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Health Services Research Jun 2009
Review
Topics: Cost Control; Cost-Benefit Analysis; Diffusion of Innovation; Efficiency, Organizational; Evidence-Based Practice; Health Services Research; Humans; Outcome and Process Assessment, Health Care; Quality of Health Care; Research Design; United States
PubMed: 19674425
DOI: 10.1111/j.1475-6773.2009.00971.x -
BMC Health Services Research Jun 2010Focusing on specific treatments or diseases is proposed as a way to increase the efficiency of hospital care. The definition of "focus" or "focused factory", however,... (Comparative Study)
Comparative Study
BACKGROUND
Focusing on specific treatments or diseases is proposed as a way to increase the efficiency of hospital care. The definition of "focus" or "focused factory", however, lacks clarity. Examples in health care literature relate to very different organizations.Our aim was to explore the application of the focused factory concept in hospital care, including an indication of its performance, resulting in a conceptual framework that can be helpful in further identifying different types of focused factories. Thus contributing to the understanding of the diversity of examples found in the literature.
METHODS
We conducted a cross-case comparison of four multiple-case studies into hospital care. To cover a broad array of focus, different specialty fields were selected. Each study investigated the organizational context, the degree of focus, and the operational performance. Focus was measured using an instrument translated from industry. Data were collected using both qualitative and quantitative methods and included site visits. A descriptive analysis was performed at the case study and cross-case studies level.
RESULTS
The operational performance per specialty field varied considerably, even when cases showed comparable degrees of focus. Cross-case comparison showed three focus domains. The product domain considered specialty based focused factories that treated patients for a single-specialty, but did not pursue a specific strategy nor adapted work-designs or layouts. The process domain considered delivery based focused factories that treated multiple groups of patients and often pursued strategies to improve efficiency and timeliness and adapted work-designs and physical layouts to minimize delays. The product-process domain considered procedure based focused factories that treated a single well-defined group of patients offering one type of treatment. The strategic focusing decisions and the design of the care delivery system appeared especially important for delivery and procedure based focused factories.
CONCLUSIONS
Focus in hospital care relates to limitations on the patient group treated and the range of services offered. Based on these two dimensions, we identified three types of focused factories: specialty based, delivery based, and procedure based. Focus could lead to better operational performance, but only when clear strategic focusing decisions are made.
Topics: Efficiency, Organizational; Health Services Research; Hospitals, Special; Humans; Internationality; Interviews as Topic; Observation; Organizational Case Studies; Quality of Health Care
PubMed: 20529299
DOI: 10.1186/1472-6963-10-154 -
Primary Health Care Research &... Jul 2019There is a need for multiprofessional comprehensive studies to better understand the relationship between design and provision of primary care and long-term care and...
There is a need for multiprofessional comprehensive studies to better understand the relationship between design and provision of primary care and long-term care and health outcomes. The PRIMORE (PRImary care MultiprOfessional REsearcher network) project aims at bringing together researchers with different backgrounds and from a wide range of professional groups within the fields of primary care research and long-term care research to develop and share knowledge for the benefit of research on municipal health and care services, and eventually, the quality of municipal health and care in Europe. Main activities of the project will be network development, capacity building, providing a platform where multiprofessional primary care research activities can take place and publishing position papers.
Topics: Adult; Biomedical Research; Capacity Building; Europe; Female; Humans; Intersectoral Collaboration; Long-Term Care; Male; Middle Aged; Primary Health Care; Program Development; Research Design; Research Personnel
PubMed: 32323642
DOI: 10.1017/S1463423619000276 -
Value in Health : the Journal of the... Nov 2019Integrating patient preferences in Health Technology Assessment (HTA) is argued to improve uptake, adherence, and patient satisfaction. However, how to elicit and...
BACKGROUND
Integrating patient preferences in Health Technology Assessment (HTA) is argued to improve uptake, adherence, and patient satisfaction. However, how to elicit and incorporate these preferences in HTA in a systematic and scientifically valid manner is subject to debate.
OBJECTIVE
This article provides a systematic review of the challenges to integrating patient preferences in HTA that have been raised in the literature about patient preferences in HTA.
METHODS
A systematic review of articles published between 2013 and 2017 addressing challenges to the integration of patient preferences in HTA was conducted in 7 databases. All issues with respect to the integration of patient preferences in HTA were extracted and divided into 5 categories: conceptual, normative, procedural, methodological, and practical issues. The issues were ranked according to how often they were mentioned.
RESULTS
Of 2147 retrieved articles, 67 were included in the analysis. Thirty-seven unique research issues were identified. In the majority of the articles, methodological issues were posed (82%), followed by procedural (73%), normative (51%), practical (24%), and conceptual (9%) issues. Frequently posed methodological issues concerned preference heterogeneity and choice of method. Common procedural issues concerned how to evaluate the impact of preference studies and their degree of being evidence based.
CONCLUSIONS
This article provides an overview of issues with respect to the integration of patient preferences in HTA procedures. Most issues were of a methodological or procedural nature; yet, the large number of different issues points to the overall importance of further researching the different aspects concerned with patient preferences in HTA. Through its ranking of how many articles mention particular issues, this article proposes an implicit research agenda.
Topics: Humans; Patient Preference; Reproducibility of Results; Research Design; Technology Assessment, Biomedical
PubMed: 31708070
DOI: 10.1016/j.jval.2019.04.1930 -
Family Practice May 2018Meta-analysis and meta-synthesis have been developed to synthesize results across published studies; however, they are still largely grounded in what is already...
BACKGROUND
Meta-analysis and meta-synthesis have been developed to synthesize results across published studies; however, they are still largely grounded in what is already published, missing the tacit 'between the lines' knowledge generated during many research projects that are not intrinsic to the main objectives of studies.
OBJECTIVE
To develop a novel approach to expand and deepen meta-syntheses using researchers' experience, tacit knowledge and relevant unpublished materials.
METHODS
We established new collaborations among primary health care researchers from different contexts based on common interests in reforming primary care service delivery and a diversity of perspectives. Over 2 years, the team met face-to-face and via tele- and video-conferences to employ the Collaborative Reflexive Deliberative Approach (CRDA) to discuss and reflect on published and unpublished results from participants' studies to identify new patterns and insights.
RESULTS
CRDA focuses on uncovering critical insights, interpretations hidden within multiple research contexts. For the process to work, careful attention must be paid to ensure sufficient diversity among participants while also having people who are able to collaborate effectively. Ensuring there are enough studies for contextual variation also matters. It is necessary to balance rigorous facilitation techniques with the creation of safe space for diverse contributions.
CONCLUSIONS
The CRDA requires large commitments of investigator time, the expense of convening facilitated retreats, considerable coordination, and strong leadership. The process creates an environment where interactions among diverse participants can illuminate hidden information within the contexts of studies, effectively enhancing theory development and generating new research questions and strategies.
Topics: Health Care Reform; Humans; Interprofessional Relations; Meta-Analysis as Topic; Organizational Innovation; Primary Health Care; Program Evaluation
PubMed: 29069335
DOI: 10.1093/fampra/cmx091 -
The British Journal of General Practice... May 1997Several advantages have been claimed for general practitioners having direct access to physical therapy (defined as having a practice-based physical therapist or open... (Review)
Review
Several advantages have been claimed for general practitioners having direct access to physical therapy (defined as having a practice-based physical therapist or open access to a hospital-based physical therapist), and general practice fundholders are increasingly committing resources to ensure such services are available to their patients. This may lead to potential increases in costs as a larger total number of patients are treated owing to improved access and awareness of such services. A review of the available published literature found eight studies that compared two or more models of providing physical therapy services. Analysis of the studies revealed that there are several advantages for patients who are referred directly for physical therapy. The main advantages are significant reductions in waiting times, convenience, reduced costs for the patient and a lower cost per treated patient. There is also some evidence that the recovery time may be slightly better for patients who have direct access to a physical therapist.
Topics: Family Practice; Health Services Accessibility; Humans; Physical Therapy Modalities; Referral and Consultation; Research Design; United Kingdom
PubMed: 9219412
DOI: No ID Found -
Australian and New Zealand Journal of... Feb 2019
Topics: Biomedical Research; Delivery of Health Care; Humans; Organizational Innovation; Program Evaluation; Public Health; Research Design
PubMed: 30690829
DOI: 10.1111/1753-6405.12867 -
Revista Brasileira de Enfermagem May 2018To structure the Computerized Nursing Process using the International Classification for Nursing Practice (ICNP®) version 2.0 to emergency care units in a computerized...
OBJECTIVE
To structure the Computerized Nursing Process using the International Classification for Nursing Practice (ICNP®) version 2.0 to emergency care units in a computerized structure.
METHOD
This is a methodological and technological research that followed the stages: (1) establishment of the development team and resources; (2) adequacy of clinical situations, diagnoses and nursing interventions for the emergency area; (3) association of diagnoses and interventions based on ICNP®; (4) organization and codification of clinical evaluation, diagnoses and nursing interventions; (5) transfer of data to the a computerized platform.
RESULTS
Readjustment and construction of 1,445 possibilities of clinical evaluations associated with 961 different diagnoses and their corresponding interventions to the most frequent situations in emergency services.
CONCLUSION
ICNP® has a strong and solid form for the development of the computerized nursing process able to support nurses in safe decision-making to improve the quality of health care.
Topics: Emergency Nursing; Emergency Service, Hospital; Humans; Medical Informatics; Nursing Diagnosis; Nursing Process; Research Design
PubMed: 29924151
DOI: 10.1590/0034-7167-2016-0619 -
BMJ Open Sep 2019Partnership models that bring researchers, policymakers and service providers closer together are gaining traction as a strategy to improve public health practice. Yet,...
INTRODUCTION
Partnership models that bring researchers, policymakers and service providers closer together are gaining traction as a strategy to improve public health practice. Yet, there is little evidence of how these models work, or indeed if they do work. The Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN) is one such model. SiREN is a partnership between researchers, policymakers and service providers that aims to develop the research and evaluation capacity and evidence-informed decision making capability of professionals working to address sexual health and bloodborne virus issues in Western Australia. This study will use a systems approach to identify the mechanisms of action, impacts and outcomes of SiREN and inform the development of evaluation tools.
METHODS AND ANALYSIS
Data will be collected from organisational documents, surveys, in-depth interviews and a workshop. It will be analysed using a complex adaptive systems lens and findings will be used to inform the development of a type of qualitative systems model called a causal loop diagram. The causal loop diagram will illustrate the: contextual factors influencing engagement; mechanisms of action; and impacts and outcomes of SiREN. Evaluation tools will then be developed that can be used to assess the indicators identified in the causal loop diagram.
ETHICS AND DISSEMINATION
Ethics approval was obtained from the Curtin University Human Research Ethics Committee (approval number: HRE2017-0090). Participants will be free to withdraw from the study at any point and confidentiality will be maintained by de-identifying participant responses in any published or shared data. The findings from this study will be shared in conference presentations, reports, peer-reviewed journals and online through websites and social media.
Topics: Australia; Blood-Borne Pathogens; Capacity Building; Evaluation Studies as Topic; Health Services Administration; Humans; Intersectoral Collaboration; Policy Making; Public Health Systems Research; Research Design; Sexual Health; Systems Integration; Virus Diseases
PubMed: 31542735
DOI: 10.1136/bmjopen-2018-026706 -
BMC Public Health Aug 2020In the present investigation the study protocol and the results at baseline of a workplace intervention are reported. It is hypothesised that the reduction of the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In the present investigation the study protocol and the results at baseline of a workplace intervention are reported. It is hypothesised that the reduction of the physical and psychosocial workload of healthcare workers increases 1 their self-assessed physical and mental work ability, and 2. clients' satisfaction with care.
METHODS
Two-arm, cluster-randomised trial. Outcome data on workers and clients are collected in questionnaires at baseline, and two follow-ups between 2019 and 2021. Participants of the interventions are healthcare workers of 11 healthcare providers in Germany. At baseline, the intervention arm comprised 22 clusters (n = 174 workers); the control arm, 47 clusters (n = 276). The intervention consists of interviews and workshops, in which employees propose measures aiming to reduce the physical and psychosocial load, and strengthen resources at work. The primary outcome is the workers' physical and mental work ability. The secondary outcome is the clients' satisfaction with care.
RESULTS
There was no evidence of substantial differences between trial arms at baseline concerning the outcomes. The design effect estimates for physical and mental work ability were 1.29 and 1.05, respectively. At the end of the trial, effect sizes of at least 0.30 and 0.27 at the 80% power and 5% significance levels can be attained.
CONCLUSIONS
The results suggest that the implementation of the study design has been satisfactory. The intervention is expected to provide evidence of relatively small to medium-size effects of the intervention activities on the work ability of healthcare workers and the clients' satisfaction with care.
TRIAL REGISTRATION
Registration trial DRKS00021138 on the German Registry of Clinical Studies (DRKS), retrospectively registered on 25 March, 2020.
Topics: Adolescent; Adult; Female; Germany; Health Personnel; Humans; Male; Middle Aged; Patient Satisfaction; Research Design; Surveys and Questionnaires; Workload; Workplace; Young Adult
PubMed: 32843005
DOI: 10.1186/s12889-020-09290-4