DOCSLIB.ORG

Medical Decision Support Systems in Africa

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Medical Decision Support Systems in Africa 47 © 2010 IMIA and Schattauer GmbH Medical Decision Support Systems in Africa G. Bediang, C. O. Bagayoko, A. Geissbuhler Department of Radiology and Medical Informatics, Geneva University, Switzerland cision support in health as «an inter- Summary Introduction active, user-controlled system (usually Objective: To present an overview of the current state of computer- The scope of medical decision support computer-based software) that are based medical decision support systems in Africa in the areas of systems has evolved over time. Initially designed specifically to facilitate the public health, patient care, and consumer support. based on models of deductive logic decision maker (health administrators Methods: Scientific and gray literature reviews complemented by ex- (clinical algorithm), Bayesian prob- or clinician) in using data, models, and pert interviews. abilistic, heuristic, analytical models knowledge elements to solve semi- Results: Various domains of decision support are developed and and expert systems - the “Greek Ora- structured and complex decision ». deployed in Sub-Saharan Africa: public health information systems, cle” [1, 2] model, the first systems of This definition, therefore, includes clinical decision-support systems, and patient-centred decision- decision support were mainly focused the efficiency of decision making (di- support systems. on computer-aided diagnosis in medi- agnosis, treatment) in the clinical en- Conclusions: Until recently, most of these systems have been de- cine. These systems were based prima- vironment but also in the broader ployed by international organizations without a real ownership rily on theories of clinical reasoning. field of healthcare and health. It ar- policy entrusted to the African stakeholders. Many of these endeav- The practitioner would enter the data gues that all stakeholders in the health ours have remained or ceased at the experimentation stage. The mul- collected from the patient in a system system (health professionals, manag- tiplicity of organizations has led to the deployment of fragmented and wait for it to provide the correct ers, policy makers) should have the in- systems causing serious interoperability problems. In addition to diagnosis [2]. Although these ap- formation needed to improve the man- basic infrastructures, these studies also highlight the importance of proaches were very innovative, they agement of patients, services and health good organization, training and support, as key to the success and were not used widely. In order to in- system, respectively [15]. In addition, sustainability of these decision support systems. crease their clinical usability, diagnos- this new approach also incorporates tic decision-support systems have direct support of patients by them- Keywords evolved into integrated systems in the selves [13]. Decision support system, Africa, telemedicine, eHealth, mHealth work environment and processes [2] In Africa the decision support is in- used by practitioners “in order to limit creasingly integrated into health systems, Yearb Med Inform 2010:47-54 the amount of data that clinicians must as there is a growing demand for infor- re-enter across isolated systems” and mation to help policy building, health provide timely assistance to the deci- systems planning and monitoring. The sion-making process based on the clini- impact of health programs in order to cal information of patients [3]. The achieve the Millennium Development concept of decision-support has wid- Goals [16, 17] cannot be neglected. In ened to encompass computerized pa- addition, given the propagating crisis of tient records, general medical knowl- health professionals (insufficient pro- edge base information resources and fessionals, inadequate distribution, applications for diagnosis, medical brain drain, etc...), the development of prescription and the interpretation of information technology and telecommu- test results, as well as alerting and re- nications offers new opportunities for de- minder systems [3-12]. cision support through access to remote Furthermore, the concept of sup- expertise for professionals located in porting the clinician with patients’ isolated areas [18]. diagnosis and therapy has evolved The objective of this review is to into an approach that also integrates present a critical overview of the cur- the support of managers and policy rent state of decision support systems makers in their decisions for patient in Africa in the areas of public health, populations [13]. Tan [14], illustrates patient care, and consumer decision- this change in approach, defining de- support. IMIA Yearbook of Medical Informatics 2010 48 Bediang et al. Methodology Design, Operation and Challenges of this vast amount of information needs DHIS to be captured by health professionals A literature search was performed themselves has resulted in the perception through MEDLINE and over the World Apart from South Africa, where the of their workload having increased. Health Organization’s databases: WHO process of setting up a DHIS has sprung Moreover, the information collected was headquarters library database (WHOLIS) from national interests involving often redundant [20, 25-27]. and WHO-AFRO Library (AFROLIB, stakeholders and national research or- Another set of difficulties relates to African Index Medicus). Papers de- ganizations [23], the majority of DHIS resources allocated for the operation of scribing implemented systems in projects in Africa have been driven by DHIS. Staffing of DHIS was often in- Sub-Saharan Africa were reviewed. international agencies and donors [19, adequate. Most of them had little or no Additional information and material 20]. Under international pressure and training and so lacked competent skills was obtained through interviews of given the time constraints for these to ensure its optimal performance [20, experts in the field of e-health and projects, the design of DHIS was lim- 25]. The managers were not suffi- medical informatics involved in de- ited to central levels, and implementa- ciently supported in their activities cision-support systems implementa- tion would be carried out without in- when using the application. Teams also tions in Africa. volving all stakeholders. These aspects gave it less attention due to weak fi- have been very important because the nancial resources, insufficient equip- sustainability of DHIS has depended ment and infrastructure [20, 25]. heavily on the ability of national and The availability and accessibility of local authorities to maintain these ac- data produced by the DHIS were not Decision Support Systems for tivities. However, the DHIS was mainly guaranteed for various groups and us- Public Health in Africa designed for the collection of patient ers of this information in the district, data, thus relegating to a secondary and as result, this information has been Background and Objectives level the administrative data collection frequently underutilized. Managers and and management of human and mate- health care professionals have not used In the late 1980’s, prompted by in- rial resources [19, 20]. it to inform, improve or monitor health ternational agencies and donors, pi- In the health systems of most Afri- programs in the district. Moreover, there lot projects for implementing District can countries, there is a multiplicity of was no analysis and use at the point of Health Information Systems (DHIS) international actors. These organizations collection. There was virtually no feed- were launched in African countries have developed many vertical programs back from the district health service to [19]. Far from being mere tools for like tuberculosis, immunization, HIV / health centers. Even if these feedbacks routine collection of data, the DHIS AIDS and the prevention of mother- were reported, there is often the prob- were designed with the objective of to-child transmission of HIV / AIDS lem of consistency between the infor- improving the health of populations [24, 25] supporting the existence of a mation provided and the real needs of within a health district [20]. Health multitude of records and various forms. the managers [20, 25]. Other barriers districts should, therefore, be Several difficulties impeding the proper to the use of the data were also identi- equipped with systems able to col- functioning of DHIS and the quality fied: the constant changes in staff and lect, analyze and interpret data in of data have emerged from the studies poor communication of knowledge, order to create locally relevant in- of such systems. insufficient information integration in formation [21]. As available, this in- The fragmentation of data from the the activities of the health district, in- formation should be shared between decision support systems has often been adequate access to data denominator in different actors in the health system noted upon [24, 25]. This comes from order to calculate the indicators, the to be used for surveillance, monitor- the lack of information sharing between need for suitable technical, administra- ing, evaluation of effectiveness, the providers of care within a health dis- tive and political means and finally the impact of interventions and health trict, but also between institutions or risk of conflict of ideas or interference programs, planning and resource groups of users of such information, with political plans [22, 25]. management [20-22]. which are: public or private health Later, in the mid 1990’s, after re- institutions, local authorities,
Load more

Recommended publications
  • Patient Decision Aids Chuck Alston, Zackary D
    Shared Decision-Making Strategies for Best Care: Patient Decision Aids Chuck Alston, Zackary D. Berger, Shannon Brownlee, Glyn Elwyn, Floyd J. Fowler Jr., Leslie Kelly Hall, Victor M. Montori, Ben Moulton, Lyn Paget, Brenna Haviland Shebel, Richard Singerman, Jim Walker, Matthew K. Wynia, and Diedtra Henderson* September 2014 *The authors are participants in the Evidence Communication Innovation Collaborative of the IOM Roundtable on Value and Science-Driven Health Care. This individually authored perspective was developeed as a contribution to the Learning Health System Series of the IOM Roundtable on Value & Science-Driven Health Care. The views expressed are those of the authors and not necessarily of the authors’ organizations or of the Institute of Meddiicine. The paper is intended to help inform and stimulate discussion. It has not been subjected to the review procedures of the Institute of Medicine and is not a report of the Institute of Medicine or of the National Research Council. Copyright 2014 by the National Academy of Sciences. All rights reserved. AUTHORS Chuck Alston Zackary D. Berger Senior Vice President; Director, Public Assistant Professor, Division of General Affairs Internal Medicine Qorvis MSLGROUP Johns Hopkins School of Medicine Glyn Elwyn Shannon Brownlee Professor Senior Vice President Senior Scientist Lown Institute Dartmouth Center for Health Care Delivery Science Victor M. Montori Director, Shared Decision Making National Floyd J. Fowler Jr. Resource Center Scientific Senior Advisor Mayo Clinic Informed Medical Decisions Foundation Healthwise Richard Singerman Adjunct Assistant Professor, Division of Leslie Kelly Hall Health Sciences Informatics Senior Vice President, Policy Johns Hopkins School of Medicine Healthwise Jim Walker Ben Moulton Principal Healthcare Informatician Senior Vice President Siemens Healthcare Informed Medical Decisions Foundation Healthwise Matthew K.
    [Show full text]
  • Chapter H: Delivering Decision Aids on the Internet
    Delivering Decision Aids on the Internet 2012 UPDATED CHAPTER H: DELIVERING DECISION AIDS ON THE INTERNET SECTION 1: AUTHORS/AFFILIATIONS Aubri Hoffman (lead) Dartmouth Centers for Health and Aging USA Robert J. Volk (co-lead) The University of Texas MD Anderson Cancer Center USA Martin Härter University Medical Center Hamburg-Eppendorf Germany Linda Li University of British Columbia Canada Hilary Llewellyn-Thomas Geisel School of Medicine at Dartmouth USA Anton Saarimaki Ottawa Hospital Research Institute & University of Canada Ottawa Christine Stirling The University of Tasmania, School of Nursing Australia SECTION 2: CHAPTER SUMMARY What is this dimension? Delivering decision aids on the Internet is defined here as the process of using the Internet to provide some or all components of a patient decision aid (PtDA) to individuals (e.g., patients, caregivers, clinicians, etc.) involved in the process of choosing between two or more medically- appropriate healthcare options. This definition is intended to differentiate this process from Internet-delivered general health education for patients (e.g., health information websites), and Internet-delivered clinical practice guidelines for clinicians. What is the theoretical rationale for including this dimension? Several theories in cognitive psychology, decision psychology, and communication emphasize the value of using the Internet to provide broad and long-term dissemination of information that can be targeted and tailored to patients’ needs and preferences. In addition, several theories of active, discovery, and social learning inform the design of interactive PtDAs to effectively provide information and support. Furthermore, theories of dissemination and implementation emphasize the need for the right information (rapidly updated), delivered to the right person (tailored), at the right time (in advance, during, and after a decision needs to be made).
    [Show full text]
  • WHO: Where Are the Patients in Decision-Making About Their Care?
    HEALTH SYSTEMS AND POLICY ANALYSIS POLICY BRIEF Where are the patients in decision-making about their own care? Angela Coulter, Suzanne Parsons and Janet Askham Keywords: © World Health Organization 2008 and World Health Organization, on behalf of the European Observatory PATIENT PARTICIPATION - on Health Systems and Policies 2008 methods DECISION MAKING Address requests about publications of the WHO DELIVERY OF HEALTH CARE Regional Office for Europe to: HEALTH POLICY Publications EUROPE WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there This policy brief, written for may not yet be full agreement. the WHO European The mention of specific companies or of certain Ministerial Conference on manufacturers’ products does not imply that they are Health Systems, 25–27 June endorsed or recommended by the World Health 2008, Tallinn, Estonia, is one Organization in preference to others of a similar of the first in what will be a nature that are not mentioned.
    [Show full text]
  • Use of Tablets and Smartphones to Support Medical Decision Making in US Adults: Cross-Sectional Study
    JMIR MHEALTH AND UHEALTH Langford et al Original Paper Use of Tablets and Smartphones to Support Medical Decision Making in US Adults: Cross-Sectional Study Aisha Langford1, PhD, MPH; Kerli Orellana1, BA; Jolaade Kalinowski1, EdD, MA; Carolyn Aird1, MPH; Nancy Buderer2, MS 1Department of Population Health, NYU Langone Health, New York, NY, United States 2Nancy Buderer Consulting, LLC, Oak Harbor, OH, United States Corresponding Author: Aisha Langford, PhD, MPH Department of Population Health, NYU Langone Health 30 E 30th Street, Room 611 New York, NY, 10016 United States Phone: 1 646 501 2914 Email: [email protected] Abstract Background: Tablet and smartphone ownership have increased among US adults over the past decade. However, the degree to which people use mobile devices to help them make medical decisions remains unclear. Objective: The objective of this study is to explore factors associated with self-reported use of tablets or smartphones to support medical decision making in a nationally representative sample of US adults. Methods: Cross-sectional data from participants in the 2018 Health Information National Trends Survey (HINTS 5, Cycle 2) were evaluated. There were 3504 responses in the full HINTS 5 Cycle 2 data set; 2321 remained after eliminating respondents who did not have complete data for all the variables of interest. The primary outcome was use of a tablet or smartphone to help make a decision about how to treat an illness or condition. Sociodemographic factors including gender, race/ethnicity, and education were evaluated. Additionally, mobile health (mHealth)- and electronic health (eHealth)-related factors were evaluated including (1) the presence of health and wellness apps on a tablet or smartphone, (2) use of electronic devices other than tablets and smartphones to monitor health (eg, Fitbit, blood glucose monitor, and blood pressure monitor), and (3) whether people shared health information from an electronic monitoring device or smartphone with a health professional within the last 12 months.
    [Show full text]
  • (202) 857-3376 Food and Drug Administration - Ophthalmic Digital Health Workshop 10/23/2017
    Food and Drug Administration - Ophthalmic Digital Health Workshop 10/23/2017 Page 1 1 FOOD AND DRUG ADMINISTRATION 2 3 OPHTHALMIC DIGITAL HEALTH WORKSHOP 4 5 6 7 8 October 23, 2017 9 7:55 AM - 4:12 PM 10 11 12 13 14 2 Montgomery Village Avenue 15 Gaithersburg, Maryland 16 17 18 19 20 21 Reported by: KeVon Congo, 22 Capital Reporting Company www.CapitalReportingCompany.com (202) 857-3376 Food and Drug Administration - Ophthalmic Digital Health Workshop 10/23/2017 Page 2 1 C O N T E N T S 2 AGENDA ITEM: 3 FDA Welcome 4 Malvina B. Eydelman, MD 5 CDRH Efforts in the Digital Health Space 6 Jeffrey Shuren, MD, JD 7 Welcome from Cosponsoring Organizations 8 American Academy of Ophthalmology (AAO) 9 Michael Xavier Repka, MD 10 American Academy of Pediatrics (AAP) 11 Ken Nischal, MD 12 American Association for Pediatric 13 Ophthalmology and Strabismus (AAPOS) 14 Derek T. Sprunger, MD 15 American Society of Cataract and 16 Refractive Surgery (ASCRS) 17 Natalie A. Afshari, MD 18 American Society of Retina Specialists 19 (ASRS) 20 Mark S. Humayun, MD, PhD 21 Stanford Medicine Byers Eye Institute 22 David Myung, MD, PhD www.CapitalReportingCompany.com (202) 857-3376 Food and Drug Administration - Ophthalmic Digital Health Workshop 10/23/2017 Page 3 1 C O N T E N T S 2 (Continued) 3 AGENDA ITEM: 4 Accelerating Innovation To Encourage 5 New Frontiers in Ophthalmic Digital 6 Health 7 Zach Bodnar, MD 8 The Regulation of Digital Health 9 Bakul Patel 10 FDA Perspectives on Ophthalmic 11 Mobile Medical Applications and 12 Telemedicine 13 Ronald Schuchard, Ph.D.
    [Show full text]
  • Breaking the Barriers to Specialty Care Practical Ideas to Improve Health Equity and Reduce Cost
    Breaking the Barriers to Specialty Care Practical Ideas to Improve Health Equity and Reduce Cost BRIEF Striving for Equity in 1 2 3 4 5 Specialty Care STRIVING FOR EQUITY IN SPECIALTY CARE | BRIEF 1 About this series of briefs This series aims to highlight the urgent need for the health care sector to make progress towards achieving equity in outcomes from diseases that require specialty care and to identify effective solutions for the payers, providers, policy makers, patient organizations, and community actors who will be critical to creating change. The series was researched and written by FSG with the support and partnership of the Bristol-Myers Squibb Foundation. Findings were informed by an extensive review of clinical and field studies and more than 60 interviews with field experts, health care providers, and representatives from insurance companies. This work builds on the exceptional research in this field done by many others, referenced throughout this report. A full list of references and contributors can be found at the end of each brief. To access all the briefs in this series, please visit www.fsg.org/publications/breaking-barriers-specialty-care. About Bristol-Myers Squibb Foundation The mission of the Bristol-Myers Squibb Foundation is to promote health equity and improve the health outcomes of populations disproportionately affected by serious diseases and conditions by strengthening community-based health care worker capacity, integrating medical care and community-based supportive services, and mobilizing communities in the fight against disease. In 2015, the Bristol-Myers Squibb Foundation launched the Specialty Care for Vulnerable Populations Initiative, which aims to address inequities in access to and utilization of specialty care services in the United States.
    [Show full text]
  • Electronic Health, Telemedicine, and New Paradigms for Training and Care
    CE: Alpana; COH/120508; Total nos of Pages: 13; COH 120508 REVIEW CURRENT OPINION Electronic health, telemedicine, and new paradigms for training and care Catherine S. Todda, Stephen J. Millsb, and Anh L. Innesb Purpose of review HIV prevention and care is changing rapidly; guideline revisions and programmatic scale-up require innovative approaches to in-service training and care extension to improve provider practice and care access. We assessed recent (12 months) peer-reviewed publications on electronic health (eHealth), telemedicine, and other innovative provider-targeted interventions for HIV-related care. Recent findings Key developments included systems merging electronic medical records (EMR) with provider clinical decision aids to prompt action, demonstration eHealth, and telemedicine projects, reviews or descriptions of technology to improve connectivity in lower resource settings, and a few trials on provider-centered interventions. Most publications were program reports and few data were available regarding efficacy of eHealth interventions for providers on patient HIV-related outcomes, notably identification and management of antiretroviral treatment failure in Kenya. Better evidence is needed for strategies to train providers and care extenders with the goal to improve impact of HIV prevention and care interventions. Summary Rapid technology introduction and expansion may change the paradigm for improving provider knowledge and practice. Although new, the developments are promising for HIV provider-targeted eHealth and innovations
    [Show full text]
  • Use of Health Information Technology to Reduce Diagnostic Errors
    BMJ Quality & Safety Online First, published on 7 August 2013 as 10.1136/bmjqs-2013-001884NARRATIVE REVIEW BMJ Qual Saf: first published as 10.1136/bmjqs-2013-001884 on 13 July 2013. Downloaded from Use of health information technology to reduce diagnostic errors Robert El-Kareh,1,2 Omar Hasan,3 Gordon D Schiff4,5 ▸ Additional material is ABSTRACT INTRODUCTION published online only. To view Background Health information technology Unaided clinicians often make diagnostic please visit the journal online (http://dx.doi.org/10.1136/bmjqs- (HIT) systems have the potential to reduce errors. Vulnerable to fallible human 2013-001884). delayed, missed or incorrect diagnoses. We memory, variable disease presentation, clin- describe and classify the current state of ical processes plagued by communication 1Division of Biomedical Informatics, UCSD, San Diego, diagnostic HIT and identify future research lapses, and a series of well-documented California, USA directions. ‘heuristics’, biases and disease-specific pit- 2 Division of Hospital Medicine, Methods A multi-pronged literature search was falls, ensuring reliable and timely diagnosis UCSD, San Diego, California, 1–3 conducted using PubMed, Web of Science, represents a major challenge. Health USA 3American Medical Association, backwards and forwards reference searches and information technology (HIT) tools and Chicago, Illinois, USA contributions from domain experts. We included systems have the potential to enable physi- 4 Division of General Medicine, HIT systems evaluated in clinical and cians to overcome—or at least minimise— Brigham and Women’s Hospital, experimental settings as well as previous reviews, Boston, Massachusetts, USA these human limitations. 5Harvard Medical School, and excluded radiology computer-aided Despite substantial progress during the Boston, Massachusetts, USA diagnosis, monitor alerts and alarms, and studies 1970s and 1980s in modelling and simu- focused on disease staging and prognosis.
    [Show full text]
  • Evaluating Patient-Centered Mobile Health Technologies: Definitions, Methodologies, and Outcomes
    JMIR MHEALTH AND UHEALTH Bruce et al Viewpoint Evaluating Patient-Centered Mobile Health Technologies: Definitions, Methodologies, and Outcomes Courtenay Bruce1, JD, MA; Patricia Harrison1, BSN, RN, MBA; Charlie Giammattei2, BA; Shetal-Nicholas Desai3,4, DPM, MBA; Joshua R Sol3,4, BSc; Stephen Jones5,6, MD, MSHI; Roberta Schwartz3, PhD 1System Quality & Patient Safety, Houston Methodist System, Houston, TX, United States 2CareSense, MedTrak, Inc, Conshohocken, PA, United States 3Center for Innovation, Houston Methodist Hospital, Houston, TX, United States 4Information Technology Division, Houston Methodist Hospital, Houston, TX, United States 5Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States 6Department of Surgery, Houston Methodist Hospital, Houston, TX, United States Corresponding Author: Courtenay Bruce, JD, MA System Quality & Patient Safety Houston Methodist System 6565 Fannin Street Houston, TX, 77030 United States Phone: 1 2816209040 Email: [email protected] Abstract Several recently published studies and consensus statements have demonstrated that there is only modest (and in many cases, low-quality) evidence that mobile health (mHealth) can improve patient clinical outcomes such as the length of stay or reduction of readmissions. There is also uncertainty as to whether mHealth can improve patient-centered outcomes such as patient engagement or patient satisfaction. One principal challenge behind the ªeffectivenessº research in this field is a lack of common understanding about what it means to be effective in the digital space (ie, what should constitute a relevant outcome and how best to measure it). In this viewpoint, we call for interdisciplinary, conceptual clarity on the definitions, methodologies, and patient-centered outcomes frequently used in mHealth research.
    [Show full text]
  • Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically Ill, and Underserved
    Evidence Report/Technology Assessment Number 175 Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically Ill, and Underserved Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-02-0024 Prepared by: Oregon Evidence-based Practice Center, Portland, Oregon Investigators Holly Jimison, Ph.D. Principal Investigator Paul Gorman, M.D. Susan Woods, M.D. Peggy Nygren, M.A. Miranda Walker, M.A. Susan Norris, M.D., M.P.H., M.Sc. William Hersh, M.D. AHRQ Publication No. 09-E004 November 2008 This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0024). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment. This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies.
    [Show full text]
  • Telemedicine with Clinical Decision Support for Critical Care
    Mackintosh et al. Systematic Reviews (2016) 5:176 DOI 10.1186/s13643-016-0357-7 RESEARCH Open Access Telemedicine with clinical decision support for critical care: a systematic review Nicola Mackintosh1* , Marius Terblanche2,3, Ritesh Maharaj4, Andreas Xyrichis5, Karen Franklin2, Jamie Keddie2, Emily Larkins5, Anna Maslen5, James Skinner5, Samuel Newman2, Joana Hiew De Sousa Magalhaes1 and Jane Sandall1 Abstract Background: Telemedicine applications aim to address variance in clinical outcomes and increase access to specialist expertise. Despite widespread implementation, there is little robust evidence about cost-effectiveness, clinical benefits, and impact on quality and safety of critical care telemedicine. The primary objective was to determine the impact of critical care telemedicine (with clinical decision support available 24/7) on intensive care unit (ICU) and hospital mortality and length of stay in adults and children. The secondary objectives included staff and patient experience, costs, protocol adherence, and adverse events. Methods: Data sources included MEDLINE, EMBASE, CINAHL, Cochrane Library databases, Health Technology Assessment Database, Web of Science, OpenGrey, OpenDOAR, and the HMIC through to December 2015. Randomised controlled trials and quasi-experimental studies were eligible for inclusion. Eligible studies reported on differences between groups using the telemedicine intervention and standard care. Two review authors screened abstracts and assessed potentially eligible studies using Cochrane guidance. Results: Two controlled before-after studies met the inclusion criteria. Both were assessed as high risk of bias. Meta-analysis wasnotpossibleaswewereunabletodisaggregatedatabetweenthetwostudies.Onestudyusedanon-randomised stepped-wedge design in seven ICUs. Hospital mortality was the primary outcome which showed a reduction from 13.6 % (CI, 11.9–15.4 %) to 11.8 % (CI, 10.9–12.8 %) during the intervention period with an adjusted odds ratio (OR) of 0.40 (95 % CI, 0.31–0.52; p = .005).
    [Show full text]
  • Diabetic Retinopathy Screening – Ontario Scaling-Up O
    Research Program Title Author Poster # Patient Engagement Comprendre l’engagement des patients partenaires de S Chipenda-Dansokho, O Drescher, B Roy, 1 l’Action diabète Canada dans une perspective de parcours M-C Tremblay, S Dupéré, J Dogba de vie Patient Engagement Patients As Teachers: Applying Patient Partners’ Expertise R. Ndjaboue, B. Boudreault, F. Frigon- 2 to Improve Diabetes Management and Care Tremblay, S. Chipenda Dansokho, J. Dogba, R. Price, P. Delgado, A.M. McComber, O. Drescher, M-C. Tremblay, J. McGavock, H. Witteman Patient Engagement Diabetes Complications Risk Calculator : Gathering Risk R. Ndjaboue, I. Farhat, C-A. Ferlatte, G. 3 Models Based on What Matters to People Living with Ngueta, D. Guay, S. Delorme, S. Straus, N. Diabetes Ivers, C. Yu, B. Shah, H. Witteman Diabetic Identifying Barriers and Enablers to Attending Diabetic MJ Dogba, M Brent, C Bach, Z van Allen, S 4 Retinopathy/Patient Retinopathy Screening in Immigrants from Ethnocultural Asad, J Grimshaw, N Ivers, F Légaré, H O. Engagement Minority Groups Witteman, J Squires, X Wang, O Sutakovic, O Drescher, M Zettl, N McCleary, M-C Tremblay, S Linklater, A Randhawa, GY Wang, J Presseau, Diabetic Experience with Telemedicine Diabetic Retinopathy R Martens, W Thickson, M Jovanovic, D 5 Retinopathy Screening in British Maberley Columbia Diabetic First Case Use of Population-Based Diabetic Retinopathy J. Cao, S. Isaackz, M. Chang, J. Bowen, V. 6 Retinopathy Screening in Ontario Rac, M. Greiver, C. Pow, R. Merritt, C. Whiteside, O. Sutakovic, M. H. Brent Diabetic Diabetic Retinopathy Screening – Ontario scaling-up O. Sutakovic, D. Sissmore, R. Merritt, V.
    [Show full text]