| 1. |
- Nilsen, Per, 1960-, et al.
(författare)
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Realizing the potential of artificial intelligence in healthcare : Learning from intervention, innovation, implementation and improvement sciences
- 2022
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Ingår i: Frontiers in Health Services. - Lausanne : Frontiers Media S.A.. - 2813-0146. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Artificial intelligence (AI) is widely seen as critical for tackling fundamental challenges faced by health systems. However, research is scant on the factors that influence the implementation and routine use of AI in healthcare, how AI may interact with the context in which it is implemented, and how it can contribute to wider health system goals. We propose that AI development can benefit from knowledge generated in four scientific fields: intervention, innovation, implementation and improvement sciences.Aim: The aim of this paper is to briefly describe the four fields and to identify potentially relevant knowledge from these fields that can be utilized for understanding and/or facilitating the use of AI in healthcare. The paper is based on the authors' experience and expertise in intervention, innovation, implementation, and improvement sciences, and a selective literature review.Utilizing knowledge from the four fields: The four fields have generated a wealth of often-overlapping knowledge, some of which we propose has considerable relevance for understanding and/or facilitating the use of AI in healthcare.Conclusion: Knowledge derived from intervention, innovation, implementation, and improvement sciences provides a head start for research on the use of AI in healthcare, yet the extent to which this knowledge can be repurposed in AI studies cannot be taken for granted. Thus, when taking advantage of insights in the four fields, it is important to also be explorative and use inductive research approaches to generate knowledge that can contribute toward realizing the potential of AI in healthcare. © 2022 Nilsen, Reed, Nair, Savage, Macrae, Barlow, Svedberg, Larsson, Lundgren and Nygren.
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| 2. |
- Hazelzet, Jan A., et al.
(författare)
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Value-based healthcare's blind spots : call for a dialogue
- 2021
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Ingår i: F1000Research. - London : F1000 Research Ltd. - 2046-1402. ; 10:1314
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- The value-based healthcare (VBHC) concept was first proposed as a solution to many of the ills of healthcare. Since then, we have seen the term “value” defined, used, confused, and interpreted in multiple ways. While we may disagree that competition based on value will solve healthcare’s complex challenges, value is a concept integral to the future of healthcare. Before VBHC becomes consigned to the long list of quality improvement trends and management fads that have passed through healthcare, we call for a dialogue around the term value and the implications of its different interpretations. The intention is not just to critique, but to facilitate ongoing efforts to substantially improve healthcare in ways that are relevant and sustainable for society at large.
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| 3. |
- Karmelić, Ema, et al.
(författare)
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Decision-making on the fly : a qualitative study of physicians in out-of-hospital emergency medical services
- 2023
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Ingår i: BMC Emergency Medicine. - London : BioMed Central (BMC). - 1471-227X. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- Background: Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods: Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results: Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs, but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions: The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journey from novice to expert. © 2023, The Author(s).
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| 4. |
- Keel, George, et al.
(författare)
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Time-driven activity-based costing for patients with multiple chronic conditions : a mixed-method study to cost care in a multidisciplinary and integrated care delivery centre at a university-affiliated tertiary teaching hospital in Stockholm, Sweden
- 2020
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Ingår i: BMJ Open. - London : BMJ Publishing Group Ltd. - 2044-6055. ; 10:6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study can be applied to cost the complex non-standardised processes used to treat patients with multiple chronic conditions. DESIGN: A mixed-method approach to cost analysis, following a modified healthcare-specific version of the seven-step Time-Driven Activity-Based Costing (TDABC) approach. SETTING: A multidisciplinary integrated and person-centred care delivery centre at a university-affiliated tertiary teaching hospital in Stockholm, Sweden, designed to improve care coordination for patients with multiple chronic conditions, specifically diabetes, cardiovascular disease and kidney disease. PARTICIPANTS: 314 patients (248 men and 66 women) fit inclusion criteria. Average age was 80 years. RESULTS: This modified TDABC analysis costed outpatient care for patients with multiple chronic conditions. The approach accounted for the difficulty of conceptualising care cycles. The estimated total cost, stratified by resources, can be reviewed together with existing managerial accounting statements to inform management decisions regarding the multidisciplinary centre. CONCLUSIONS: This article demonstrates that the healthcare-specific seven-step approach to TDABC can be applied to cost care for patients with multiple chronic conditions, where pathways are not yet discernable. It became clear that there was a need for slight methodological adaptations for this particular patient group to make it possible to cost these pathways, stratified by activity and resource. The value of this approach can be discerned from the way management incorporated the results of this analysis into the development of their hospital strategy. In the absence of integrated data infrastructures that can link patients and resources across financial, clinical and process data sets, the scalability of this method will be difficult. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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| 5. |
- Rafiq, Muhammad, et al.
(författare)
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Predictive analytics support for complex chronic medical conditions : An experience-based co-design study of physician managers’ needs and preferences
- 2024
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Ingår i: International Journal of Medical Informatics. - Shannon : Elsevier. - 1386-5056 .- 1872-8243. ; 187, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The literature suggests predictive technology applications in health care would benefit from physician and manager input during design and development. The aim was to explore the needs and preferences of physician managers regarding the role of predictive analytics in decision support for patients with the highly complex yet common combination of multiple chronic conditions of cardiovascular (Heart) and kidney (Nephrology) diseases and diabetes (HND). Methods: This qualitative study employed an experience-based co-design model comprised of three data gathering phases: 1. Patient mapping through non-participant observations informed by process mining of electronic health records data, 2. Semi-structured experience-based interviews, and 3. A co-design workshop. Data collection was conducted with physician managers working at or collaborating with the HND center, Danderyd University Hospital (DSAB), in Stockholm, Sweden. HND center is an integrated practice unit offering comprehensive person-centered multidisciplinary care to stabilize disease progression, reduce visits, and develop treatment strategies that enables a transition to primary care. Results: Interview and workshop data described a complex challenge due to the interaction of underlying pathophysiologies and the subsequent need for multiple care givers that hindered care continuity. The HND center partly met this challenge by coordinating care through multiple interprofessional and interdisciplinary shared decision-making interfaces. The large patient datasets were difficult to operationalize in daily practice due to data entry and retrieval issues. Predictive analytics was seen as a potentially effective approach to support decision-making, calculate risks, and improve resource utilization, especially in the context of complex chronic care, and the HND center a good place for pilot testing and development. Simplicity of visual interfaces, a better understanding of the algorithms by the health care professionals, and the need to address professional concerns, were identified as key factors to increase adoption and facilitate implementation. Conclusions: The HND center serves as a comprehensive integrated practice unit that integrates different medical disciplinary perspectives in a person-centered care process to address the needs of patients with multiple complex comorbidities. Therefore, piloting predictive technologies at the same time with a high potential for improving care represents an extreme, demanding, and complex case. The study findings show that health care professionals’ involvement in the design of predictive technologies right from the outset can facilitate the implementation and adoption of such technologies, as well as enhance their predictive effectiveness and performance. Simplicity in the design of predictive technologies and better understanding of the concept and interpretation of the algorithms may result in implementation of predictive technologies in health care. Institutional efforts are needed to enhance collaboration among the health care professionals and IT professionals for effective development, implementation, and adoption of predictive analytics in health care. © 2024 The Author(s)
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| 6. |
- Ramos, Pedro, et al.
(författare)
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It takes two to dance the VBHC tango : A multiple case study of the adoption of value-based strategies in Sweden and Brazil
- 2021
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Ingår i: Social Science and Medicine. - Oxford : Elsevier. - 0277-9536 .- 1873-5347. ; 282
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Tidskriftsartikel (refereegranskat)abstract
- Although Value-Based Health Care (VBHC) is widely debated and cited, there are few empirical studies focused on how its concepts are understood and applied in real-world contexts. This comparative case study of two prominent adopters in Brazil and Sweden, situated at either end of the spectrum in terms of contextual prerequisites, provides insights into the complex interactions involved in the adoption of value-based strategies. We found that the adoption of VBHC emphasized either health outcomes or costs – not both as suggested by the value equation. This may be linked to broader health system and societal contexts. Implementation can generate tensions with traditional business models, suggesting that providers should first analyze how these strategies align with their internal context. Adoption by a single provider organization is challenging, if not impossible. An effective VBHC transformation seems to require a systematic and systemic approach where all stakeholders need to clearly define the purpose and the scope of the transformation, and together steer their actions and decisions accordingly. © 2021 The Authors
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| 7. |
- Reinius, Maria, et al.
(författare)
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Patient-driven innovations reported in peer-reviewed journals : a scoping review
- 2022
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Ingår i: BMJ Open. - London : BMJ Publishing Group Ltd. - 2044-6055. ; 12:1
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Forskningsöversikt (refereegranskat)abstract
- BackgroundAwareness of patients' innovative capabilities is increasing, but there is limited knowledge regarding the extent and nature of patient-driven innovations in the peer-reviewed literature.ObjectivesThe objective of the review was to answer the question: what is the nature and extent of patient-driven innovations published in peer-reviewed scientific journals?Eligibility criteriaWe used a broad definition of innovation to allow for a comprehensive review of different types of innovations and a narrow definition of 'patient driven' to focus on the role of patients and/or family caregivers. The search was limited to years 2008-2020.Sources of evidenceFour electronic databases (Medline (Ovid), Web of Science Core Collection, PsycINFO (Ovid) and Cinahl (Ebsco)) were searched in December 2020 for publications describing patient-driven innovations and complemented with snowball strategies.Charting methodsData from the included articles were extracted and categorised inductively.ResultsA total of 96 articles on 20 patient-driven innovations were included. The number of publications increased over time, with 69% of the articles published between 2016 and 2020. Author affiliations were exclusively in high income countries with 56% of first authors in North America and 36% in European countries. Among the 20 innovations reported, 'Do-It-Yourself Artificial Pancreas System' and the online health network 'PatientsLikeMe', were the subject of half of the articles.ConclusionsPeer-reviewed publications on patient-driven innovations are increasing and we see an important opportunity for researchers and clinicians to support patient innovators' research while being mindful of taking over the work of the innovators themselves.
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| 8. |
- Savage, Carl, 1975-, et al.
(författare)
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Translating ‘See-and-Treat’ to primary care : opening the gates does not cause a flood
- 2019
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Ingår i: International Journal for Quality in Health Care. - Cary, NC : Oxford University Press. - 1353-4505 .- 1464-3677. ; 31:7, s. 30-36
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore how the See-and-Treat concept can be applied in primary care and its effect on volume and productivity. Design: An explanatory single-case study design with a mixed methods approach and presented according to the SQUIRE 2.0 guidelines. Setting: A publicly-funded, private primary care provider within the Stockholm County, which caters to a diverse patient population in terms of ethnicity, religion, socioeconomic status and care needs. Participants: CEO, center manager, four physicians, two licensed practical nurses, one medical secretary and one lab assistant. Intervention: A See-and-Treat unit was established to offer same-day service for acute unplanned visits. Standardized patient symptom forms were created that allowed patients to self-triage and then enter into a streamlined care process consisting of a quick diagnostic lab and a physician visit. Main Outcome Measures: Volume, productivity, staff perceptions and patient satisfaction were measured through data on number and type of contacts per 1000 listed patients, visits per physician, observations, interviews and a questionnaire. Results: A significant decrease in the acute and total number of visits, a continued trend of diminishing telephone contacts, and a non-significant increase in physician productivity. Patients were very satisfied, and staff perceived an improved quality of care. Conclusions: See-and-Treat appears to be a viable approach for a specific primary care patient segment interested in acute same-day-service. Opening up access and standardizing care made it possible to efficiently address these needs and engage patients. © 2019 The Author(s) 2019. Published by Oxford University Press in association with the International Society for Quality in Health Care.
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| 9. |
- Sharma, Malvika, et al.
(författare)
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Artificial Intelligence Applications in Health Care Practice : Scoping Review
- 2022
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Ingår i: Journal of Medical Internet Research. - Toronto : JMIR Publications. - 1438-8871. ; 24:10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Artificial intelligence (AI) is often heralded as a potential disruptor that will transform the practice of medicine. The amount of data collected and available in health care, coupled with advances in computational power, has contributed to advances in AI and an exponential growth of publications. However, the development of AI applications does not guarantee their adoption into routine practice. There is a risk that despite the resources invested, benefits for patients, staff, and society will not be realized if AI implementation is not better understood.Objective: The aim of this study was to explore how the implementation of AI in health care practice has been described and researched in the literature by answering 3 questions: What are the characteristics of research on implementation of AI in practice? What types and applications of AI systems are described? What characteristics of the implementation process for AI systems are discernible?Methods: A scoping review was conducted of MEDLINE (PubMed), Scopus, Web of Science, CINAHL, and PsycINFO databases to identify empirical studies of AI implementation in health care since 2011, in addition to snowball sampling of selected reference lists. Using Rayyan software, we screened titles and abstracts and selected full-text articles. Data from the included articles were charted and summarized.Results: Of the 9218 records retrieved, 45 (0.49%) articles were included. The articles cover diverse clinical settings and disciplines; most (32/45, 71%) were published recently, were from high-income countries (33/45, 73%), and were intended for care providers (25/45, 56%). AI systems are predominantly intended for clinical care, particularly clinical care pertaining to patient-provider encounters. More than half (24/45, 53%) possess no action autonomy but rather support human decision-making. The focus of most research was on establishing the effectiveness of interventions (16/45, 35%) or related to technical and computational aspects of AI systems (11/45, 24%). Focus on the specifics of implementation processes does not yet seem to be a priority in research, and the use of frameworks to guide implementation is rare.Conclusions: Our current empirical knowledge derives from implementations of AI systems with low action autonomy and approaches common to implementations of other types of information systems. To develop a specific and empirically based implementation framework, further research is needed on the more disruptive types of AI systems being implemented in routine care and on aspects unique to AI implementation in health care, such as building trust, addressing transparency issues, developing explainable and interpretable solutions, and addressing ethical concerns around privacy and data protection.Keywords: artificial intelligence; health care; implementation; scoping review; technology adoption.©Malvika Sharma, Carl Savage, Monika Nair, Ingrid Larsson, Petra Svedberg, Jens M Nygren. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 05.10.2022.
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| 10. |
- Siira, Elin, 1987-, et al.
(författare)
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What Are We Talking About When We Talk About Information-Driven Care? A Delphi-Study on a Definition
- 2023
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Ingår i: Studies in Health Technology and Informatics. - Amsterdam : IOS Press. - 0926-9630 .- 1879-8365. ; 302, s. 346-347
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, the term information-driven care has recently been put forward by healthcare organizations and researchers as a means for taking a comprehensive approach to the introduction of Artificial Intelligence (AI) in healthcare. The aim of this study is to systematically generate a consensus definition of the term information-driven care. To this end, we are conducting a Delphi study utilizing literature and experts' opinions. The definition is needed to enable knowledge exchange on information-driven care and operationalize its introduction into healthcare practice. © 2023 European Federation for Medical Informatics (EFMI) and IOS Press.
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