Optimizing person-centered chronic care

PurposeFocusing on the Indian context, with the increase in the amount of data and its analysis in health-care knowledge management (KM), the privacy concerns rise which results in loss of trust of an individual in e-health-care systems. Privacy issues in health care, specific to India, are caused by prevalent complacency, culture, politics, budget limitations, large population and infrastructures. Because of these factors, data security requires a backseat that allows easy access to confidential information. Furthermore, the prevalent culture affects health-care disclosure in India. In many cultures, disclosing sensitive personal health-care data is considered ill mannered. This leads to discrepancies in the recorded health-care data and a decrease in the level of treatment meted out. The results and statistics of treatments given do not match the records because of inaccurate data reporting. With the significant rise in the analysis and use of technology in health-care KM systems, it is important to understand the perception of KM in terms of its use and awareness about data sharing in the KM system. The purpose of the paper is to measure the perception of privacy issues in the context of Indian healthcare management systems.Design/methodology/approachTo measure the perception of the use of the KM system, a set of 20 questions was circulated with a sample size of 337 which includes health-care researchers, doctors, practitioners and patients. The questions focused upon the use, share the sensitive health data in the KM platform. All the demographic information such as age, sex, religion, occupation is recorded. The privacy of the individual is maintained while circulating the questionnaire. The usage of health KM system and its privacy is measured through means and t-test.FindingsThe results of the t-test were found positive. This research study finds that the privacy factor is important among the Indians to share the information with the KM repository. It is also found that medical practitioners or data custodians are not much serious about sensitive data is being stored for analysis. From the statistical perception of usage of KM and its privacy, new architecture and privacy guidelines were suggested which can be considered in future research.Research limitations/implicationsFrom the literature review, the questionnaire has developed which can help policymakers and hospital administrators collect information about KM processes in health-care organizations, and this can result in higher performance of health organizations. The privacy factor can also be included in typical health KM architecture ensure that while knowledge acquisition process, privacy of individual or organization can be maintained.Social implicationsKM enhances the value of corporations and business industries through knowledge production, distribution and provides reliable access to the knowledge resources. KM in health care can comprise a confluence of formal methodologies and techniques to facilitate the creation, identification, acquisition, development, preservation, dissemination and finally the utilization of the various facets of a health-care enterprise’s knowledge assets. According to IBM Global executive report in the year 2012, the entire health-care system has changed from diseases-centric to patient-centric. India is emerging in terms of revenue and employment in the health-care field. The advances of information and communication technology help the health-care sector streamline for data structure and access and health analytics.Originality/valueIn India, the KM is frequently used in health-care industries majorly by health-care practitioners and professionals. As health-care data and knowledge are considered to be sensitive, the privacy of an individual while using the data cannot be compromised. The proposed empirical work will provide a solution in determining the main barriers of implementing privacy policies that need to be solved first and to ensure effective implementation of KM in the health care of India.

Introduction: Systematic assessment of patient experience (PE) might contribute to transform the patient-professional interaction model and to improve outcomes. This type of assessments stems from the recognition of the person’s rights and, therefore, of his/her active role in their wellbeing. It is a promising alternative to the fruitless efforts of the traditional approaches to achieve patient’s participation in the design of care processes.Patient Experience describes results from the patient viewpoint when receiving care in relation to the interaction with professionals (relational aspects) and to the care process in which the person is involved (functional aspects). PE measure allows the assessment of how health and social care providers are organized to satisfy patient needs in each moment adequately. In this type of measurements, elements such as integrated care, personalized care plans, recognition of patient’s role in their own health (co-production) or communication adapted to patient’s needs and personal circumstances are crucial.IEXPAC (Instrumento de Evaluación de la eXperiencia del Paciente Crónico in Spanish, (see www.iemac.org/iexpac) is a 12 structured items scale with a 0-10 points-scale response that allows to assess the experience of a chronic patient. It has been validated in Spain considering ceiling and floor effects, reliability and face and construct validity. IEXPAC converged into 3 factors exploring: (1) the type and scope of patient and professionals interactions oriented to patient activation; (2) the patient’s self-management capacity of his/her wellbeing thanks to the interventions received and (3) new relational model of the patient with the system through internet or with partners in group interventions. This scale has its origin in the instrument IEMAC/ARCHO (Assessment of Readiness for Chronicity of Health Care Organizations, see www.iemac.org), designed to monitor progress of health and social care organizations towards an integrated, person-centered chronic care model.To facilitate the introduction of patient experience assessment in the evaluation procedures of health and social care organizations, a website was designed. IEXPAC website is accessible to patients from different profiles of users,as healthcare institutions, providers, patients’ associations or research’s teamwork. The objective of the current study was to evaluate the usefulness and user friendliness of the IEXPAC website, and the use of IEXPAC scale.Methods: The IEXPAC website (http://www.iemac.es/iexpac/default.asp) was designed for Chrome, Explorer, Safari, Firefox, Edge and to allow the introduction and recovery of data regarding one or several evaluations. Comparisons inter and intra evaluations are available so users obtain useful information to introduce changes to improve care. This website suggests recommendations about how to conduct studies in several contexts. The IEXPAC website was assessed exploring its friendliness, usefulness, and impact to introduce changes. Assessments were performed with self-assessed, online, standardized questionnaires. The number of users and downloads were also considered.Results: Preliminary results render an average rating in the IEXPAC scale of 5.7 points (SD 0.7, IC95% 3.0-3.2). Average rating for each factor is: 7.7 (SD 0.9) for factor 1; 7 (SD 0.9) for factor 2, 2.5 (SD 0.9) for factor 3.New integrated care models incorporate people’s needs, preferences and expectations. IEXPAC participates of this approach emphasizing, for instance, the need to improve patient’s active participation in their therapeutic and care plan by agreeing health targets with his/her professionals (item 6, rated 6.85, SD 1.4); facilitating information of the different health and social resources available in patient’s environment to improve their health and wellbeing (item 10, rated 5.72, SD 1.6). Capture of friendliness’ and usefulness’ data is being performed and should be finished in January 2016.Discussion: IEXPAC website is a tool that allows the assessment of Patient experience and from this measure, promoting changes in chronic care approach. The active participation of patients and the integration of all care they receive are objectives of the person-centered care that professionals and organizations strive to achieve. The new evaluative frameworks look for the integration of measures of effectiveness and efficiency together with the experience of patients. This study aims in this direction.Conclusion: The IEXPAC scale facilitates the reorientation towards person-centered care. A useful and user-friendly framework has been designed to introduce the PE measure in several health and social contexts.

In the United States, the incidence rate of new or recurrent stroke is approximately 795 000 per year, and stroke prevalence for individuals over the age of 20 years is estimated at 6.5 million.1 Mortality rates in the first 30 days after stroke have decreased because of advances in emergency medicine and acute stroke care. In addition, there is strong evidence that organized postacute, inpatient stroke care delivered within the first 4 weeks by an interdisciplinary healthcare team results in an absolute reduction in the number of deaths.2,3 Despite these positive achievements, stroke continues to represent the leading cause of long-term disability in Americans: An estimated 50 million stroke survivors worldwide currently cope with significant physical, cognitive, and emotional deficits, and 25% to 74% of these survivors require some assistance or are fully dependent on caregivers for activities of daily living (ADLs).4,5 Notwithstanding the substantial progress in acute stroke care over the past 15 years, the focus of stroke medical advances and healthcare resources has been on acute and subacute recovery phases, which has resulted in substantial health disparities in later phases of stroke care. Additionally, healthcare providers (HCPs) are often unaware of not only patients’ potential for improvement during more chronic recovery phases but also common issues that stroke survivors and their caregivers experience. Furthermore, even with evidence that documents neuroplasticity potential regardless of age and time after stroke,6 the mean lifetime cost of ischemic stroke (which accounts for 87% of all strokes) in the United States is an estimated $140 000 (for inpatient, rehabilitation, and follow-up costs), with 70% of first-year stroke costs attributed to acute inpatient hospital care1; therefore, fewer financial resources appear to be dedicated to providing optimal care during the later phases of stroke recovery. Because there remains a …

Knowledge management (KM) is the source for creating a sustainable competitive advantage, and it helps the organizations to retain, develop, organize and utilize their knowledge. Due to globalization, the organizations must maintain their knowledge assets to survive. Many organizations have realized the potential of KM and are applying it. Since the healthcare industry is growing significantly, it is continuously generating a wealth of knowledge. This knowledge can be recorded, communicated and used by many health care professionals with the help of KM. There is a wealth of research on KM in healthcare of developed countries, but very few studies regarding KM implementation can be found in developing countries i.e., Pakistan. Pakistan is now looking towards the implementation of KM; it is in its initial stages. The implementation of KM in the healthcare of Pakistan is affected by different barriers. In this study, the barriers will be identified and analyzed. An interrelationship between the barriers will be determined, and how the different barriers support each other (driving power), and how they influence each other (dependence power). The results of interpretive structural modeling (ISM) and MICMAC (Matrice d’Impacts croises-multipication appliqué an classment i.e., cross-impact matrix multiplication applied to classification) approach show that lack of support from top management, insufficient strategic planning and lack of support from organizational structure are the main barriers to KM adoption in the healthcare of Pakistan. This study provides a solution in determining the main barriers that need to be solved first, and to ensure effective implementation of KM in the healthcare of Pakistan.

<h3>Context, Objective, Instrument:</h3> COVID-19 propelled the integration of telehealth visits to healthcare delivery. Using the Assessment of Chronic Illness Care (ACIC) survey, we aimed to examine chronic care management in primary care facilities in Southern California during the transition from in-person to a mix of in-person and telehealth following the onset of COVID-19. <h3>Study Design, Setting, Dataset, Outcome Measures:</h3> In this study, the ACIC survey was administered to a convenience sample of healthcare providers, clinical and ancillary staff, and administrators working at seven clinical sites (n=39). It aimed to evaluate chronic illness care across sites and it contains seven subscales. Each subscale has three to six items in which respondents assign a score between 0 – 11. The sum of the scores form the total sub-scale score and the average of the scores form the subscale score. The mean of the subscale scores across the seven subscales form the overall program score. We used the following guidelines to map scores onto clinical interpretations: 0-2 = limited support (LS), 3-5= basic support (BAS), 6-8 = reasonably good support (RGS), 9-11 = fully developed chronic illness care (FD). <h3>Results and Outcomes:</h3> The mean (sd) [category] score for the subscales are as follow: Organization of the Healthcare Delivery System 8.76 (1.76) [RGS]; Community Linkages 7.67 (2.50) [RGS]; Self-Management Support was 8.23 (2.25) [RGS]; Delivery System Design subscale 8.08 (2.63) [RGS]; Clinical Information System 8.44 (2.43) [RGS]; Integration of Chronic Care management Components 8.18 (2.52) [RGS]; Decision Support 8.33 (2.49) [RGS]. The average (sd) overall ACIC score in the full sample was 8.24 (2.12), [RGS]. <h3>Conclusions:</h3> Overall, survey respondents found that their clinic is providing reasonably good support for chronic illness care and for each of the seven constructs. However, the survey respondents’ opinions varied on the item scores, subscale scores, and overall score. The analysis did not find any statistically significant differences between roles and between sites. To further explore any potential patterns observed, either between roles or sites would require larger sample sizes for hypothesis testing with sufficient statistical power. Future directions include an analysis of what role telehealth has played in chronic care management beyond the scope of the ACIC survey and amplifying the ACIC survey instrument to analyze hybrid chronic care models.

By and large, the emerging field of knowledge management (KM) has failed to deliver on its promises. The literature contains a variety of attempts to define the field, to explain its core components, and to discuss its relevance and utility to organizations. But, much of this literature is replete with narratives and descriptive statements, albeit with some cases of implementation. There is a lack of a cohesive set of research questions and an even more striking lack of an appropriate, generally accepted methodology for research in knowledge management. This void becomes particularly apparent when we begin to examine the role of KM in health care and how, by incorporating KM techniques, superior health care operations might ensue. Clearly, it is almost impossible to reach such consensus and convergence when there is a lack of metrics of what constitutes knowledge and how we process it. This paper describes the subfield of epistemetrics, the metrics of knowledge in relation to the application of KM to enabling effective, efficient, and quality health care delivery. It fills the need in the literature of having a coherent system to measure knowledge. Epistemetrics is the metrics of knowledge, and is composed of three inter-related parts: what we measure in knowledge; how we measure; and why we measure (what is the value generated by knowledge). This paper describes the conceptual domain of epistemetrics and suggests some applications of knowledge management in the healthcare context. We contend that by taking such an approach the nascent field of knowledge management will be able to mature into a substantive and rigorous discipline, which in turn will be able to provide health care with needed solutions.

BackgroundNurses play a critical role in supporting the self-management of patients with chronic illnesses. However, there is a lack of evidence on this important topic from the South Asian context. This study aimed to understand what influences nurses’ role in the provision of self-management support in chronic care within the South Asian context.MethodsAn exploratory, descriptive qualitative study was conducted at two private university hospitals and one public university hospital in Pakistan. Purposive sampling was employed. Fifty-four healthcare professionals, with at least one year of experience in chronic non-communicable disease care, participated. Data were collected using a self-developed semi-structured interview guide. Seven focus groups (with nurses and nursing faculty) and 16 individual interviews (with nurse managers and physicians) were conducted. Thematic analysis was done. We adhered to the consolidated criteria for reporting qualitative studies (COREQ) for reporting the current study.ResultsNurses’ supportive role in chronic illness self-management appears to be influenced by interdependent external and internal factors. Their motivation to perform supportive roles seems fragile and heavily dependent on external factors. Amongst the other factors, due to the institutions’ narrow perspective on self-management support, nurses face a mismatch between their expected and documented roles. Moreover, trust in positioning nurses in a supportive role seems superficial and situation-driven.ConclusionsThe factors influencing nurses’ supportive role in self-management reflected a unique perspective from the South Asian context. The study suggests implementing measures that can be undertaken at the nurses and healthcare system levels, to strengthen nurses’ role in the provision of self-management support in chronic care, in the South Asian context. It also emphasizes the need for training interventions to increase nurses’ motivation and self-efficacy, and to reduce their reliance on external factors affecting on their role performance.Clinical trial numberNot applicable.

ObjectivesThe COVID-19 pandemic has had a profound and pervasive impact on psychosocial health and disrupted care systems world-wide. Our research aims to assess the psychosocial impact of the pandemic and related changes in chronic care provision on patients with chronic obstructive pulmonary disease (COPD) and heart failure.DesignA qualitative survey using semi-structured interviews was held among patients with COPD and heart failure.Setting and ParticipantsUsing randomized sampling, 23 patients with COPD, heart failure, or both were recruited to participate in semi-structured interviews. Interviews were held by phone or videocall. The survey was held during the summer of 2021, when strict national containment strategies were widely implemented but gradually loosened and vaccination was ongoing.MethodsInductive coding using Gioia's approach was used to analyze the data in Atlas.Ti 9.1 software. Using an iterative approach, the data were synthesized in a data structure and data table, which was analyzed using an interpretative approach.ResultsWe found 3 aggregate dimensions in which the COVID-19 pandemic has a negative impact on psychosocial health of patients with chronic disease: (1) perceived vulnerability to disease, (2) influence of health policy, and (3) a mismatch of supply and demand of health care. In these dimensions, the impact of the COVID-19 crisis was found to have a negative impact on psychosocial well-being, compounded by national strategies to contain the pandemic and a disruption of chronic care for patients.Conclusions and ImplicationsHealth care providers should be aware of a multidimensional nature of psychosocial distress for chronic disease patients due to the COVID-19 crisis. Future practice and health policy could be improved by increasing awareness among health care providers, promote regular attention for psychosocial well-being of patients, provision of clear information related to the pandemic, and strategies to secure continuity of care. Results of this study might be further explored in larger studies.

Transforming health care delivery to provide safer and more effective services that contribute to improving population health whilst containing costs is a significant challenge for health systems worldwide – a challenge that has been incorporated into the much cited Triple Aim Framework [1]. A key feature of transformation efforts has been to reduce the existing fragmentation both in the cure and care sectors, and support integration of systems, services, organisations, professionals and the wider communities depending on local context and needs. A plethora of tools and concepts has emerged to potentially support this transformation and integration process e.g. [2]. Yet, the discussion on how to measure progress and success of integrated care has only recently started to pick up pace despite our understanding over many years that the lack of evidence on what works and what doesn’t in integrated care is partly due to the poor or non-existent evaluation and measurement of interventions e.g. [3]. From the history of innovation in integrated care it seems that people have shied away from investing in evaluation and measurement. Like the legend of the Gordian knot, the task is seemingly considered impossible – for example, amongst other reasons, researchers and practitioners alike comment that such interventions are too complex to understand, have too many stakeholders and perspectives involved, making it too difficult to attribute causality with too much of a time lag in observing any results. However, with the growing profile, interest and resources available to support integrated care initiatives, the demand for robust evidence and outcome measurement has become critical. There are a number of ways in which the Gordian knot might be cut to advance our abilities to measure and evaluate integrated care. Before one embarks on the development of such measures and indicators, for example, one should be very clear on what purpose and perspective these should fulfil and take. Too often the evaluation of integrated care has been hampered by vague, unclear or non-existing goals and objectives. Defining the different purposes (e.g. accountability, informed decision making) and audiences (e.g. public, policymakers) for the evaluation will also help in breaking down the complexity of integrated care to a manageable subset. Another defining factor is the availability and access to (high-quality) data. As with public health interventions, there can be a significant timelag for when actual impact is measurable; so being clear on the objectives and their attainability over time must be considered. If integrated care initiatives are to be truly able to provide the depth of evidence that we need then a measuring and monitoring framework should form an integral part of the overall transformational change strategy. Such a framework would need to be designed to support feedback on progress to populations, professionals, organisations and the system at large. Thus, approaches to measuring integrated care must be seen as an essential element of building a learning environment to support the Triple Aim. In order to do so effectively, measuring the impact of integrated care from the perspective of patients and service users (in terms of their care experiences as well as their health outcomes) needs to start on equal terms with measuring impacts from the systems’ or organizational perspectives. Indeed, measuring people’s experience of care has become the new trend in healthcare management. In many places, traditional patient satisfaction surveys are being replaced with care experience surveys with minimal changes in content, yet these questionnaires continue to focus on episodic care, adopt a fragmented focus with separate questions for doctors, nurses and other providers, and do not consider IT innovations that are changing the traditional interactions between healthcare staff and patients. Fortunately, in the field of integrated care, the measurement of people’s experience with integrated chronic care is rich in terms of new tools (or updates of existing ones) that are challenging the standard approaches. In fact this area of knowledge has been called the ‘next frontier in health care delivery’ [4]. Although, a systematic review performed in 2009 by Vrijhoef et al. [5] only identified one appropriate patients’ survey for measuring quality of integrated chronic care: the PACIC (Patient assessment of chronic illness care) based on Wagner’s Chronic Care Model [6], in the last 6 years new tools have been developed like:

The use of respectful communication is essential to establishing a good therapeutic relationship between the healthcare professional (HCP) and the patient. Negative language can adversely affect interactions between the public and HCPs. Person-centred care is advocated in cardiovascular care, but there is lack of information regarding on how communication and respectful language can be applied. The aim of this statement is to explore the concept of respectful language in the delivery of person-centred cardiovascular care and present a working definition of respectful language in the context of healthcare and HCPs. This paper outlines of the role of communication in the delivery of cardiovascular care with critical analysis of the relevant literature. Factors influencing respectful language including ethnicity and culture and the move from the term 'patient' to 'person' are explored. Digital technologies (such as remote monitoring) now play a key role in delivering healthcare and HCPs need to be mindful on how it affects communication. Another important consideration is artificial intelligence and its potential impact on respectful language. Many healthcare providers and organizations have developed plain language documents, and non-technical lay summaries are available for evidence-based guidelines and research. This paper offers suggestions for ensuring best practice in the use of respectful language. Undoubtedly, respectful language is central to delivering person centred care. Every individual HCP involved in providing cardiovascular care can make some changes to their communication. Further education and training in the use of respectful language is needed along with evidence highlighting patient-reported outcomes and experience.

Towards more effective, efficient, and person-centered care for patients with chronic conditions in Spain through the CARABELA initiative.

Introduction : (comprising context and problem statement) The increase of patients affected by multiple chronic conditions requires a shift in health care delivery from acute episodic interactions towards continuous, proactive care. In order to be effective, chronic care needs to put the patients’ personal needs, experiences and values are in the center of care delivery. Yet, interventions translating these policies into everyday care delivery are scarce and highly sought after by healthcare policy makers and health practitioners. One answer to these imperatives are “Group Medical Visits” (GMV). GMVs are an innovative primary care intervention empowering and engaging chronically ill patients not only in their own care delivery. GMV have been recognized to be an effective and efficient tool improving outcomes for chronically ill patients, and to decreasing costs. Short description of practice change implemented : Out of various GMV models, Cooperative Health Care Clinics (CHCCs), developed at Kaiser Permanente, is the most commonly one used. In CHCC the same 10-12 patients, affected by the same chronic disease, meet bi-monthly in a group session with their GP, instead of seeing him individually in one-on-one visits. Each CHCC session is composed of five phases conducted in the group setting, concluded by optional one-on-one patient-physician-time. Table 1. Template CHCC model Phase Duration Introduction / Warm up ~ 5-10 Minutes Patient centered group discussion ~ 20-30 Minutes Treatment ~ 30-50 Minutes Questions and Answers ~ 10-15 Minutes Closing and Planning ~ 5-10 Minutes Brief one-on-one visits as necessary Aim and theory of change : CHCC reside on the facts, that patients have accumulated comprehensive disease specific knowledge and gained a wealth of problem solving skills and personal experience in how to overcome disease related challenges. By providing a supportive, physician guided peer group format for patients to exchange their individual knowledge, their “real-world-tested” coping strategies and their personal experience, CHCC aim to utilize and foster the patients’ self-care capabilities and strengthen their health literacy. Targeted population and stakeholders : Chronically ill patients were targeted to improve their ability to better self-manage and engage in their healthcare. Stakeholders are GPs as well as patients themselves, fostering… …exchange of problem solving strategies and coping mechanisms for disease specific challenges …motivation to alter hazard lifestyles …dealing with psychosocial aspects of chronic care Timeline :3 years Highlights : (innovation, impact and outcomes) Proven CHCCs outcomes: patient satisfaction physician satisfaction quality of care effectiveness and efficiency in care provision Comments on sustainability : CHCC constitute an efficient alternative to one-on-one visits, as they require less physician time per patient. Comments on transferability : Developed by Kaiser Permanente, CHCCs have now been successfully trialed in various integrated and non-integrated healthcare systems. Conclusions : (comprising key findings) Aiming at supporting chronically ill to manage their conditions, to access and adapt coping strategies via peers affected from the same challenges, has been proven an effective tool. CHCCs… improve user experience as chronic care is translated from episodic to continuous interactions with the primary care provider in a group setting with peers improve health of chronically ill, by inter-patient exchange of knowledge and coping strategies increase the efficiency of primary care provision by replacing one-on-one visit Discussions : GMVs are not the panacea for chronic care delivery; however they are an instrument every GP should have in his “chronic care toolbox”. CHCC support GPs to help patients self-manage effectively, improve health outcomes and avoid inappropriate usage of healthcare resources. They are an instrument to enable patients to make choices of treatment options, to alter hazard lifestyles, and to access coping strategies. Lessons learned : Implementing GMVs to multiply self-care skills and enhance health literacy for the entire chronically ill patient panel at physician clinics requires change management and project management capabilities, which are not necessarily present in small independent GP practices.

To reach consensus on the definition and attributes of 'person-centred handover practices' in emergency departments. Handover practices between emergency care practitioners and healthcare professionals in emergency departments are important and should be conducted meticulously. Person-centred handover practices may enhance the delivery of person-centred care in emergency departments. A three-round online Delphi survey. Nine experts participated in a three round Delphi survey. The expert panel comprised experts from nine countries. Quantitative data were descriptively analysed, and qualitative data were thematically analysed. A consensus of 80% had to be reached before an attribute and definition could be accepted. Experts reached a consensus of 79% in round one, 95% in round two and 95% in round three. A final set of six attributes were agreed upon and the final concept definition was formulated. Person-centred handover practices have not been implemented in emergency departments. Yet, person-centred handover practices may enhance the delivery of person-centred care, which has multiple benefits for patients and healthcare practitioners. Person-centred care is not generally implemented in emergency departments. Person-centred handover practices can lead to person-centred care. Handover practices in emergency departments are a high-risk activity. Despite numerous calls to standardise and improve handover practices, they remain a problem. Developing a standardised definition could be a first step towards implementing person-centred handover practices in emergency departments. The study adhered to the relevant EQUATOR reporting guidelines: Guidance on Conducting and Reporting Delphi Studies (CREDES) checklist. Improve handover practices and patient care. Improve person-centred care in emergency departments. Emergency care practitioners and nurses experienced in handover practices and/or person-centred care, working in clinical and academic fields, participated in the study by sharing their expert knowledge during each of the Delphi rounds.

The objective of this chapter is to propose a framework examining the impacts of technological, organizational and environmental factors on the innovation adoption of knowledge management (KM) in long-term care context. This chapter begins with the definition, rationale and importance of KM. Secondly, KM stories, KM in long-term care, prior frameworks in long-term care and knowledge barriers in health care settings will be reviewed. Furthermore, the KM for long-term care in Technology-Organization-Environment (TOE) framework is discussed and proposed. The technology dimension includes security, complexity and costs. Besides, organizational dimension is composed of top management support, firm size, nursing leadership and the readiness. For environmental dimensions, this chapter will focus on competitive pressure and vendor support. As KM is proven to understand performance in long-term care organizations, the proposed framework provides insight to health care organization leaders on how to enhance the effectiveness of KM system.

As medical science advances and the applications of information and communications technologies to healthcare operations diffuse, more and more data and information begin to permeate healthcare databases and repositories. However, given the voluminous nature of these disparate data assets, it is no longer possible for healthcare providers to process these data without the aid of sophisticated tools and technologies. The goal of knowledge management is to provide the decision maker with appropriate tools, technologies, strategies, and processes to turn data and information into valuable knowledge assets. This chapter discusses the benefits to the healthcare arena of incorporating these tools and techniques in order to make healthcare delivery more effective and efficient, and thereby maximize the full potential of all healthcare knowledge assets. To ensure a successful knowledge management initiative in a healthcare setting, the chapter proffers the knowledge management infrastructure framework and intelligence continuum model.The benefits of these techniques lie not only in the ability to make explicit the elements of these knowledge assets, and in so doing enable their full potential to be realized, but also to provide a systematic and robust approach to structuring the conceptualization of knowledge assets across a range of healthcare environments, as the case study data presented demonstrate.KeywordsKnowledge ManagementTacit KnowledgeOrganizational MemorySpine UnitKnowledge AssetThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.