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Holmberg, C., Gremyr, A., Karlsson, V. & Asztély, K. (2022). Digitally excluded in a highly digitalized country: An investigation of Swedish outpatients with psychotic disorders and functional impairments. European Journal of Psychiatry, 36(3), 217-221
Open this publication in new window or tab >>Digitally excluded in a highly digitalized country: An investigation of Swedish outpatients with psychotic disorders and functional impairments
2022 (English)In: European Journal of Psychiatry, ISSN 0213-6163, E-ISSN 2340-4469, Vol. 36, no 3, p. 217-221Article in journal (Refereed) Published
Abstract [en]

Access to digital devices and digital services increases accessibility to mental health services. We investigated access to smartphones and digital identification methods (digital-IDs) in an outpatient unit focusing on patients with psychotic disorders and functional impairments. Patients’ case managers completed an online anonymous survey. Most patients (85%) did not have digitalIDs, which is required in Sweden to access digital health care. High age and living in assisted living facilities influenced patients' access to smartphones and digitalID negatively. Even in a highly digitalized society, outpatients with psychotic disorders and functional impairments have much less access to digital technology than the population on average.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Digital divide, Digital technology, Function impairment, Psychotic disorders, Smartphone
National Category
Psychiatry
Identifiers
urn:nbn:se:hj:diva-58060 (URN)10.1016/j.ejpsy.2022.04.005 (DOI)000823277200010 ()2-s2.0-85131251731 (Scopus ID)HOA;;822899 (Local ID)HOA;;822899 (Archive number)HOA;;822899 (OAI)
Available from: 2022-07-26 Created: 2022-07-26 Last updated: 2022-07-26Bibliographically approved
Lindenfalk, B., Gremyr, A., Lundmark, M. & Jacobsson, T. (2022). Digitally mediated schizophrenia care – A Swedish case of translating, designing and expert evaluation of Dialog+. In: P. Otero, P. Scott, S. Z. Martin, & E. Huesing (Ed.), MEDINFO 2021: One world, one health – Global partnership for digital innovation: Proceedings of the 18th World Congress of Medical and Health Informatics. Paper presented at 18th World Congress of Medical and Health Informatics, 2-4 October 2021 (virtual) (pp. 882-886). Amsterdam: IOS Press
Open this publication in new window or tab >>Digitally mediated schizophrenia care – A Swedish case of translating, designing and expert evaluation of Dialog+
2022 (English)In: MEDINFO 2021: One world, one health – Global partnership for digital innovation: Proceedings of the 18th World Congress of Medical and Health Informatics / [ed] P. Otero, P. Scott, S. Z. Martin, & E. Huesing, Amsterdam: IOS Press, 2022, p. 882-886Conference paper, Published paper (Refereed)
Abstract [en]

This work presents initial results of translation, design, development and expert testing of a digitally mediated dialogue based tool for schizophrenia care in Sweden. Dialog+ is a conversational methodology that has been shown to empower patients, promote co-produced and more cost-effective care. Dialog+ was translated and the digital application was redesigned to fit with the local context using human-centered design principles. Initial results of expert user testing, using heuristic evaluations and cognitive walkthroughs, shows promise for the method to work well also in Swedish settings. Initial testing with patients shows promising results. This work exemplifies how care patterns can be improved by considering the information layer of the interaction and creating shared and collaborative working spaces during treatment sessions can help to both empower patients and facilitate a more co-produced treatment plan.

Place, publisher, year, edition, pages
Amsterdam: IOS Press, 2022
Series
Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365 ; 290
Keywords
Schizophrenia, Empowerment, Digital Technology
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-56997 (URN)10.3233/SHTI220206 (DOI)2-s2.0-85131474213 (Scopus ID)978-1-64368-264-8 (ISBN)978-1-64368-265-5 (ISBN)
Conference
18th World Congress of Medical and Health Informatics, 2-4 October 2021 (virtual)
Available from: 2022-06-09 Created: 2022-06-09 Last updated: 2022-07-25Bibliographically approved
Holmberg, C., Torgerson, J. & Gremyr, A. (2022). Elevated pulse pressure and its associations with demographic and clinical parameters in a clinically representative sample of outpatients with psychotic disorders. BJPsych Open, 8(3), Article ID e79.
Open this publication in new window or tab >>Elevated pulse pressure and its associations with demographic and clinical parameters in a clinically representative sample of outpatients with psychotic disorders
2022 (English)In: BJPsych Open, E-ISSN 2056-4724, Vol. 8, no 3, article id e79Article in journal (Refereed) Published
Abstract [en]

Elevated pulse pressure is associated with metabolic and neurocognitive diseases. Preliminary small-scale studies among patients with psychotic disorders have indicated that these patients had an increased pulse pressure compared with controls. However, it is unclear whether and how these associations are manifested among larger heterogenous samples of patients with psychotic disorders. We examined elevated pulse pressure and its associations with demographic and clinical characteristics in a clinically representative sample of outpatients with psychotic disorders (n = 1289). In a subsample (n = 343), we also examined associations with six domains of functioning. Controlling for age and cardiovascular disease, body mass index (BMI) and employment status independently predicted the odds ratio of having elevated pulse pressure. Elevated pulse pressure was also primarily associated with the physical domains of functioning. Outpatients with psychotic disorders that have high BMI and are unemployed thus seem to be at increased risk for elevated pulse pressure and should therefore be particularly considered for blood pressure screenings.

Place, publisher, year, edition, pages
Cambridge University Press, 2022
Keywords
Psychotic disorders, schizophrenia, outpatient treatment, comorbidity, primary care
National Category
Psychiatry
Identifiers
urn:nbn:se:hj:diva-56245 (URN)10.1192/bjo.2022.52 (DOI)000779749300001 ()35388791 (PubMedID)2-s2.0-85128860680 (Scopus ID)HOA;;808001 (Local ID)HOA;;808001 (Archive number)HOA;;808001 (OAI)
Available from: 2022-04-21 Created: 2022-04-21 Last updated: 2022-05-10Bibliographically 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
Gremyr, A. (2022). Improving health with and for individuals with schizophrenia using a learning health system approach: From idea to daily practice. (Doctoral dissertation). Jönköping: Jönköping University, School of Health and Welfare
Open this publication in new window or tab >>Improving health with and for individuals with schizophrenia using a learning health system approach: From idea to daily practice
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Psychotic disorders like schizophrenia have a typical onset in early adulthood with symptoms of hallucinations and disturbances of thought. Despite knowledge on what constitutes effective schizophrenia care, more than 70% of treatment attempts fail in Sweden, sometimes leading to early death. An appraisal of schizophrenia care shows a lack of ways to jointly plan and evaluate care, and an absence of a trustworthy theory-of-change. The Learning Health System (LHS) is a vision that has been translated into theories and models associated with improved outcomes for patients with other chronic conditions. The aim of this thesis is to enhance the understanding of the applicability of the LHS vision in the context of schizophrenia care, from the perspectives of both individuals and the health system in enabling coproduction of better health by addressing two research questions:

i) How can improvement of health for individuals with schizophrenia and improvement of system performance be supported by coproduction in an LHS model?

ii) Can an LHS-based intervention, i.e. the use of a point of care dashboard, contribute to better health for individuals with schizophrenia?

Studying the existing published knowledge of LHS show that the concept has not yet been applied in mental healthcare settings but has potential to increase patient coproduction, continuous improvement and better health. Different forms of coproduction are supported in the most comprehensive LHS models and applications, ranging from dashboards at point of care to platforms that can help facilitate improvement initiatives.

A case study, focused on studying the use and usefulness of a point-of-care dashboard at patient visits in outpatient care at the Department of Schizophrenia Spectrum Disorders at Sahlgrenska University Hospital in western Sweden. Use of the dashboard is associated with improved communication and health for patients. Assessment of the dashboard-project’s complexity using the Non-adoption, abandonment, scale-up, spread and sustainability complexity assessment tool (NASSS-CAT) was perceived as helpful in evaluating challenges and provided insight that can guide future development. An LHS model, that builds on both the reviewing of the literature and practical testing, is proposed.

Further research is proposed in two areas, exploration of how dashboard initiatives can support coproduction and better health for individuals with complex chronic conditions and further development of LHS models by studying different LHS initiatives regarding system properties, forms of coproduction at play and effects on health outcomes for individuals and populations.

Abstract [sv]

Schizofreni och liknande psykossjukdomar debuterar vanligtvis i ung vuxen ålder med symtom som vanföreställningar och tankestörningar, vilket bidrar till svårigheter av många slag, t ex att etablera och upprätthålla relationer. Dessa tillstånd har omfattande påverkan på individers hälsa och välbefinnande, och genererar stora samhällskostnader. Trots att det finns kunskap om vad som utgör effektiva behandlingar så avbryts över 70% av behandlingsförsök i förtid i Sverige, vilket ibland leder till för tidig död. En kartläggning av psykos- och schizofrenivård i några regioner visar på svårigheter för både patienter och behandlare att systematiskt navigera mot bättre hälsa för individer. Detta beror dels på bristande sätt att gemensamt planera och utvärdera vård, och på avsaknad av en trovärdig teori om hur förändring kan drivas. Visionen om det lärande hälsosystemet (eng. Learning Health System, LHS) har omsatts till teorier och modeller som använts för att systematiskt förbättra hälsoutfall för patienter med andra kroniska tillstånd. Syftet med denna avhandling är att öka förståelsen för LHS och dess användbarhet inom schizofreni- och psykosvård i samskapandet av bättre hälsa, både ifrån patientens och hälso- och sjukvårdssystemets perspektiv. Detta syfte adresseras genom två forskningsfrågor:

i) Hur kan förbättring av hälsa för individer med schizofreni och förbättring av systemets funktion stödjas genom samskapande (eng. coproduction) i en LHS modell?

ii) Kan en LHS-baserad intervention, användningen av en digital patientöversikt under vårdbesök, bidra till bättre hälsa för individer med schizofreni?

Två processer med olika forskningsdesign har använts. Den första processen har fokuserat på att samla, kartlägga, diskutera och utvärdera tillgänglig forskningslitteratur om LHS funktionalitet och karaktäristika genom att använda olika metoder för litteraturgenomgång. I den andra processen tillämpas fallstudiemetodik, grundat på den första processen, fast med fokus på att utvärdera lokal utveckling och testning inom psykosvård på Sahlgrenska universitetssjukhuset i Göteborg, av nya arbetssätt som bygger på idéer om LHS. Detta gjordes genom att studera användning och nytta aven patientöversikt för schizofreni utformad för att användas av patienter och behandlare under vårdbesök inom öppenvård.

Litteraturgenomgången visar att LHS idéer ännu inte tillämpats inom psykiatrisk vård, men att det finns potential att öka samskapande, kontinuerliga förbättringar och stödja bättre hälsa. Olika former av samskapande stöds i de mest kompletta LHS modellerna och dess tillämpningar i praktiken. De stödjer mobilisering av intressenters resurser och engagemang i strävan mot ett gemensamt mål, med stöd av teknologier, allt från patientöversikter till stöd under besök till sociala-medie-liknande plattformar som kan stödja kommunikation, utbyte av material och gemensamma förbättringsinitiativ. Fallstudien visade positiva resultat associerade till förbättrad kommunikation och hälsa för individer i psykosvård, när de använde patientöversikten under besök i vården. Kartläggning av patientöversiktsprojektets komplexitet med verktyget NASSS-CAT (the Non-adoption, Abandonment, Scale-up, Spread and Sustainability-Complexity Assessment Tool) uppfattades som användbart för att förstå och utvärdera utmaningar och bidrog till insikter som stödjer den fortsatt utvecklingen. Utifrån avhandlingens delarbeten föreslås en modell som grund för fortsatt utveckling av ett LHS för psykiatri.

LHS egenskaper som kan guida fortsatt utveckling har identifierats genom arbetet med denna avhandling: i) identifiera systemet som ett komplext adaptivt system, ii) stödja samskapande mellan aktörer, iii) använda stödjande teknik, iv) för att möjliggöra fullständiga lärcykler, v) och använda utfallsmått för att guida förbättringar. Identifierade svårigheter, såväl i litteraturen som i empiriska studier, i att omsätta LHS-idéer, beror sannolikt på olika syn på kunskap, och om komplexitet adresseras eller inte. Framtida forskning föreslås inom två områden. För det första, fortsatt utforskande av olika patientöversiktsinitiativ för att undersöka vilka egenskaper, funktioner och former för samarbete som stödjer samskapande av bättre hälsa för individer med komplexa kroniska tillstånd. För det andra, teorier och modeller över hur förändring kan drivas blir aldrig färdiga utan kan kontinuerligt utvecklas. En LHS-modell, som den som föreslås i denna avhandling, kan användas och fortsätta utvecklas genom att studera olika LHS-initiativ när det gäller systemegenskaper, olika former av samskapande och effekter på hälsoutfall för individer och populationer.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2022. p. 113
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 114
Keywords
Coproduction; Learning Health Systems; Schizophrenia, Severe Mental Illness; Psychiatry; Quality Improvement; Improvement Science; Complex Adaptive Systems
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Psychiatry
Identifiers
urn:nbn:se:hj:diva-56234 (URN)978-91-88669-13-1 (ISBN)
Public defence
2022-05-25, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2022-04-20 Created: 2022-04-20 Last updated: 2022-04-21Bibliographically approved
Holmberg, C., Gremyr, A., Torgerson, J. & Mehlig, K. (2021). Clinical validity of the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders. BMC Psychiatry, 21(1), Article ID 147.
Open this publication in new window or tab >>Clinical validity of the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders
2021 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 21, no 1, article id 147Article in journal (Refereed) Published
Abstract [en]

Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) is a self-administered instrument to assess functional impairment. It is used in the general population as well as different patient groups. However, its application to patients with psychotic disorders may be hampered by disease-specific difficulties of self-estimation. This study aimed to examine the psychometric properties of the short (12-item) WHODAS-2.0 in a naturalistic sample of outpatients attending a psychosis clinic in Gothenburg, Sweden. Methods: Annual data from two outpatient clinics registered 2016–2019 were analyzed retrospectively. The assessment of the short WHODAS-2.0 was based on the first questionnaire completed by 881 patients. Confirmatory factor analysis evaluated previously validated models. Item convergent and discriminant validity as well as internal reliability were computed. Construct validity was assessed by comparing mean differences in accord with previous research regarding patients’ characteristics associated with functioning such as advanced age, diagnosed comorbidities, antipsychotic treatment status, and symptom severity measured with PANSS-8 remission items. Results: A heterogeneous sample was obtained in terms of age (range: 20–92), various living situations, and different geographic areas of birth. Most patients (75%) had been diagnosed with psychotic disorders more than 10 years ago and the majority (89%) were on antipsychotic medication. We confirmed an adjusted two-level factor model with a single second-order disability factor and six first-order factors representing the six IFC dimensions. The WHODAS-2.0 sum score measuring general disability showed good reliability (Cronbach's alpha = 0.89). Construct validity was confirmed as older patients, patients with comorbidities, and patients in assisted living had higher WHODAS-2.0 scores. Patients with no or mild psychotic symptoms had significantly lower WHODAS-2.0 sum scores than patients with more severe symptoms. Conclusions: The findings further validate the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders. This study corroborates the clinical significance of the short, 12-item WHODAS-2.0 by demonstrating consistent associations between patients’ age, medical comorbidities, living situation, antipsychotic treatment status, and psychotic symptom severity.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Assessment, Disability, IFC, PANSS, Psychometrics, Psychotic disorders, Validity, WHODAS-2.0
National Category
Psychiatry
Identifiers
urn:nbn:se:hj:diva-52065 (URN)10.1186/s12888-021-03101-9 (DOI)000627834400005 ()33691655 (PubMedID)2-s2.0-85102391996 (Scopus ID)GOA;;1538878 (Local ID)GOA;;1538878 (Archive number)GOA;;1538878 (OAI)
Available from: 2021-03-22 Created: 2021-03-22 Last updated: 2024-01-17Bibliographically approved
Gremyr, A., Andersson-Gäre, B., Thor, J., Elwyn, G., Batalden, P. B. & Andersson, A.-C. (2021). The role of co-production in Learning Health Systems. International Journal for Quality in Health Care, 33(Supplement 2), ii26-ii32
Open this publication in new window or tab >>The role of co-production in Learning Health Systems
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2021 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 33, no Supplement 2, p. ii26-ii32Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Co-production of health is defined as 'the interdependent work of users and professionals who are creating, designing, producing, delivering, assessing, and evaluating the relationships and actions that contribute to the health of individuals and populations'. It can assume many forms and include multiple stakeholders in pursuit of continuous improvement, as in Learning Health Systems (LHSs). There is increasing interest in how the LHS concept allows integration of different knowledge domains to support and achieve better health. Even if definitions of LHSs include engaging users and their family as active participants in aspects of enabling better health for individuals and populations, LHS descriptions emphasize technological solutions, such as the use of information systems. Fewer LHS texts address how interpersonal interactions contribute to the design and improvement of healthcare services.

OBJECTIVE: We examined the literature on LHS to clarify the role and contributions of co-production in LHS conceptualizations and applications.

METHOD: First, we undertook a scoping review of LHS conceptualizations. Second, we compared those conceptualizations to the characteristics of LHSs first described by the US Institute of Medicine. Third, we examined the LHS conceptualizations to assess how they bring four types of value co-creation in public services into play: co-production, co-design, co-construction and co-innovation. These were used to describe core ideas, as principles, to guide development.

RESULT: Among 17 identified LHS conceptualizations, 3 qualified as most comprehensive regarding fidelity to LHS characteristics and their use in multiple settings: (i) the Cincinnati Collaborative LHS Model, (ii) the Dartmouth Coproduction LHS Model and (iii) the Michigan Learning Cycle Model. These conceptualizations exhibit all four types of value co-creation, provide examples of how LHSs can harness co-production and are used to identify principles that can enhance value co-creation: (i) use a shared aim, (ii) navigate towards improved outcomes, (iii) tailor feedback with and for users, (iv) distribute leadership, (v) facilitate interactions, (vi) co-design services and (vii) support self-organization.

CONCLUSIONS: The LHS conceptualizations have common features and harness co-production to generate value for individual patients as well as for health systems. They facilitate learning and improvement by integrating supportive technologies into the sociotechnical systems that make up healthcare. Further research on LHS applications in real-world complex settings is needed to unpack how LHSs are grown through coproduction and other types of value co-creation.

Place, publisher, year, edition, pages
Oxford University Press, 2021
Keywords
Learning Health System, co-production, health quality improvement, health service research, patient-centred care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-55438 (URN)10.1093/intqhc/mzab072 (DOI)000755791300008 ()34849971 (PubMedID)2-s2.0-85121281643 (Scopus ID)HOA;intsam;787557 (Local ID)HOA;intsam;787557 (Archive number)HOA;intsam;787557 (OAI)
Available from: 2022-01-04 Created: 2022-01-04 Last updated: 2022-04-20Bibliographically approved
Allerby, K., Goulding, A., Ali, L., Gremyr, A. & Waern, M. (2020). Person-Centered Psychosis Care How Increasing Person-Centeredness In Psychosis Inpatient Care Relate To Care Consumption And Ward Burden. Paper presented at Congress of the Schizophrenia-International-Research-Society (SRIS), APR 04-08, 2020, Florence, ITALY. Schizophrenia Bulletin, 46(Supplement 1), S323-S323
Open this publication in new window or tab >>Person-Centered Psychosis Care How Increasing Person-Centeredness In Psychosis Inpatient Care Relate To Care Consumption And Ward Burden
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2020 (English)In: Schizophrenia Bulletin, ISSN 0586-7614, E-ISSN 1745-1701, Vol. 46, no Supplement 1, p. S323-S323Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Oxford University Press, 2020
National Category
Psychiatry Nursing
Identifiers
urn:nbn:se:hj:diva-50346 (URN)000537751800736 ()
Conference
Congress of the Schizophrenia-International-Research-Society (SRIS), APR 04-08, 2020, Florence, ITALY
Available from: 2020-08-21 Created: 2020-08-21 Last updated: 2022-02-05Bibliographically approved
Greenhalgh, T., Maylor, H., Shaw, S., Wherton, J., Papoutsi, C., Betton, V., . . . Taylor, J. (2020). The NASSS-CAT Tools for Understanding, Guiding, Monitoring, and Researching Technology Implementation Projects in Health and Social Care: Protocol for an Evaluation Study in Real-World Settings. JMIR Research Protocols, 9(5), Article ID e16861.
Open this publication in new window or tab >>The NASSS-CAT Tools for Understanding, Guiding, Monitoring, and Researching Technology Implementation Projects in Health and Social Care: Protocol for an Evaluation Study in Real-World Settings
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2020 (English)In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 9, no 5, article id e16861Article in journal (Refereed) Published
Abstract [en]

Background: Projects to implement health care and social care innovations involving technologies are typically ambitious and complex. Many projects fail. Greenhalgh et al’s nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to analyze the varied outcomes of such projects.

Objective: We sought to extend the NASSS framework to produce practical tools for understanding, guiding, monitoring, and researching technology projects in health care or social care settings.

Methods: Building on NASSS and a complexity assessment tool (CAT), the NASSS-CAT tools were developed (in various formats) in seven co-design workshops involving 50 stakeholders (industry executives, technical designers, policymakers, managers, clinicians, and patients). Using action research, they were and are being tested prospectively on a sample of case studies selected for variety in conditions, technologies, settings, scope and scale, policy context, and project goals.

Results: The co-design process resulted in four tools, available as free downloads. NASSS-CAT SHORT is a taster to introduce the instrument and gauge interest. NASSS-CAT LONG is intended to support reflection, due diligence, and preliminary planning. It maps complexity through stakeholder discussion across six domains, using free-text open questions (designed to generate a rich narrative and surface uncertainties and interdependencies) and a closed-question checklist; this version includes an action planning section. NASSS-CAT PROJECT is a 35-item instrument for monitoring how subjective complexity in a technology implementation project changes over time. NASSS-CAT INTERVIEW is a set of prompts for conducting semistructured research or evaluation interviews. Preliminary data from empirical case studies suggest that the NASSS-CAT tools can potentially identify, but cannot always help reconcile, contradictions and conflicts that block projects’ progress.

Conclusions: The NASSS-CAT tools are a useful addition to existing implementation tools and frameworks. Further support of the implementation projects is ongoing. We are currently producing digital versions of the tools, and plan (subject to further funding) to establish an online community of practice for people interested in using and improving the tools, and hold workshops for building cross-project collaborations. International Registered Report Identifier (IRRID): DERR1-10.2196/16861

Place, publisher, year, edition, pages
JMIR Publications, 2020
Keywords
evaluation, complexity, theory-driven evaluation, diffusion of innovation, scale-up, sustainability, implementation, NASSS (nonadoption, abandonment, scale-up, spread, sustainability) framework, innovation adoption, project management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-55437 (URN)10.2196/16861 (DOI)000537952500016 ()32401224 (PubMedID)2-s2.0-85095789154 (Scopus ID)GOA;intsam;787460 (Local ID)GOA;intsam;787460 (Archive number)GOA;intsam;787460 (OAI)
Funder
Wellcome trust, WT104830MA
Available from: 2022-01-03 Created: 2022-01-03 Last updated: 2024-01-17Bibliographically approved
Gremyr, A., Andersson-Gäre, B., Greenhalgh, T., Malm, U., Thor, J. & Andersson, A.-C. (2020). Using complexity assessment to inform the development and deployment of a digital dashboard for schizophrenia care: Case study. Journal of Medical Internet Research, 22(4), Article ID e15521.
Open this publication in new window or tab >>Using complexity assessment to inform the development and deployment of a digital dashboard for schizophrenia care: Case study
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2020 (English)In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 22, no 4, article id e15521Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care.

OBJECTIVE: This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders' experiences with using NASSS-CAT, and practical implications.

METHODS: We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness.

RESULTS: Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described.

CONCLUSIONS: This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general.

Place, publisher, year, edition, pages
JMIR Publications, 2020
Keywords
complexity, coproduction, health care, learning health systems, schizophrenia
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-48322 (URN)10.2196/15521 (DOI)000527880000001 ()32324143 (PubMedID)2-s2.0-85083949192 (Scopus ID)GOA HHJ 2020;HHJIMPROVEIS (Local ID)GOA HHJ 2020;HHJIMPROVEIS (Archive number)GOA HHJ 2020;HHJIMPROVEIS (OAI)
Available from: 2020-05-11 Created: 2020-05-11 Last updated: 2024-01-17Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6153-2957

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