientation to evaluate technical efficiency. The Tobit method was utilized to
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A Drift-Oriented Adaptive Framework for Concept Drift Detection in Large-Scale Internet-of-Medical-Things Data Streams medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-20 Vikash Chander Maheshwari, Nurul Aida Bt. Osman, H Daud, Angelina Prima Kurniati, Wa Nur Syahidah binti Wan Yusoff
Background: The rise of the Internet-of-Medical-Things (IoMT) and smart devices has led to a substantial increase in extensive data streams in the healthcare domain. The interconnected nature of medical devices introduces dynamic and evolving data patterns. However, this dynamism poses a significant challenge known as Concept Drift, particularly crucial in the medical field. Concept Drift reflects
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Common misconceptions held by health researchers when interpreting linear regression assumptions, a cross-sectional study medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-20 Lee Jones, Adrian Barnett, Dimitrios Vagenas
Background Statistical models are powerful tools that can be used to understand complex relationships in health systems. Statistical assumptions are a part of a framework for understanding analysed data, enabling valid inferences and conclusions. When poorly analysed, studies can result in misleading conclusions, which, in turn, may lead to ineffective or even harmful treatments and poorer health outcomes
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Prohibiting Babel - A call for professional remote interpreting services in pre-operation anaesthesia information medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-18 Gernot Gerger, Nikolaus Graf, Elisabeth Klager, Klara Doppler, Armin Langauer, Verena Albrecht, Aylin Bilir, Harald Willschke, David M. Baron, Maria Kletecka-Pulker
Introduction: Language barriers within clinical settings pose a threat to patient safety. As a potential impediment to understanding, they hinder the process of obtaining informed consent. This study investigates the impact of the current use of interpreters, with a particular focus on the efficacy of engaging laypersons as interpreters, rather than professional interpreters. A further objective is
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A Qualitative Evidence Synthesis Exploring Caregiver Information Needs and Experiences Caring for a Child with Chronic Heart Failure medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-17 Chentel Cunningham, Katie Schroeder, Tabatha Plesuk, Jennifer Conway, Mark J Haykowsky, Shannon D. Scott
Aim: To synthesize qualitative studies relating to caregivers' information needs and experiences caring for a child with chronic heart failure. Background: Children with chronic heart failure (HF) place a considerable burden on healthcare systems each year and is associated with significant stress for caregivers. Despite substantial knowledge generation and implementation amongst healthcare providers
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Outcome evaluation of effect of organizational strategies on reduction of patient waiting time at the outpatient department at Kilimanjaro Christian Medical Centre – Northern, Tanzania medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-17 Henry Mollel, Manasseh Joel Mwanswila
Background The Tanzanian healthcare system has long grappled with extended waiting times in outpatient departments (OPD). Studies at Kilimanjaro Christian Medical Centre (KCMC) revealed an average wait of six hours, marking KCMC with the longest waiting time among Tanzanian referral hospitals. Thus, this study was undertaken to assess the efficacy of the programme interventions and their effect on
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Physicians experiences with telemedicine during the COVID-19 pandemic in India medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-11 Vikranth Nagaraja, Biswanath Ghosh Dastidar, Shailesh Suri, Anant Jani
Purpose: Digital health is an important factor in Indias healthcare system. Inclusive policy measures, a fertile technological landscape, and relevant infrastructural development with unprecedented levels of telemedicine adoption catalysed by the recent COVID-19 pandemic have thrown open new possibilities and opportunities for clinicians, end-users, and other stakeholders. Nevertheless, there are still
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HEALTH PROMOTION AND PREVENTIVE INTERVENTIONS FOR SENIOR CITIZENS IN COUNTRIES WITH ACCESSIBLE AND FUNDED HEALTH CARE: STUDY PROTOCOL FOR A SCOPING REVIEW medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-09 Petra Lostelius, Henri Aromaa, Åsa Revenäs, Malin Lohela Karlsson, Lena Nordgren
To improve health in a growing population with increasing life expectancy, a stepwise health care program for citizens aged 65 years and older will be implemented in Region Västmanland in Central Sweden. This scoping review builds on a previous review and aims to map interventions in a larger number of countries and from 2019 to present. The objective of this scoping review is to map the literature
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Systematic review of contemporary improvement interventions on care coordination, discharge support and transitional care from the patient experience perspective medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-09 Tiago S Jesus, Brocha Z Stern, Dongwook Lee, Manrui Zhang, Jan Struhar, Allen W Heinemann, Neil Jordan, Anne Deutsch
Aim: To synthesize the impact of improvement interventions related to care coordination and discharge support on patient experience measures. Method: Systematic review. Searches were completed in six scientific databases, five specialty journals and through snowballing. Eligibility included studies in English (2015-2022) on improving care coordination, discharge support, or transitional care assessed
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Association of Center-Level Operative Volume and Acute Outcomes following Robotic-Assisted Colectomy for Malignancy medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-09 Nam Yong Cho, Shineui Kim, Joseph Hadaya, Nikhil Chervu, Shayan Ebrahimian, Emma Cruz, Hanjoo Lee, Peyman Benharash
Background: The adoption of RAC remains limited due to high costs. There is a paucity of data regarding the impact of institutional robotic experience on costs in patients undergoing RAC for colorectal cancer. Methods: All adult patients undergoing RAC for colorectal cancer were identified using the 2016-2020 Nationwide Readmissions Database. A multivariable regression to model major adverse events
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An overview of global monitoring systems for the side effects and adverse events associated with medicinal cannabis use: A scoping review using a systematic approach medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-04 Rebecca Qi Wang, Yvonne Ann Bonomo, Christine Mary Hallinan
The use of cannabis-based medicines (CBM) as a therapeutic has grown exponentially over the last 5 years in Australia. Prior to this increase, there was significant legislative resistance to the use of CBM for clinical trials, hence pre-clinical data is limited. Safety monitoring systems for CBM are not structured and do not fit easily into the workflow of busy health professionals. Hence, post-marketing
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The process of developing and piloting a tool in the Maldives and Zimbabwe for assessing disability inclusion in health systems performance medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-04 Hannah Kuper, Phyllis Heydt, Shaffa Hameed, Tracey Smythe, Tapiwanashe Kujinga
There are 1.3 billion people with disabilities globally. On average, they experience greater healthcare needs and more barriers accessing healthcare. Yet, health systems have failed to adequately include people with disabilities. The purpose of this study was to develop and pilot-test a tool for assessing disability inclusion in health system performance. We presented the Missing Billion disability-inclusive
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A framework for confounder considerations in AI-driven precision medicine medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-04 Vera Komeyer, Simon B. Eickhoff, Christian Grefkes, Kaustubh R. Patil, Federico Raimondo
Artificial intelligence holds promise for individualized medicine. Yet, transitioning models from prototyping to clinical applications poses challenges, with confounders being a significant hurdle. We introduce a two-dimensional confounder framework (Confound Continuum), integrating a statistical dimension with a biomedical perspective. Informed and context-sensitive confounder decisions are indispensable
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Patient Safety of Remote Primary Care: A Qualitative Study Assessing Risks and Mitigation and Prevention Strategies medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-02-01 Olivia Lounsbury, Edmond Li, Tetiana Lunova, Jackie van Dael, Niki O’Brien, Ahmed Alboksmaty, Alay Rangel-Cristales, Ara Darzi, Ana Luisa Neves
Background While virtual care delivery has numerous advantages, it can also introduce safety risks and unintended consequences. Considering that it has become an integral part of today’s healthcare service, uncovering its unintended consequences is imperative to ensure patient safety.
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Supporting carers: Study protocol of a meta-review of psychosocial interventions for carers of people with cancer medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-01-31 Bróna Nic Giolla Easpaig, Bronwyn Newman, Judith Johnson, Rebekah Laidsaar-Powell, Ursula M Sansom-Daly, Lucy Jones, Lukas Hofstätter, Eden G Robertson, Stephen Mears, Kabir Sattarshetty, Reema Harrison
Background While there is a clear need for psychosocial interventions that promote cancer carer wellbeing, the corresponding evidence base is disparate, complex and difficult for end-users to navigate and interpret. Carers remain under-supported with a lack of dedicated, effective, evidence-based programs. We will conduct a meta-review to synthesise this evidence and determine the state of science
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Analyzing the Usage of the GIM-COVID-19 Long-Term Sequelae Rapid Access to Consultative Expertise (RACE) Line medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-01-29 Saniya Kaushal, Peter Birks, Jesse Greiner, Adeera Levin, Michelle Malbeuf, Zachary Schwartz
Real time access to guidance for physicians has been offered through Rapid Access to Consultative Expertise (RACE) in British Columbia (BC) for the past 12 years. 1 In the context of the novel coronavirus (COVID-19), the service for RACE was expanded to include a Long-COVID RACE line. 1 We report here the types and frequencies of questions asked to General Internal Medicine (GIM) experts in Long-COVID
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Application of hybrid failure mode effect analysis based on fuzzy AHP and fuzzy TOPSIS in quality risk assessment of fixed-dose artemether-lumefantrine tablets medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-01-28 Salim Ilyasu, Sani Malami, Garba Mohammed Khalid, Umar Sharif Abdussalam, Abubakar Magaji Dawud, Saratu Mohammed, Al-Kasim Rabiu Falalu, Mustapha Fatima Zaharadeen, Farouq Idris Sani, Abdussalam Yayo Manu, Ibrahim Adamu Yakasai, Basheer Abba-Zubair Chedi, Aminu Sahalu Bello, Adam Bashir Ibrahim, Saadatu Julde, Maryam Shehu Idris, Lawal Alhassan Bichi
Background: A hybrid Failure Mode Effect Analysis (FMEA) based on fuzzy logic and multicriteria decision analytics was applied as a post-marketing surveillance tool for troubleshooting potential quality problems of Artemisinin Combination Therapies (ACTs) as a means of aggregating subjective opinions of quality experts in providing vital information for continuous management and improvement of safety
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Quality of maternal care at public health centers of Siltie zone, Central Ethiopia 2022 medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-01-28 abdulfeta Mohammednur shafi, Neima Ridwan Abdu
Introduction: Quality of care is “the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people-centered (WHO). Quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications
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Understanding children’s behavioral health outcomes: A story of overcoming trauma and building strengths medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-01-26 Jordan H. McAllister, Olga A. Vsevolozhskaya, Xiaoran Tong, Daniel P. Lakin, Scott K. Fairhurst, John S. Lyons
Background Among children enrolled in behavioral health treatment, those with multiple trauma experiences (known as Adverse Childhood Experiences, or ACEs) typically see worse outcomes. In this study, we examine whether having or building strengths can help such children become more resilient and experience better outcomes.
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Sex-Based Utilization of Guideline Recommended Statin Therapy and Cardiovascular Disease Outcomes: A Primary Prevention Healthcare Network Registry medRxiv. Health Syst. Qual. Improv. Pub Date : 2024-01-23 Agnes Koczo, Adipong Brickshawana, Jianhui Zhu, Floyd W Thoma, Kathryn L Berlacher, Malamo E. Countouris, Erin D. Michos, Martha Gulati, Steven Reis, Suresh R. Mulukutla, Anum Saeed
Background: In the US, women have similar cardiovascular death rates than men. Less is known about sex differences in statin use for primary prevention and associated atherosclerotic cardiovascular disease (ASCVD) outcomes. Methods- Statin prescriptions using electronic health records were examined in patients without ASCVD (myocardial infarction (MI), revascularization or ischemic stroke) between