1.
Olsson, Ulf
(författare)
OM FRISKVÅRDSPEDAGOGIK I ARBETSLIVET. : EN O/RÄTTVIS BETRAKTELSE.
1993
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
I fokus för detta arbete står friskvård inom arbetslivet som pedagogisk praktik med hälsoprofilsbedömning, en metod för undersökning och påverkan av människors hälsostatus och hälsovanor, som konkret exempel. En bakgrund till detta är framväxten av insatser för folkhälsa och den ökade betoning av friskvård inom arbetslivet som skett inom såväl privat som offentlig sektor. Friskvård handlar om människors levnadsvanor när det gäller kost, motion, stress, alkohol, tobak m.m.Hälsoprofilsbedömning och friskvårdspedagogik inom arbetslivet ses här ur två olika perspektiv. Ur det ena perspektivet behandlas verksamheten på dess egna villkor - som en metod att inom ramen för arbetslivet få till stånd ner hälsosamma livsstilar genom kontrakt mellan självständiga parter. Det andra perspektivet kan ses som kritiskt granskande. Här ifrågasätts premissema för hälsoprofilsbedömningen utifrån begrepp som makt och disciplinering. En inspirationskälla har därvid bland annat Michel Foucaults arbeten varit. Som empiriskt material för analysen används två avhandlingar som presenterar hälsoprofilbedömningen som metod.Ur dessa båda perspektiv erhålles två olika betraktelser om hälsoprofilsbedömning och friskvårdspedagogik inom arbetslivet - en rättvis och en orättvis. På basis av en kritisk pragmatisk ansats diskuteras möjligheten till ett samtal baserad på relationen mellan de båda betrakelserna.
2.
Cakici, Baki, 1984-
(författare)
Disease surveillance systems
2011
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Recent advances in information and communication technologies have made the development and operation of complex disease surveillance systems technically feasible, and many systems have been proposed to interpret diverse data sources for health-related signals. Implementing these systems for daily use and efficiently interpreting their output, however, remains a technical challenge. This thesis presents a method for understanding disease surveillance systems structurally, examines four existing systems, and discusses the implications of developing such systems. The discussion is followed by two papers. The first paper describes the design of a national outbreak detection system for daily disease surveillance. It is currently in use at the Swedish Institute for Communicable Disease Control. The source code has been licenced under GNU v3 and is freely available. The second paper discusses methodological issues in computational epidemiology, and presents the lessons learned from a software development project in which a spatially explicit micro-meso-macro model for the entire Swedish population was built based on registry data.
3.
Miedema, Elke, 1985
(författare)
HEALTH PROMOTION AND HEALTHCARE ARCHITECTURE - Conceptualizations of Health Promotion in relation to Healthcare Building Design
2017
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Background: Today's healthcare system is under development and reorienting and adapting to embrace a person centred and holistic perspective on health, including a focus on health promotion. This reorientation results in changes in the healthcare models, processes as well as it sets new requirements for healthcare building design. A vast majority of research has been devoted to the relation between inpatient healthcare building design and individual health, e.g. how our hospitals affects treatments and patient outcomes. Less attention has been paid to the relation between outpatient healthcare building design and public or population health and wellbeing, e.g. healthcare in the community to lessen the load on large hospitals. At the same time as the aforementioned development is happening there is a growing body of research emphasizing the importance of the built environment for public health. Objective: This licentiate thesis aim to explore conceptualizations of health promotion in the context of outpatient healthcare building design, the aim is to enable a broader platform to enable incorporation of several health promotion perspectives into future healthcare building design. The main research question is: How is health promotion conceptualized in the context of outpatient healthcare building design? In addition, several other questions emerged in the research process: What aspects of building design result in health-promoting building design? How is health-promoting building design conceptualized in the literature and in practice? What tools and outcomes are referred to when evaluating health-promoting building design? Methods: The research included two studies with an explorative approach: a scoping review and a content analysis of interviews. Results: The results present different conceptualizations of health promotion in the context of healthcare building design. In addition, the results provide an interpretation of health-promoting building design. The results also relate to health promotion strategies, perspectives on health-promoting building design and some aspects of building design that can contribute to, or prevent, health promotion. Discussion: The discussion emphasizes challenges related to developing health-promoting building design, such as vague and contradicting definitions and interpretations of core concepts as health promotion and itís interpretation in the built environment. In addition, the discussion highlights the challenges associated with evaluating health-promoting building design. Conclusions: Health promotion perspectives, have been shown to influence healthcare building design through altered implications for the built environment. As shown, healthcare building design thus seems to have the opportunity to promote the health and wellbeing of patients, staff, visitors and the community. However, the vocabulary used to address health promotion, the different perspectives and health-promotion is weak and inconsistent. The thesis therefore proposed definitions for health promotion and health-promoting building design, that might guide future research and discussions on health promotion vocabulary. Future research should focus on developing the health-promoting building design vocabulary, collecting examples of health-promoting building design, relating health promotion theory to existing architecture theory, and methods and outcomes to evaluate health-promotion building design.
4.
Sandberg, Johanna, 1981-
(författare)
Institutionally Shaped Response to the Introduction of National Guidelines : Case Studies in the Swedish Regional Health Policy Arena
2018
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
The purpose of this thesis is to explore the institutionally shaped response to the introduction of the national guidelines on the Swedish regional health policy arena. The thesis consists of two case studies. Adapting a qualitative approach, the data is based on individual interviews and these were analysed thematically. The first paper explores the response by four Swedish regional health authorities to the introduction of the National Guidelines for Cardiac Care, while the second paper aims to broaden the understanding of how the national guidelines are used for strategic purposes among politicians.As illustrated in this thesis, organizations will respond, adjust and react to external pressure according to conditions shaped by the institutional context. Key findings here are that the national guidelines are a complex policy instrument that, beyond being able to be used in an instrumental fashion by the medical managment, can also serve a legitimizing function for political decision-makers.The goals of the national guidelines, i.e. equal and efficient care, and the uncertainty about who, among multiple stakeholders, is responsible for the guidelines in the regional health authority, is a source of ambiguity and potential conflict. Those who are potentially responsible represent different rationales – a political rationale and a scientific rationale. The dominating scientific rationale of the national guidelines can create instability, when pushing towards the use of explicit priority-setting.Priority-setting in the institutional setting of a regional health authority has strong elements of becoming “wicked problems” since the dilemma of prioritization remains regardless of ambitions to apply a “technocratic fix”. A wicked problem is characterized by high complexity and being persistently hard to solve (Williams et al. 2012). A recurring dilemma is that priority-setting still contains many wicked problems, as social values and political considerations remain important parts of the policy process. One weakness of the national guidelines, identified in this thesis, is that the guidelines discuss each service area separately, and thereby reinforce a silo mentality in the Swedish health policy arena.To sum up, the national guidelines create a multifaceted and complex response in the Swedish health policy arena where different rationalities collide, and where conflicts appear and are dealt with within the regional health authorities.
5.
Anskär, Eva, 1957-
(författare)
Time flies in primary care : a study on time utilisation and perceived psychosocial work environment
2019
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Background: Time utilisation among primary care professionals has been affected by structural changes and reorganisation performed in Swedish primary care over several decades. The work situation is complex with a heavy administrative work load. The overall aim with this thesis was to describe time utilisation among staff in Swedish primary care and to investigate associations with perceived psychosocial work environment and legitimacy of work tasks.Methods: A multicentre, descriptive, cross-sectional study design was used including all staff categories in primary care i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals (physiotherapists, occupational therapists, psychologists, counsellors, dieticians and chiropodists) at eleven primary care centres located in southeast Sweden. The data collection consisted of a questionnaire including a subjective estimate of workload, the Bern Illegitimate Tasks Scale (BITS) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Also, a time study was performed, where the participants reported their work time based on three main categories; direct patient work tasks, indirect patient work tasks and other work tasks, each with a number of subcategories. The participants reported time spent on different work tasks, day by day during two separate weeks. Response rates were 75% for the questionnaire and 79% for the time study.Results: In paper I the time study revealed that health professionals at the primary care centres spent 37% of their work time with direct patient work tasks. All professions estimated a higher proportion of time spent directly with patients than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress and role conflicts. The proportion of administrative work tasks was associated with role conflicts, the more administration the more role conflicts. Findings in paper II were that more than a quarter of physicians scored above the cut-off value for BITS regarding unnecessary work tasks, which was significantly more than the proportion observed in all other professions in the survey. Across all staff groups, a perception of having to perform illegitimate work tasks was associated with experiencing negative psychosocial work environment and with high proportion of administrative-related work tasks.Conclusions: Swedish primary care staff spend a limited proportion of their work time directly with patients and primary care physicians perceive the psychosocial work environment in negative terms to a greater extent than all other staff members. Allocation of work tasks has an influence on the perceived psychosocial work environment. The perception of having a large number of illegitimate work tasks affects the psychosocial work environment negatively, which might influence the perception the staff have of their professional roles. Perception of high proportion of unreasonable work tasks is associated with a high proportion of non-patient-related administration.This thesis illuminates the importance of decision makers thoroughly considering the distribution and allocation of non-patient related work tasks among staff in primary care, in order to achieve efficient use of personnel resources and favourable working conditions. Hopefully, the results of this study will contribute to further development of primary care so that medical competence will benefit patients as much as possible.
6.
Ashfaq, Awais, 1990-
(författare)
Predicting clinical outcomes via machine learning on electronic health records
2019
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
The rising complexity in healthcare, exacerbated by an ageing population, results in ineffective decision-making leading to detrimental effects on care quality and escalates care costs. Consequently, there is a need for smart decision support systems that can empower clinician's to make better informed care decisions. Decisions, which are not only based on general clinical knowledge and personal experience, but also rest on personalised and precise insights about future patient outcomes. A promising approach is to leverage the ongoing digitization of healthcare that generates unprecedented amounts of clinical data stored in Electronic Health Records (EHRs) and couple it with modern Machine Learning (ML) toolset for clinical decision support, and simultaneously, expand the evidence base of medicine. As promising as it sounds, assimilating complete clinical data that provides a rich perspective of the patient's health state comes with a multitude of data-science challenges that impede efficient learning of ML models. This thesis primarily focuses on learning comprehensive patient representations from EHRs. The key challenges of heterogeneity and temporality in EHR data are addressed using human-derived features appended to contextual embeddings of clinical concepts and Long-Short-Term-Memory networks, respectively. The developed models are empirically evaluated in the context of predicting adverse clinical outcomes such as mortality or hospital readmissions. We also present evidence that, surprisingly, different ML models primarily designed for non-EHR analysis (like language processing and time-series prediction) can be combined and adapted into a single framework to efficiently represent EHR data and predict patient outcomes.
7.
Berezecki Mårtensson, Maria, 1974
(författare)
Den fysiska vårdmiljöns påverkan på vårdpersonal och patienter på operationssalar och intensivvårdsavdelningar
2015
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
The high technology environment for health care is highly resource consuming in terms of economic investment, operating costs and human contributions. Therefore providing effective and efficient health care is of great importance. This licentiate thesis discusses the role of ar-chitectural design and its successful contribution to improved patient outcomes and health care professionals’ working conditions (Hamilton and McCuskey Shepley, 2009). Although many health care high technologies are available today they often cause negative side effects putting constraints on patients and staff (Hamilton and McCuskey Shepley, 2009, Ulrich et al., 2004). Identified and recognized basic environmental elements of health care architecture must be considered in order to provide positive effects on patients and staff. This study examined a group of elements particularly recognized for the intensive care units and operating theatres that has impacts on patient recovery and staff well-being. These include light, air quality, noise, temperature and humidity, noise, daylight, orientation, nature, dis-tance, distraction and accessibility.For data collection a setup combination of qualitative and quantitative methods were applied. They consisted in literature reviews, reference group workshops, focus group seminars and conducted questionnaires.The study provides findings and an improved understanding of relevant environmental design issues related to intensive care units and operating theatres. The studied material substantiates arguments that are supported by evidence concerning impacts of environmental design on pa-tient recovery and staff performance, including patient’s experience, successful treatment out-comes and satisfaction with working conditions. The results from the study are considered valid for medical personnel and health care planning architects and designers.
8.
Colldén, Christian, 1983
(författare)
At the End of the Funnel: Translation of Improvement Approaches in Healthcare
2018
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Myriad approaches aimed to improve different aspects of healthcare organizations, such as Lean healthcare and patient-centered care, are presented to managers in pursuit of operational improvements. At the same time, the focus of healthcare improvement is shifting from quality to value, and value-based healthcare has become one of the more bespoken contemporary improvement approaches (IA). However, many attempts to implement such IAs have failed. One vital factor for the successful application of IAs is the process of implementation, for which several guiding frameworks have been presented. However, other scholars have challenged the often instrumental view applied in implementation science by proposing that IAs – which are more ambiguous than more technical care interventions – are translated into a context, implying a greater acceptance for transformations of the original concepts. This thesis builds on a participative, longitudinal single-case study of implementation of value-based healthcare to the context of psychiatry, using qualitative methods and elements of action research. Focusing on the aspects of content, context, and process of the implementation, a model is proposed for how IAs can be viewed and handled as moldable concepts that are translated into a context-dependent local management model in the target organization. The thesis suggests that both practitioners and scholars could benefit from actively considering the contexts in which IAs are applied, including preexisting IAs and attitudes among organization members, to better grasp the complexity of healthcare management.
9.
Dahlin, Sara, 1980
(författare)
Understanding quality improvement in care: The case of public care procurement and process mining
2017
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Healthcare is facing challenges of increased cost and complexity originating from factors such as new technology and diversified treatments, increased life expectancy, an ageing population, and multi-comorbidity, making the need for Quality Improvement (QI) in care highly relevant. This is, however, easier said than done, considering that healthcare is complex, dynamic, ad-hoc, and multidisciplinary. Additionally, despite efforts taken, improvement initiatives sometimes fail or could potentially be improved further. QI in care has been defined as ´...the combined and unceasing efforts of everyone - healthcare professionals, patients and their families, researchers, payers, planners and educators - to make changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)...´. To understand care and find new ways of further improving care, inspiration is sometimes taken from other research fields and subjects. This thesis continues that journey by identifying an existing context and methodology that may support and drive QI efforts. The purpose of this thesis is to explore how QI in care can be understood by expanding QI application into a new context and through the support of a new methodology. Although a significant amount of care is handled through public procurement, there is little understanding of this system's potential for QI. To explore how QI applications can be expanded into the context of public care procurement, one study in the thesis analyzes procurement documents and performs interviews with municipalities. Identified QI criteria were statistically analyzed for correlation to procurement-specific statistics. Although legal requirements sometimes work against QI, such as through advocating static requirements rather than the flexibility necessary to QI, this thesis identified potential ways to support and drive QI through public care procurement. One way to achieve QI is through a focus on process and a use of planned to-be care pathways. However, since as-is care pathways, based on documented patient data, are often highly variable, they are seldom possible to recognize through mainstream pathway analysis, e.g. process mapping. Therefore, care variation may need to be better understood to attain the desired improvement. Process mining is a recently developed methodology in which knowledge is extracted from event logs based on individual patient data to produce process maps including all pathway variation. Despite this method's aim of discovering, monitoring, and improving processes and its application in healthcare settings, improvement efforts are lacking, and few papers address the combination of QI and process mining. This thesis explores how QI may be understood by expanding QI applications into the methodology of process mining both theoretically and empirically. This thesis further elaborates upon the effects public care procurement and process mining have on the theoretical knowledge domains of QI and the practice of QI in care.
10.
Galozy, Alexander, 1991-
(författare)
Data-driven personalized healthcare : Towards personalized interventions via reinforcement learning for Mobile Health
2021
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Medical and technological advancement in the last century has led to the unprecedented increase of the populace's quality of life and lifespan. As a result, an ever-increasing number of people live with chronic health conditions that require long-term treatment, resulting in increased healthcare costs and managerial burden to the healthcare provider. This increase in complexity can lead to ineffective decision-making and reduce care quality for the individual while increasing costs. One promising direction to tackle these issues is the active involvement of the patient in managing their care. Particularly for chronic diseases, where ongoing support is often required, patients must understand their illness and be empowered to manage their care. With the advent of smart devices such as smartphones, it is easier than ever to provide personalised digital interventions to patients, help them manage their treatment in their daily lives, and raise awareness about their illness. If such new approaches are to succeed, scalability is necessary, and solutions are needed that can act autonomously without costly human intervention. Furthermore, solutions should exhibit adaptability to the changing circumstances of an individual patient's health, needs and goals. Through the ongoing digitisation of healthcare, we are presented with the unique opportunity to develop cost-effective and scalable solutions through Artificial Intelligence (AI).This thesis presents work that we conducted as part of the project improving Medication Adherence through Person-Centered Care and Adaptive Interventions (iMedA) that aims to provide personalised adaptive interventions to hypertensive patients, supporting them in managing their medication regiment. The focus lies on inadequate medication adherence (MA), a pervasive issue where patients do not take their medication as instructed by their physician. The selection of individuals for intervention through secondary database analysis on Electronic Health Records (EHRs) was a key challenge and is addressed through in-depth analysis of common adherence measures, development of prediction models for MA and discussions on limitations of such approaches for analysing MA. Furthermore, providing personalised adaptive interventions is framed in the contextual bandit setting and addresses the challenge of delivering relevant interventions in environments where contextual information is significantly corrupted. The contributions of the thesis can be summarised as follows: (1) Highlighting the issues encountered in measuring MA through secondary database analysis and providing recommendations to address these issues, (2) Investigating machine learning models developed using EHRs for MA prediction and extraction of common refilling patterns through EHRs and (3) formal problem definition for a novel contextual bandit setting with context uncertainty commonly encountered in Mobile Health and development of an algorithm designed for such environments.
