Development and implementation of digital remote care in COPD: A collaborative service model

Introduction: Studies and national patient safety organizations recognize benefits of a dedicated warfarin anticoagulation service in maximizing efficacy and minimizing adverse events, hospitalizations and cost. The impact of a pharmacist-led anticoagulation service on adult patient outcomes and health care expenditures has been established, however, similar data is lacking in a pediatric setting. In 2013, the outpatient anticoagulation program within the Heart Institute at Cincinnati Children’s Hospital Medical Center (CCHMC) transitioned from a nurse-managed service model to a pharmacist-managed collaborative service model. This study will describe the differences between a nurse-managed (NM) service model and a pharmacist-managed (PM) service model for outpatient anticoagulation management of cardiology patients followed at a pediatric medical center. Methods: A retrospective study was conducted to evaluate warfarin anticoagulation management of a NM service and PM service at CCHMC. Each service model was reviewed for thirteen months between November 1, 2011 and November 30, 2014. The primary outcomes are percent of time within therapeutic INR range and median time to patient follow-up for INR monitoring (days). Results: Fifty-eight cardiology patients managed by both outpatient anticoagulation services were evaluated during each study group time frame. Median age was 19.1 years (IQR 14.2, 25.7) and 65.5% were male (38 of 58). Of the 58 patients evaluated, 51.7% (30 of 58) were managed within an INR goal range of 2- 3. Most common indications for anticoagulation were cardiac valve replacement (50%; 29 of 58) and Fontan procedure (37.9%; 22 of 58). Percent of time within therapeutic range was 65.7% (12,897 of 19,636 days) for the NM service model and 80.6% (18,650 of 23,131 days) for the PM service model. Percent of time below therapeutic INR range was reduced with the PM model compared to NM model, respectively (12.3% v. 24%). Median time between INR lab draws was 35.1 days (IQR 23.8-73.6) for NM model and 22.3 days (IQR 17.9-26.5) for the PM model. Conclusions: A pharmacist-managed collaborative outpatient anticoagulation service model improved the time within therapeutic range and frequency with INR lab monitoring at a pediatric medical center compared to nurse-managed model.

Service-oriented collaboration framework based on cloud platform and critical factors identification

This chapter contains sections titled: The Policy Context Building Knowledge of Collaboration A Model for Collaboration Across Sectors Conclusion References

“How could I apply this information?” Strong parent–professional partnerships are critical to successful therapeutic programs. This article highlights specific ways to support parent partnerships including intensive therapy focused on parent-identified goals considered vital to enhance their child's quality of life, skilled therapists who not only see potential in but also establish a strong bond with their child, and a collaborative service model with home instruction to ensure carryover. However, parents and therapists must recognize that the benefits of intensive therapy are associated with a “cost”: not only the direct costs of time and money for the intensive program, but indirect costs associated with not being able to participate in other therapeutic or educational programs, group recreational programs, or family-based activities. In addition, indirect costs associated with logistical issues such as transportation time and work commitments must be recognized. “What should I be mindful about when applying this information?” Parents are continually balancing conflicting priorities to provide their child with the best quality of life. This is challenging. Although many therapeutic interventions are supported by research evidence, frequently insufficient information is available to accurately determine the appropriate dosage and potential long-term outcomes for a particular child of a specific age, diagnosis, and functional level with specific family and community resources. Even more difficult is the comparison of a specific intervention program with all other programs that may also benefit the child. Yet, these are the decisions parents are continually forced to make. Because parents are experts on their child and family situation, they are in the best position to make these decisions. Therapists need to support parents in their efforts by providing the best available evidence to inform their decisions, and also by identifying practical considerations that may help them clarify their priorities to determine what type of program would be the best fit for their child and family at that specific time in the child's life. Julie Lynas Flagg, MA, and Paluel Flagg Parents of a child with cerebral palsy, Rossmoor, California Lauren Beeler, PT, DPT, PCS, C/NDT South Coast Therapy, Cypress, California Barbara Sargent, PT, PhD, PCS University of Southern California, Los Angeles, California

To test whether adoption of a collaborative consultative service model results in improved patient outcomes. Twelve pediatric practices were randomly assigned to receive access to collaborative consultative services or to a control group. Community-based pediatric offices. Fifty-two pediatricians and their 377 patients with attention-deficit/hyperactivity disorder (ADHD). Intervention A collaborative consultative service promoting the use of titration trials and periodic monitoring during medication maintenance. Main Outcome Measure Physician practice behaviors and child ADHD symptomatology. Using self-report of pediatricians, the collaborative consultative service increased the use of evidence-based practices by pediatricians, but no difference in children's ADHD symptomatology was observed between the groups. However, many pediatricians did not fully use the collaborative consultative services. Those children who actually received collaborative consultative services showed significant behavioral improvement compared with children not receiving these services. When actually implemented by pediatricians, the collaborative consultative service appears to be an effective method for facilitating evidence-based treatment procedures for ADHD and use of these procedures appear to improve children's outcomes. Barriers to implementation of collaborative consultative service in pediatric practice need to be further understood.

This study sought to explore the views and experiences of women and midwives participating in the Pre And Postnatal Outpatients Collaborative Service (PAPOOSE) model of care at a hospital in Sydney, NSW. The study was guided by two research questions: What are the experiences of women receiving their antenatal and postnatal care through the PAPOOSE model of care; and what are the views of the PAPOOSE midwives about the MAPS model of care? In this qualitative study informed by feminist standpoint theory, in-depth interviews were conducted via Zoom with ten women who received their antenatal and postnatal care through PAPOOSE. In addition, two focus groups were undertaken with ten midwives and two midwifery students providing care. The transcripts from the interviews and focus group discussions were analysed through reflexive thematic analysis. Four themes were constructed from the women’s data: ‘Looking for the right model of care’; ‘Enjoying antenatal and postnatal continuity of care’; ‘Missing the known midwife during labour and birth’; and ‘There’s room for improvement’. In the case of the midwives, four themes were constructed: “It’s my slice of heaven”; “It’s great for the women to have that continuity”; ‘Finding our place as a new model of care’; and ‘There’s room for improvement’. These themes reflected the perspectives of women and midwives and showed that although the relational aspects of the PAPOOSE model were valued overall by all participants, each group had distinct concerns about different aspects of the model of care. Both women and midwives had suggestions for how the PAPOOSE model of care could be improved. Although MAPS models show potential for increasing women’s access to MCOC in Australia, this study revealed a need for the models to be more woman-centred. Midwifery students have shown great potential for enhancing continuity of care within the context of MAPS. Findings from this research and ongoing feedback from women and midwives need to be incorporated into the continuous refinement of MAPS models. More research is needed to evaluate maternal and neonatal clinical outcomes of MAPS models, as well as the experiences of women and midwives participating in these models of care.

The rapid development of the IoT (Internet of Things) is bringing about a functional change of communication networks from “information transmission” to “information service”. First, the conception and characteristics of the IoT are introduced, i.e., an Internet of humans, machines, and things meant to achieve smart information services. Then, the technology requirements for realizing ubiquitous and smart information services are described. The corresponding key technologies are also discussed, including the integration of communications, computing and control technology (3C), heterogeneous network fusion theory and technology, intelligent sensor technology and short-distance networking theory, large-scale network transmission theory and technology, the network virtualization and intelligent computing technology geared toward information service, and the collaborative network system and service model geared to the application of the IoT. Finally, the development trends of information technologies and information networks in the next five to ten years are analyzed, and give some suggestions for main research areas to be explored and key issues to be resolved.

The Advancing Research and Clinical practice through close Collaboration (ARCC© ) Model is a system-wide framework for implementing and sustaining evidence-based practice (EBP) in hospitals and healthcare systems. The model involves assessing organizational culture and readiness for EBP in addition to the development of a critical mass of EBP mentors who work with point-of-care clinicians to facilitate the implementation of evidence-based care. Determining how the various components of the ARCC© Model relate to one another is important for understanding how EBP culture and mentorship impact EBP implementation, nurses' job satisfaction, and intent to stay. The current study aimed to test a model that could explain the relationships and direct pathways among eight key variables in the ARCC© Model: (1) EBP culture, (2) mentorship, (3) knowledge, (4) beliefs, (5) competency, (6) implementation, (7) nurses' job satisfaction, and (8) intent to stay. Structural equation modeling was used to test relationships among the variables in the ARCC© Model with data obtained from an earlier cross-sectional descriptive study with 2,344 nurses from 19 hospitals and healthcare systems across the United States. The final structural equation model found that EBP culture and mentorship were key variables that positively impacted EBP knowledge, beliefs, competency, implementation, job satisfaction, and intent to stay among nurses. As described in the ARCC© Model, establishing a strong sustainable EBP culture along with a critical mass of EBP mentors is crucial for the development of EBP competency and consistent implementation of evidence-based care by nurses. A strong EBP culture along with EBP mentorship also can result in higher job satisfaction and intent to stay. Implementation of the ARCC© Model is a key strategy in assisting systems to reach health care's Quadruple Aim.

The literature on the health of and services for older Aboriginal and Torres Strait Islander populations is relatively sparse. This study explored the development and implementation of a locally designed community service model of care for older people, and people with disability and/or mental health problems in remote Aboriginal Australia. Based on extensive community consultation with older people, families, carers, community members and stakeholders, a model of care was developed to address unmet needs for the target population and their carers in the remote community of Looma, in the Kimberley region of Australia. The model was implemented and evaluated over 12 months. The main outcome measures included the number of services (including home services, meals, transport, respite, personal care and advocacy) provided. Outcomes of community participation, capacity building, resources, partnerships, workforce, service delivery and cultural protection were assessed qualitatively by an external evaluator. The number of people receiving community care services in Looma increased from eight to 22, and services increased in all domains from 140 total services delivered for 1 month at baseline to 2356 by the final month of the program. The Lungurra Ngoora community care service model pilot project demonstrated a successful collaborative service model that addressed the care needs of older persons, those with disability and mental illness, and their carers in this remote community. The developmental approach, and model structure, could serve as a template for future delivery of services in remote Aboriginal communities.

Remote surgery is an emerging medical business derived from information networking technology and plays an increasingly essential role in the medical system. In remote surgery, it is imperative to facilitate cross-regional information transmission and processing by leveraging medical information networks to establish a collaborative service model served by multiple data centers in different regions, enabling collaboration and support for surgery operations. Additionally, the implementation of service function chain scheduling technology is crucial for the efficient allocation of computing resources of data centers. In this paper, we design a novel multi-cloud collaborative medical information network framework. Based on this framework, the service function chain (SFC) scheduling problem is investigated to minimize the total weighted end-to-end delay. To solve the scheduling problem, the original problem is reformulated as a Multiple Markov Decision Process (MMDP). Then, a multiple-state-action deep reinforcement learning (MSA-DRL) algorithm is developed to learn the best scheduling policy. Simulation results are presented to demonstrate the superiority of the proposed approach in the aspect of total weighted end to end delay against other benchmark algorithms.

Social innovation is a dynamic phenomenon; with solutions emerging and moving from the margins of society to the mainstream. The word ‘‘social’’ in “social innovation” refers both to the means and the end. As a means; it indicates that these innovations are based on the capabilities of the people who activate and benefit from the innovation; and on unexpected interactions and partnerships between citizens; institutions; businesses; and governments. As an end; it indicates that the social effort is targeted to solve commonly recognized problems that existing businesses and technological solutions have failed to address. This implies that design discipline (and service design) can have an important role in identifying these small; local social inventions and their working prototypes; and make them spread to address economic; social and environmental challenges. p> Research activities on service design for social innovation - particularly undertaken in DESIS Network - have identified a particular kind of service configurations known as collaborative services: services where the final users are actively involved and assume the role of service codesigners and co-producers. Recognition of the collaborative service model led to the coining of another one: relational services; in which participants need not only to be operationally active and collaborative; but also well inclined and willing to relate with others in an intensive personal manner.

Health care professionals' readiness for an interprofessional orthogeriatric unit: A cross-sectional survey

PurposeThe purpose of this study was to explore the experiences of nursing managers in implementing palliative care in long-term care facilities and to provide recommendations for managers who plan to introduce palliative care into their facilities.MethodsThis study used semi-structured interviews and grounded theory methodology, with purposive sampling. A total of 11 long-term care facilities in eastern Taiwan that had implemented palliative care were selected, and 11 facility nursing managers participated in in-depth, face-to-face interviews.ResultsThe introduction of palliative care in long-term care facilities can be divided into four stages: (1) the opportunity for change, (2) playing a supportive role, (3) a new collaboration model, and (4) facility transformation. The core category shared by the participants may be summed up as “the palliative care captain in the facility”. It reflects the spirit of the successful implementation of palliative care by managers in long-term care facilities.ConclusionThe study reveals that during the initial phases of implementing palliative care, the palliative care teams assume a crucial leadership role, while the facilities play a supportive role. At this stage, managers should focus on personnel training and addressing internal issues within the facilities to facilitate successful collaboration with the palliative care teams. In the later stages, the facilities transition from a supportive role to one of independence, marking a critical juncture for the facilities’ potential stable development. During this period, managers are tasked not only with establishing the facilities’ own palliative care team but also with facilitating the transformation of staff from learners to instructors. Finally, even after successful implementation, managers must contemplate how to innovate and set more ambitious goals.

<bold>Background:</bold> NuvoAir Home is a digital platform for the self-management and remote care of patients with lung disease. This study aims to test the engagement with and the impact of NuvoAir Home in patients with obstructive lung disease. Method Spirometry and peripheral oxygen saturation (SpO2) were measured daily with biometric devices and the NuvoAir App for 1 year in COPD patients with frequent exacerbations or asthma (GINA≥3). An event was classified as a drop of >10% in forced expiratory in 1 second (FEV1) or >20% in peak expiratory flow (PEF) for >2 consecutive days or SpO2<88% compared to an individual stable disease state. The primary end-point was the number and type of interventions. <bold>Results:</bold> 34 patients were monitored (figure 1). Compliance was similar in both groups. More events were seen in the COPD groups. The majority of events were FEV1-related. SpO2 was relevant in COPD only. There was more contact that led to action (medication change, referral) and more event-related adverse events (AE) in the asthma group. 15 patients had no event-related contacts. <fig><object-id>erj;64/suppl_68/PA5189/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig> <bold>Conclusion:</bold> There was good engagement with the app and patient satisfaction was high. There is not always a direct link between clinical deterioration and preceding events and contact from the centre to the patient did not always result in action. Research should focus on calculating resource use and in identifying patients most likely to benefit from home monitoring.

Whole system integration of health and social care has been positioned as key to improving care, increasing efficiency and controlling costs. However, evidence for the benefits of whole system integration is scarce. Drawing on organizational theory, this study uses the implementation of remote care services, viewed as an enabler for whole system working, to explore the reality of achieving this policy objective. Qualitative, longitudinal data were collected across nine UK sites adopting remote care over three years. Three sites formed the Department of Health's Whole Systems Demonstrator (WSD) programme for remote care. In addition, the implementation of remote care was explored in six other sites unconstrained by the randomized control trial procedures of the WSD programme. The methods were ethnographic (including 235 hours of observations and 184 interviews). Participants were health and social care staff and Government policy makers. Remote care did not lead to system redesign; however, local 'ownership' of new services did lead to more collaborative practices across the care system. Lack of integration was an enduring and endemic challenge across all sites, relating to differences in statutory responsibilities, absence of shared budgets and hybrid organizational roles, differences in work practices and organizational philosophies, and ambiguity around what 'whole system working' actually entailed. Policy initiatives like the WSD programme provide opportunities to phase in collaborative practices and create an awareness of the need for joint working. However, the progress observed suggests that the concept of whole system redesign around remote care is currently unrealistic.