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Lim, E. L., Ong, R. H., Thor, J., Wilińska, M., Andersson-Gäre, B. & Thumboo, J. (2023). An Evaluation of the Relationship between Training of Health Practitioners in a Person-Centred Care Model and their Person-Centred Attitudes. International Journal of Integrated Care, 23(4), Article ID 11.
Open this publication in new window or tab >>An Evaluation of the Relationship between Training of Health Practitioners in a Person-Centred Care Model and their Person-Centred Attitudes
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2023 (English)In: International Journal of Integrated Care, E-ISSN 1568-4156, Vol. 23, no 4, article id 11Article in journal (Refereed) Published
Abstract [en]

Introduction: The Esther Network (EN) person-centred care (PCC) advocacy training aims to promote person-centred attitudes among health practitioners in Singapore. This study aimed to assess the relationship between the training and practitioners’ PCC attributes over a 3-month period, and to explore power sharing by examining the PCC dimensions of “caring about the service user as a whole person” and the “sharing of power, control and information”. Methods: A repeated-measure study design utilising the Patient-Practitioner Orientation Scale (PPOS), was administered to 437 training participants at three time points – before training (T1), immediately after (T2) and three months after training (T3). A five-statement questionnaire captured knowledge of person-centred care at T1 and T2. An Overall score, Caring and Sharing sub-scores were derived from the PPOS. Scores were ranked and divided into three groups (high, medium and low). Ordinal Generalised Estimating Equation (GEE) model analysed changes in PPOS scores over time. Results: A single, short-term training appeared to result in measurable improvements in person-centredness of health practitioners, with slight attenuation at T3. There was greater tendency to “care” than to “share power” with service users across all three time points, but the degree of improvement was larger for sharing after training. The change in overall person-centred scores varied by sex and profession (females score higher than males, allied health showed a smaller attenuation at T3). Conclusion: Training as a specific intervention, appeared to have potential to increase health practitioners’ person-centredness but the aspect of equalising power was harder to achieve within a hierarchical structure and clinician-centric culture. An ongoing network to build relationships, and a supportive system to facilitate individual and organisational reflexivity can reinforce learning.

Place, publisher, year, edition, pages
Ubiquity Press, 2023
Keywords
advocacy, coproduction, integrated care, person-centred care, power, practitioners, training, article, attitude, care behavior, controlled study, female, health practitioner, human, knowledge, learning, male, physician, questionnaire, Singapore
National Category
Nursing Learning
Identifiers
urn:nbn:se:hj:diva-63032 (URN)10.5334/ijic.7564 (DOI)2-s2.0-85178114411 (Scopus ID)GOA;intsam;920193 (Local ID)GOA;intsam;920193 (Archive number)GOA;intsam;920193 (OAI)
Available from: 2023-12-11 Created: 2023-12-11 Last updated: 2024-01-12Bibliographically approved
Holmqvist, M., Thor, J., Ros, A. & Johansson, L. (2023). Applying a Co-designed Medication Plan for SaferMedication Treatment in Older Persons – A Feasibility Study. , 6, Article ID e41950.
Open this publication in new window or tab >>Applying a Co-designed Medication Plan for SaferMedication Treatment in Older Persons – A Feasibility Study
2023 (English)Manuscript (preprint) (Other academic)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-62891 (URN)
Note

Included in doctoral thesis in manuscript form.

Available from: 2023-11-17 Created: 2023-11-17 Last updated: 2023-11-17
Gäre, K., Andersson, A.-C., Andersson-Gäre, B. & Thor, J. (2023). Evidence informed healthcare improvement: Design and evaluation. Jönköping: Jönköping University, School of Health and Welfare
Open this publication in new window or tab >>Evidence informed healthcare improvement: Design and evaluation
2023 (English)Report (Other academic)
Abstract [en]

Healthcare is in constant change with fast development in knowledge, new technology and varying needs and expectations from patients, citizens, management, and politicians. There is a challenge in balancing the involved actors´ focus, needs, preferences, and resources for healthcare improvement. Improvement of healthcare is an ongoing activity, sometimes managed and controlled, often not. A key ingredient for success is competence where the need for competence varies with perspectives of the improving actors. Actors in healthcare improvement are professionals, patients, politicians, management, citizens, researchers, research foundations and others. In this report a review of frameworks in healthcare improvement are presented together with management myths and questions around needs for healthcare improvement competence and capabilities currently on the agenda.

Most improvement initiatives of some size have substantial parts of IT and have had so for a considerable time. This rather long experience of more and less successful IT implementation and use is transparent and useful in all kinds of healthcare improvement. One important issue in this report is what has real impact is the actual understanding and use of innovations and artefacts by healthcare actors in a broad sense for healthcare improvement (e.g., new clinical evidence, clinical guidelines, process changes, information systems and more). The aim in this report is to review frameworks which can be useful in healthcare improvement as well as in the study of healthcare improvement.

Conclusions concern what is found to be important to study and understand healthcare improvement, considering the presented frameworks. Improvement of healthcare is present in all the frameworks but in different ways and what is emphasized concerning scope and focus. Improving healthcare take place in the interaction of at least two parts, one of which is healthcare professionals, and another is the patient/next-of-kin. Professionals and patient populations interact in processes of social networks and structures. Actors and context are useful concepts for understanding action (use) and its social contexts. The actual use of innovations is best understood in terms of integration into clinical activities and processes – actors’ interaction, coordination and communication activities and processes.

Theoretical implications are that there is a need for more research concerning meso and macro perspectives on methods for healthcare improvement, and the interplay of perspectives regarding the understanding of improvement in healthcare. Of course, a challenge is that the objects of improvement are complex adaptive systems of healthcare is not easily to catch in simple rules. They are genuinely difficult both to change and evaluate changes. Practical implications of the report support design and contents of education programs in improvement of healthcare, in better understanding usefulness, practice, use, and experience base. To help the understanding of the need and usefulness of integrating different perspectives for successful healthcare improvement, e.g., micro, meso, and macro perspectives, use of mixed methods and more. 

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2023. p. 48
Series
Arbetsrapporter från Hälsohögskolan ; 2023:1
Keywords
healthcare improvement, complex adaptive systems, frameworks, co-production, sensemaking, sensegiving, adoption, implementation, organizing
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-61123 (URN)
Available from: 2023-06-15 Created: 2023-06-15 Last updated: 2023-06-15Bibliographically approved
Stevenson, K., Thor, J., D'Eon, M., Headrick, L. & Andersson-Gäre, B. (2023). From Theory to Practice: The Enacted Curriculum of a Successful Master's Program in Quality Improvement and Leadership. Journal of Continuing Education in the Health Professions, 43(4), 234-240
Open this publication in new window or tab >>From Theory to Practice: The Enacted Curriculum of a Successful Master's Program in Quality Improvement and Leadership
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2023 (English)In: Journal of Continuing Education in the Health Professions, ISSN 0894-1912, E-ISSN 1554-558X, Vol. 43, no 4, p. 234-240Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Blended learning has taken on new prominence in the fields of higher and continuing education, especially as programs have shifted in response to teaching in a global pandemic. The faculty at the Jönköping Academy's Masters in Quality Improvement and Leadership program has been offering a blended learning curriculum, based on four core design principles, since 2009. We studied key features of the enacted curriculum to understand conditions that can support an effective blended learning model. METHODS: We used a case study approach underpinned by interactive research. Document analysis, a focus group, individual interviews, and stimulated recall interviews were used for data collection. Themes were identified through qualitative content analysis and data reduction, data display, and conclusion drawing. RESULTS: We grouped data into six emergent themes that clarify the enacted curriculum of an established Master's program: focusing on a common purpose, developing technical and relational knowledge and skills, linking theory and practice in the workplace, leveraging collaboration for mutual benefit, concentrating on leadership and coaching, and applying a blended and interprofessional learning model. CONCLUSION: Educators faced with increased demands to be flexible and to offer opportunities for distance education can learn from this case example of effective teaching of quality improvement and leadership in a blended format.

Keywords
Curriculum, Faculty, Focus Groups, Humans, Leadership, Quality Improvement, human, information processing, total quality management, university
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Pedagogy
Identifiers
urn:nbn:se:hj:diva-63031 (URN)10.1097/CEH.0000000000000463 (DOI)001109893800006 ()37092547 (PubMedID)2-s2.0-85178497214 (Scopus ID)HOA;intsam;920155 (Local ID)HOA;intsam;920155 (Archive number)HOA;intsam;920155 (OAI)
Available from: 2023-12-11 Created: 2023-12-11 Last updated: 2024-01-15Bibliographically approved
Thor, J., Andersson, A.-C. & Andersson-Gäre, B. (2023). Förbättringskunskap behöver fortsatt tillämpas i vården [Improvement knowledge has been applied when changing health services - and continues to be needed]. Läkartidningen, 120, Article ID 22154.
Open this publication in new window or tab >>Förbättringskunskap behöver fortsatt tillämpas i vården [Improvement knowledge has been applied when changing health services - and continues to be needed]
2023 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 120, article id 22154Article in journal (Refereed) Published
Abstract [sv]

Förbättringskunskap har tillämpats i förändringsarbetet inom vården i Sverige i stor utsträckning sedan ämnet introducerades i Läkartidningen år 2002.

Flera tillämpningar har dokumenterats i vetenskapliga publikationer med koppling till förbättrade kliniska utfall, ofta visade i nationella kvalitetsregister.

Förbättringsvetenskap bidrar till utvärdering och utveckling av förbättringskunskapstillämpning.

Patienters och närståendes erfarenhet och kunskap integreras i nyare beskrivningar och tillämpning av förbättringskunskap.

Förbättringskunskap behöver tillämpas av såväl kliniska medarbetare som ledare och uppdragsgivare för att möta kommande utmaningar för hälso- och sjukvården.

Abstract [en]

In 2002, Läkartidningen published a call to apply improvement knowledge in efforts to change health services. Looking back over the past 20 years, we highlight many scientifically documented examples of such application. Many efforts, often within »breakthrough collaboratives«, have included Swedish national quality registries, with documented health outcome improvements related to application of Improvement Knowledge. Applications have been evaluated through improvement science studies. A literature review documented 32 PhD theses addressing healthcare improvement published by Swedish universities. Increasingly, improvement knowledge definitions and applications include - and harness - the experiences and knowledge among patients and their families. To meet challenges in the future, all health care stakeholders will need to master and apply improvement knowledge.

Place, publisher, year, edition, pages
Läkartidningen Förlag AB, 2023
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-63593 (URN)36757306 (PubMedID)
Note

Medicinsk kommentar.

Available from: 2024-02-14 Created: 2024-02-14 Last updated: 2024-02-14Bibliographically approved
Holmqvist, M., Ros, A., Lindenfalk, B., Thor, J. & Johansson, L. (2023). How older persons and health care professionals co-designed a medication plan prototype remotely to promote patient safety: Case study. JMIR Aging, 6, Article ID e41950.
Open this publication in new window or tab >>How older persons and health care professionals co-designed a medication plan prototype remotely to promote patient safety: Case study
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2023 (English)In: JMIR Aging, E-ISSN 2561-7605, Vol. 6, article id e41950Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Harm from medications is a major patient safety challenge. Most adverse drug events arise when a medication is prescribed or reevaluated. Therefore, interventions in this area may improve patient safety. A medication plan, that is, a plan for continued treatment with medications, may support patient safety. Participation of patients in the design of health care products or services may improve patient safety. Co-design, as in the Double Diamond framework from the Design Council, England, can emphasize patient involvement. As the COVID-19 pandemic brought restrictions to face-to-face co-design approaches, interest in remote approaches increased. However, it is uncertain how best to perform remote co-design. Therefore, we explored a remote approach, which brought together older persons and health care professionals to co-design a medication plan prototype in the electronic health record, aiming to support patient safety.

OBJECTIVE: This study aimed to describe how remote co-design was applied to create a medication plan prototype and to explore participants' experiences with this approach.

METHODS: Within a case study design, we explored the experiences of a remote co-design initiative with 14 participants in a regional health care system in southern Sweden. Using descriptive statistics, quantitative data from questionnaires and web-based workshop timestamps were analyzed. A thematic analysis of the qualitative data gathered from workshops, interviews, and free-text responses to the survey questions was performed. Qualitative and quantitative data were compared side by side in the discussion.

RESULTS: The analysis of the questionnaires revealed that the participants rated the experiences of the co-design initiative very high. In addition, the balance between how much involved persons expressed their wishes and were listened to was considered very good. Marked timestamps from audio recordings showed that the workshops proceeded according to the plan. The thematic analysis yielded the following main themes: Everyone's perspective matters, Learning by sharing, and Mastering a digital space. The themes encompassed what helped to establish a permissive environment that allowed the participants to be involved and share viewpoints. There was a dynamic process of learning and understanding, realizing that despite different backgrounds, there was consensus about the requirements for a medication plan. The remote co-design process seemed appealing, by balancing opportunities and challenges and building an inviting, creative, and tolerant environment.

CONCLUSIONS: Participants experienced that the remote co-design initiative was inclusive of their perspectives and facilitated learning by sharing experiences. The Double Diamond framework was applicable in a digital context and supported the co-design process of the medication plan prototype. Remote co-design is still novel, but with attentiveness to power relations between all involved, this approach may increase opportunities for older persons and health care professionals to collaboratively design products or services that can improve patient safety.

Place, publisher, year, edition, pages
JMIR Publications, 2023
Keywords
co-design, engagement, medication plan, medications, older people, participatory, patient experience, patient safety, remote
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-60183 (URN)10.2196/41950 (DOI)000999614000014 ()37027205 (PubMedID)2-s2.0-85159816805 (Scopus ID)GOA;;875946 (Local ID)GOA;;875946 (Archive number)GOA;;875946 (OAI)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenRegion Jönköping County
Available from: 2023-04-19 Created: 2023-04-19 Last updated: 2023-11-17Bibliographically approved
Kilander, H., Sorcher, R., Berglundh, S., Petersson, K., Wängborg, A., Danielsson, K. G., . . . Larsson, E. C. (2023). IMplementing best practice post-partum contraceptive services through a quality imPROVEment initiative for and with immigrant women in Sweden (IMPROVE it): a protocol for a cluster randomised control trial with a process evaluation. BMC Public Health, 23(1), Article ID 806.
Open this publication in new window or tab >>IMplementing best practice post-partum contraceptive services through a quality imPROVEment initiative for and with immigrant women in Sweden (IMPROVE it): a protocol for a cluster randomised control trial with a process evaluation
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2023 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 806Article in journal (Refereed) Published
Abstract [en]

Background: Immigrant women’s challenges in realizing sexual and reproductive health and rights (SRHR) are exacerbated by the lack of knowledge regarding how to tailor post-partum contraceptive services to their needs. Therefore, the overall aim of the IMPROVE-it project is to promote equity in SRHR through improvement of contraceptive services with and for immigrant women, and, thus, to strengthen women’s possibility to choose and initiate effective contraceptive methods post-partum. Methods: This Quality Improvement Collaborative (QIC) on contraceptive services and use will combine a cluster randomized controlled trial (cRCT) with a process evaluation. The cRCT will be conducted at 28 maternal health clinics (MHCs) in Sweden, that are the clusters and unit of randomization, and include women attending regular post-partum visits within 16 weeks post birth. Utilizing the Breakthrough Series Collaborative model, the study’s intervention strategies include learning sessions, action periods, and workshops informed by joint learning, co-design, and evidence-based practices. The primary outcome, women’s choice of an effective contraceptive method within 16 weeks after giving birth, will be measured using the Swedish Pregnancy Register (SPR). Secondary outcomes regarding women’s experiences of contraceptive counselling, use and satisfaction of chosen contraceptive method will be evaluated using questionnaires completed by participating women at enrolment, 6 and 12 months post enrolment. The outcomes including readiness, motivation, competence and confidence will be measured through project documentation and questionnaires. The project’s primary outcome involving women’s choice of contraceptive method will be estimated by using a logistic regression analysis. A multivariate analysis will be performed to control for age, sociodemographic characteristics, and reproductive history. The process evaluation will be conducted using recordings from learning sessions, questionnaires aimed at participating midwives, intervention checklists and project documents. Discussion: The intervention’s co-design activities will meaningfully include immigrants in implementation research and allow midwives to have a direct, immediate impact on improving patient care. This study will also provide evidence as to what extent, how and why the QIC was effective in post-partum contraceptive services. Trial registration: NCT05521646, August 30, 2022.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Cluster randomized control trial, Co-design, Immigrants, Joint learning, Post-partum contraception, Process evaluation, Quality Improvement Collaborative
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:hj:diva-60390 (URN)10.1186/s12889-023-15776-8 (DOI)000981906100004 ()37138268 (PubMedID)2-s2.0-85158073407 (Scopus ID)GOA;;880938 (Local ID)GOA;;880938 (Archive number)GOA;;880938 (OAI)
Funder
Swedish Research Council, 2020–01121
Available from: 2023-05-22 Created: 2023-05-22 Last updated: 2023-12-12Bibliographically approved
Suutari, A.-M., Thor, J., Nordin, A. & Areskoug Josefsson, K. (2023). Improving heart failure care with an Experience-Based Co-Design approach: what matters to persons with heart failure and their family members?. BMC Health Services Research, 23(1), Article ID 294.
Open this publication in new window or tab >>Improving heart failure care with an Experience-Based Co-Design approach: what matters to persons with heart failure and their family members?
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 294Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Heart failure is a chronic heart condition. Persons with heart failure often have limited physical capability, cognitive impairments, and low health literacy. These challenges can be barriers to healthcare service co-design with family members and professionals. Experience-Based Co-Design is a participatory healthcare quality improvement approach drawing on patients', family members' and professionals' experiences to improve healthcare. The overall aim of this study was to use Experience-Based Co-Design to identify experiences of heart failure and its care in a Swedish cardiac care setting, and to understand how these experiences can translate into heart failure care improvements for persons with heart failure and their families.

METHODS: A convenience sample of 17 persons with heart failure and four family members participated in this single case study as a part of an improvement initiative within cardiac care. In line with Experienced-Based Co-Design methodology, field notes from observations of healthcare consultations, individual interviews and meeting minutes from stakeholders' feedback events, were used to gather participants' experiences of heart failure and its care. Reflexive thematic analysis was used to develop themes from data.

RESULTS: Twelve service touchpoints, organized within five overarching themes emerged. The themes told a story about persons with heart failure and family members struggling in everyday life due to a poor quality of life, lack of support networks, and difficulties understanding and applying information about heart failure and its care. To be recognized by professionals was reported to be a key to good quality care. Opportunities to be involved in healthcare varied, Further, participants' experiences translated into proposed changes to heart failure care such as improved information about heart failure, continuity of care, improved relations, and communication, and being invited to be involved in healthcare.

CONCLUSIONS: Our study findings offer knowledge about experiences of life with heart failure and its care, translated into heart failure service touchpoints. Further research is warranted to explore how these touchpoints can be addressed to improve life and care for persons with heart failure and other chronic conditions.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Experience-Based Co-Design, Healthcare quality improvement, Heart failure, Patient and public involvement, Thematic analysis
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-60111 (URN)10.1186/s12913-023-09306-w (DOI)000962498500004 ()36978125 (PubMedID)2-s2.0-85151111282 (Scopus ID)GOA;;874896 (Local ID)GOA;;874896 (Archive number)GOA;;874896 (OAI)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenRegion Jönköping County
Available from: 2023-04-11 Created: 2023-04-11 Last updated: 2023-05-04Bibliographically approved
Holmqvist, M., Johansson, L., Lindenfalk, B., Thor, J. & Ros, A. (2023). Older persons' and health care professionals' design choices when co-designing a medication plan aiming to promote patient safety: Case study. JMIR Aging, 6, Article ID e49154.
Open this publication in new window or tab >>Older persons' and health care professionals' design choices when co-designing a medication plan aiming to promote patient safety: Case study
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2023 (English)In: JMIR Aging, E-ISSN 2561-7605, Vol. 6, article id e49154Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Harm from medications is a major patient safety challenge among older persons. Adverse drug events tend to arise when prescribing or evaluating medications; therefore, interventions targeting these may promote patient safety. Guidelines highlight the value of a joint plan for continued treatment. If such a plan includes medications, a medication plan promoting patient safety is advised. There is growing evidence for the benefits of including patients and health care professionals in initiatives for improving health care products and services through co-design.

OBJECTIVE: This study aimed to identify participants' needs and requirements for a medication plan and explore their reasoning for different design choices.

METHODS: Using a case study design, we collected and analyzed qualitative and quantitative data and compared them side by side. We explored the needs and requirements for a medication plan expressed by 14 participants (older persons, nurses, and physicians) during a co-design initiative in a regional health system in Sweden. We performed a directed content analysis of qualitative data gathered from co-design sessions and interviews. Descriptive statistics were used to analyze the quantitative data from survey answers.

RESULTS: A medication plan must provide an added everyday value related to safety, effort, and engagement. The physicians addressed challenges in setting aside time to apply a medication plan, whereas the older persons raised the potential for increased patient involvement. According to the participants, a medication plan needs to support communication, continuity, and interaction. The nurses specifically addressed the need for a plan that was easy to gain an overview of. Important function requirements included providing instant access, automation, and attention. Content requirements included providing detailed information about the medication treatment. Having the plan linked to the medication list and instantly obtainable information was also requested.

CONCLUSIONS: After discussing the needs and requirements for a medication plan, the participants agreed on an iteratively developed medication plan prototype linked to the medication list within the existing electronic health record. According to the participants, the medication plan prototype may promote patient safety and enable patient engagement, but concerns were raised about its use in daily clinical practice. The last step in the co-design framework is testing the intervention to explore how it works and connects with users. Therefore, testing the medication plan prototype in clinical practice would be a future step.

Place, publisher, year, edition, pages
JMIR Publications, 2023
Keywords
co-design, engagement, medication plan, medications, older adults, older people, participatory, patient experience, patient safety, remote
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-62640 (URN)10.2196/49154 (DOI)001085458100001 ()37796569 (PubMedID)2-s2.0-85176753115 (Scopus ID)GOA;;908748 (Local ID)GOA;;908748 (Archive number)GOA;;908748 (OAI)
Available from: 2023-10-10 Created: 2023-10-10 Last updated: 2023-12-04Bibliographically approved
Gremyr, A., Holmberg, C., Thor, J., Malm, U., Andersson-Gäre, B. & Andersson, A.-C. (2022). How a Point-of-Care Dashboard Facilitates Co-production of Health Care and Health for and with Individuals with Psychotic Disorders: A Mixed-methods Case Study. BMC Health Services Research, 22, Article ID 1599.
Open this publication in new window or tab >>How a Point-of-Care Dashboard Facilitates Co-production of Health Care and Health for and with Individuals with Psychotic Disorders: A Mixed-methods Case Study
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2022 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, article id 1599Article in journal (Refereed) Published
Abstract [en]

Background

Individuals with psychotic disorders experience widespread treatment failures and risk early death. Sweden’s largest department specializing in psychotic disorders sought to improve patients’ health by developing a point-of-care dashboard to support joint planning and co-production of care. The dashboard was tested for 18 months and included more than 400 patients at two outpatient clinics.

Methods

This study evaluates the dashboard by addressing two questions:

  1. Can differences in health-related outcome measures be attributed to the use of the dashboard?
  2. How did the case managers experience the accessibility, use, and usefulness of the dashboard for co-producing care with individuals with psychotic disorders? 

This mixed-method case study used both Patient-Reported Outcome Measures (PROM) and data from a focus group interview with case managers. Data collection and analysis were framed by the Clinical Adoption Meta Model (CAMM) phases: i) accessibility, ii) system use, iii) behavior, and iv) clinical outcomes. The PROM used was the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0), which assesses functional impairment and disability. Patients at clinics using the dashboard were matched with patients at clinics not using the dashboard. PROM data were compared using non-parametric statistics due to skewness in distribution. The focus group included five case managers who had experience using the dashboard with patients.

Results

Compared to patients from clinics that did not use the dashboard, patients from clinics that did use the dashboard improved significantly overall (p = 0.045) and in the domain self-care (p = 0.041). Focus group participants reported that the dashboard supported data feedback-informed care and a proactive stance related to changes in patients’ health. The dashboard helped users identify critical changes and enabled joint planning and evaluation.

Conclusion

Dashboard use was related to better patient health (WHODAS scores) when compared with matched patients from clinics that did not use the dashboard. In addition, case managers had a positive experience using the dashboard. Dashboard use might have lowered the risk for missing critical changes in patients’ health while increasing the ability to proactively address needs. Future studies should investigate how to enhance patient co-production through use of supportive technologies.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Coproduction, Learning health systems, Schizophrenia, Psychosis
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Psychiatry
Identifiers
urn:nbn:se:hj:diva-56233 (URN)10.1186/s12913-022-08992-2 (DOI)000906200000002 ()36585696 (PubMedID)2-s2.0-85145377857 (Scopus ID)GOA;;1652948 (Local ID)GOA;;1652948 (Archive number)GOA;;1652948 (OAI)
Note

Published in doctoral thesis in manuscript form.

Available from: 2022-04-20 Created: 2022-04-20 Last updated: 2023-02-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1814-4478

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