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| 2. |
- Davoody, Nadia, et al.
(författare)
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Accessing and sharing health information for post-discharge stroke care through a national health information exchange platform : a case study
- 2019
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Ingår i: BMC Medical Informatics and Decision Making. - : Springer Science and Business Media LLC. - 1472-6947. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Patients and citizens need access to their health information to get a retrospective as well as a prospective view on their care and rehabilitation processes. However, patients' health information is stored in several health information systems and interoperability problems often hamper accessibility. In Sweden a national health information exchange (HIE) platform has been developed that enables information exchange between different health information systems. The aim of this study is to explore the opportunities and limitations of accessing and interacting with important health information through the Swedish national HIE platform.METHODS:A single case study approach was used for this study as an in-depth understanding of the subject was needed. A fictive patient case with a pseudo-name was created based on an interview with a stroke coordinator in Stockholm County. Information access through the national health information exchange platform and available service contracts and application programming interfaces were studied using different scenarios.RESULTS:Based on the scenarios created in this study, patients would be able to access some health related information from their electronic health records using the national health information exchange platform. However, there is necessary information which is not retrievable as it is either stored in electronic health records and eHealth services which are not connected to the national health information exchange platform or there is no service contract developed for these types of information. In addition, patients are not able to share information with healthcare professionals.CONCLUSION:The national Swedish HIE platform provides the building blocks needed to allow patients online access to their health information in a fragmented and distributed health system. However, more complex interaction scenarios allowing patients to communicate with their health care providers or to update their health related information are not yet supported. Therefore it is of great importance to involve patients throughout the design and evaluation of eHealth services on both national and local levels to ensure that their needs for interoperability and information exchange are met.
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| 3. |
- Davoody, Nadia, et al.
(författare)
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Collaborative interaction points in post-discharge stroke care.
- 2014
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Ingår i: International Journal of Integrated Care. - : Ubiquity Press, Ltd.. - 1568-4156 .- 1568-4156. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Lack of appropriate electronic tools for supporting patient involvement and collaboration with care professionals is a problem in health care.METHODS: Care and rehabilitation processes of post-discharge stroke patients were analysed using the concept of interaction points where patients, next-of-kin and care professionals interact and exchange information. Thirteen interviews with care professionals and five non-participatory observations were performed. Data were analysed using content analysis and modelling of interaction points in the patient journey.RESULTS: Patient participation and interaction patterns vary; patients requiring home care have a passive role and next-of-kin or nurses become advocates by coordinating care on behalf of the patient, whereas patients who are able to visit primary care coordinate their own care by initiating interactions. Important categories of participation include the following: participation in care planning, in monitoring risk factors and in rehabilitation planning.CONCLUSIONS: Designing a supportive electronic tool requires understanding the interactions and patients' activity levels at each interaction point. A tool for patients with higher activity level should support them to coordinate their own care, whereas for a less-active patient group, the tool could focus on supporting next-of-kin and care professionals in motivating, guiding and including passive patients in their care and rehabilitation processes.
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| 4. |
- Davoody, Nadia, et al.
(författare)
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Post-discharge stroke patients' information needs as input to proposing patient-centred eHealth services.
- 2016
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Ingår i: BMC Medical Informatics and Decision Making. - : Springer Science and Business Media LLC. - 1472-6947. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Despite the potential of eHealth services to revolutionize the way healthcare and prevention is provided many applications developed for patients fail to deliver their promise. Therefore, the aim of this study is to use patient journey mapping to explore post-discharge stroke patients' information needs to propose eHealth services that meet their needs throughout their care and rehabilitation processes.METHODS: Three focus groups with younger (<65 years) and older (> = 65 years) stroke patients were performed. Content analysis was used to analyse the data. Stroke patients' information needs was explored using patient journey model.RESULTS: Four main events (discharge from hospital, discharge from rehab clinic, coming home, and clinical encounters) and two phases (at rehab clinic, at home) have been identified in patients' post-discharge journey. The main categories identified in this study indicate that patients not only need to have access to health related information about their care and rehabilitation processes but also practical guidance through healthcare and community services. Patients also have different information needs at different events and during different phases. Potential supportive eHealth services were suggested by the researchers considering different parts of the patients' journeys.CONCLUSIONS: Patient journey models and qualitative analysis of patients' information needs are powerful tools that can be used to improve healthcare from a patient perspective. As patients' understanding of their illness changes over time, their need of more flexible support throughout the care and rehabilitation processes increases. To design appropriate eHealth services that meet patients' information needs, it is imperative to understand the current care and rehabilitation processes and identify patients' information needs throughout their journey.
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| 6. |
- Engström, Sven, 1949-
(författare)
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Quality, costs and the role of primary health care
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis is to describe and analyse the role of primary care in health care systems in terms of health, health care utilisation and costs, and to study the feasibility of retrieval of data from computerised medical records to monitor medical quality.The thesis includes five studies, a systematic literature review, a register study of utilisation of hospital and primary care, a study based on data from computerised medical records of individual patients cost for primary care, and two studies of management of respiratory infections in primary care based on data from computerised medical records of twelve health centres.The general findings of the literature review were that an expansion of the primary care component of the health care system would most likely result in better health, lower hospital care consumption and lower expenses for care. The personal physician and continuity of care were core elements to achieve this, and the significance of the way primary care is organised and funded was evident.In the register study fifty health centres were compared. Age and rates of outpatient hospital visits were the most important factors explaining the variation of rates of hospitalisations between the health centres’ areas. Hospital district also influenced hospitalisation rates in the different health centres’ areas, indicating that the health care structure in the district per se was an important factor. The rates of visits to general practitioners correlated negatively with rates of hospitalisations.The study of costs in primary care showed that the variation in the costs of the individual patients was substantial, also within age groups and within the diagnosis-related Adjusted Clinical Groups (ACG). Age and gender explained a smaller part of the variation in costs per patient in primary care. Adding the ACG weight had a major influence on improving the ability to explain the variation in costs at patient level. The ACG system might be of value in the calculation of weighted capitation in Swedish primary care, but appears to be sensitive to the thoroughness with which physicians register diagnoses.The retrieval of data from computerised medical records comprised a total number of 19 965 encounters for respiratory tract infections i.e. 199 per 1000 inhabitants during the year 2001. Most frequent diagnoses were common cold, acute tonsillitis, and acute bronchitis. The number of antibioticprescriptions was 7 961, accounting for 47% of the episodes. The most commonly prescribed antibiotics were phenoxymethylpenicillin (61%), tetracyclines (18%) and macrolides (8%).A rapid test was performed in 43% of the encounters: for C-reactive protein (CRP) in 31%; for Group A beta-haemolytic streptococci (StrepA) in 22%; and both tests were performed in 10% of the encounters. The findings in the study indicate that StrepA and CRP tests were used too frequently and often with minor contributions to patient management. The frequencies of tests and of antibiotic prescriptions varied greatly between health centres in a way that hardly could be explained by differences in morbidity.Computerised medical records provided a source of clinical information, which might be a feasible and pragmatic method for studying daily practice, and for follow-up of adherence to guidelines in general practice.
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| 7. |
- Eriksson, Margaretha, et al.
(författare)
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The impact of birth weight on coronary heart disease morbidity and mortality in a birth cohort followed up for 85 years : a population-based study of men born in 1913
- 2004
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 256:6, s. 472-81
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To analyse whether there is a relationship between birth weight on the one hand and coronary heart disease (CHD) and cardiovascular disease (CVD) mortality and morbidity on the other, whether such a relationship is influenced by potential modifying factors from the time of birth, adult height and the presence of diabetes, and what significance these possible associations might have for the CHD and CVD rates in the general population. Design. Population-based birth cohort. Setting. Sweden. Subjects. A total of 1319 singleton men born in 1913, surviving until age 20 and from then on followed until 85 years of age. Main outcome measures. CHD and CVD mortality and morbidity events. Results. The gestational age adjusted CHD and CVD mortality and morbidity hazard ratios were virtually unaffected by birth weight. Taking possible effect-modifying variables into account did not change the results. The population attributable risk percentage for CHD and CVD mortality and morbidity due to a birth weight ≤3000 g was 1% or less. Conclusions. Birth weight did not significantly affect CHD or CVD mortality or morbidity. A birth weight ≤3000 g contributes little to the burden of CHD and CVD on a community level.
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| 8. |
- Eriksson, Margaretha, 1951-, et al.
(författare)
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The impact of birth weight on prostate cancer incidence and mortality in a population-based study of men born in 1913 and followed up from 50 to 85 years of age
- 2007
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Ingår i: The Prostate. - : Wiley. - 0270-4137 .- 1097-0045. ; 67:11, s. 1247-1254
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Insulin-like growth factor-I (IGF-I) hormone is directly associated with birth weight (BW), and high IGF-I measured in adults is associated with increased risk of prostate cancer (PCA). Whether BW and PCA are related is inconclusive to date. METHODS: BW and PCA incidence and mortality data for a population-based cohort of 1,436 singleton Swedish men born in 1913 and followed until 85 years of age were obtained. RESULTS: BW > or = 4,250 g was associated with significantly higher PCA incidence [62% (CI: 4%-151%)] and PCA mortality [82% (CI: 3%-221%)] than BW 3,001-4,249 g, even when other potential effect modifiers were taken into account. The hazards ratio for PCA incidence fell from approximately 3 at age 50 to unity at age 85. Approximately one out of every six PCA incident cases between 50 and 70 years of age could be attributed to BW > or = 4,250 g. CONCLUSIONS: In the current study PCA incidence and mortality rate appears to increase with BW.
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| 9. |
- Hägglund, Maria, Lektor, 1975-, et al.
(författare)
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IntegrIT : Towards Utilizing the Swedish National Health Information Exchange Platform for Clinical Research
- 2017
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Ingår i: Informatics for Health. - : IOS Press. ; 235, s. 146-150
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Konferensbidrag (refereegranskat)abstract
- This paper describes how the Swedish national Health Information Exchange platform can be used to facilitate clinical research in the future. Different e-services for different user groups are being developed using a user-centered design approach. The main user groups are study participants, clinical researchers and healthcare professionals. The different e-services are based on an in-depth analysis of the clinical research process, and the main identified needs relate to recruitment of study participants, access to clinical data from different sources as well as improved tools for patients' self-reporting. The national Swedish HIE platform has the potential to enable a seamless connection between patients/citizens as study participants, health care professionals and everyday clinical work and clinical researchers in both academia and industry.
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| 10. |
- Jonsson, Marina, et al.
(författare)
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Adherence to national guidelines for children with asthma at primary health centres in Sweden : potential for improvement
- 2012
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Ingår i: Primary Care Respiratory Journal. - : Elsevier. - 1471-4418 .- 1475-1534. ; 21:3, s. 276-282
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although asthma is the most common chronic paediatric disease in Western Europe, the extent of adherence to guidelines for primary care management of paediatric asthma remains unclear. AIMS: To evaluate adherence to national guidelines for primary care management of children with asthma. METHODS: This survey involved 18 primary healthcare centres in Stockholm, Sweden. The medical records of 647 children aged 6 months to 16 years with a diagnosis of asthma, obstructive bronchitis, or cough were selected and scrutinised. 223 children with obstructive bronchitis or cough not fulfilling the evidence-based criteria for asthma were excluded, yielding a total of 424 subjects. Documentation of the most important indicators of quality as stipulated in national guidelines (i.e., tobacco smoke, spirometry, pharmacological treatment, patient education, and demonstration of inhalation technique) was examined. RESULTS: Only 22% (n=49) of the children 6 years of age or older had ever undergone a spirometry test, but the frequency was greater when patients had access to an asthma nurse (p=0.003). Although 58% (n=246) of the total study population were treated with inhaled steroids, documented patient education and demonstration of inhalation technique was present in 14% (n=59). Exposure to tobacco smoke was documented in 14% (n=58). CONCLUSIONS: This study reveals a substantial gap between the actual care provided for paediatric asthma and the recommendations formulated in national guidelines.
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