Paulus Torkki

• PhD (Engineering)
• Professor (Associate) at Helsinki University

Background Many digital mental health interventions meet low levels of use. However, current use measurement methods do not necessarily help identify which intervention elements are associated with dropout, despite this information potentially facilitating iterative intervention development. Here, we suggest improving the comprehensiveness of inter...

Aim An ageing population increases the demand for emergency department (ED) visits and hospitalisations, and people living in nursing homes in particular are impacted by burdensome transfers and hospitalisations. As such, several onsite‐provided care services have been developed to reduce hospitalisations, but more evidence of their cost‐effectiven...

Background The global trend of emergency department (ED) crowding can be mitigated with outreach care. The Mobile Hospital is an outreach acute care service in Espoo, Finland. This study describes the results of the Mobile Hospital intervention to nursing homes in a pre–post study setting with benchmarking validation data. Methods We compared Emer...

Background An enriched understanding is necessary concerning the association between hypertension and cognitive impairment in older adults, particularly regarding the potential underlying mechanisms at a biological level. This study aimed to explore the mediating role of methylmalonic acid (MMA) in the hypertension-cognition link in the older popul...

Background Lean management provides hospitals with tools to respond to today´s rapidly changing health care environment. However, evidence of its success is inconclusive. In some cases, well-executed Lean management supports effective, beneficial and safe patient care, reduces costs and increases patient and staff satisfaction. In other cases, thou...

Background The management of patients with skin changes can be challenging in primary healthcare; general practitioners (GPs) often lack the expertise to make accurate assessments and treatment decisions. The standard care pathway for skin changes can result in extended treatment times and costs. Objectives This study was designed to evaluate the...

Background Primary healthcare centres are burdened by the management of patients with skin conditions, while general practitioners might lack the expertise to assess skin changes accurately. The traditional care chain for skin findings is a multistage process that can cause delayed diagnosis and treatment, distressing the patient. This study aimed...

Objectives Study objective was to map the current literature on the economic effects of priority setting at the system level in healthcare. Design The study was conducted as a scoping review. Data sources Scopus electronic database was searched in June 2023. Eligibility criteria We included peer-reviewed articles published 1 January 2020–1 Janua...

Background While digital health and social services offer promising solutions, they often overlook the perspectives and needs of older adults. This study aims to comprehensively investigate the preferences of older adults regarding the use and development of digital health and social services. Methods The survey spanned from 19 March to 31 March 2...

Background The integration of patient-centered care (PCC) and value-based healthcare (VBHC) principles, emphasizing personalized, responsive care and cost efficiency, is crucial in modern healthcare. Despite advocation from the International Consortium for Health Outcomes Measurement (ICHOM) for the global adoption of these principles through patie...

Objectives An increasing prevalence of disability and sickness absences related to mental health highlights the need to find scalable measures to identify common occupational health challenges early on. This study (1) investigates how well current work ability measures capture psychosocial occupational health challenges, (2) examines how online wel...

Background There has been a significant expansion in the measurement of healthcare system performance. However, there is a lack of a comprehensive performance measurement framework to assess the effects of telephone triage services on the urgent care system. The aim of our Delphi study was to construct and validate a performance measurement framewo...

Background Helsinki University Hospital has developed a digital care pathway (DCP) for people with multiple sclerosis (MS) to improve the care quality. DCP was designed for especially newly diagnosed patients to support adaptation to a chronic disease. Objective This study investigated the MS DCP user behavior and its impact on patient education-m...

Purpose This article aims to clarify the concepts used to understand, analyze and improve a patient’s progress through a health service system. A patient pathway describes plans and intentions. Within it, we distinguish between the clinical pathway of decisions and interventions and the care pathway of supportive activities. As a patient pathway is...

Objectives: This study compares the demographics, diagnoses, re-admission rates, sick leaves, and prescribed medications of patients accessing digital general practitioner (GP) visits with those of patients opting for traditional face-to-face appointments in a primary health care setting. Design: The study adopted a retrospective analysis of pat...

Background Our population‐based study has previously shown that being born in winter or spring was associated with adult‐onset asthma. The aim was to study if season of birth (SOB) is associated with airway allergy and related diseases: NSAID exacerbated respiratory disease (N‐ERD), asthma, allergic rhinitis (AR), nonallergic rhinitis (NAR), chroni...

Objectives In this study, we evaluated the amount of public funds spent on the operative treatment of carpal tunnel syndrome (CTS) in Finland in 2011–2015. Design A registry-based cost burden study. Setting The data were collected in primary and secondary care in both private and public hospitals, covering the whole population of Finland. Partic...

Objectives Since Helicopter Emergency Medical Services (HEMS) is an expensive resource in terms of unit price compared to ground-based Emergency Medical Service (EMS), it is important to further investigate which methods would allow for the optimization of these services. The aim of this study was to evaluate the cost-effectiveness of physician-sta...

Objectives Occupational health challenges are changing, emphasising the need for a more comprehensive approach. This study examines how a subjective well-being assessment can be used to identify target groups for work well-being interventions and brings insight into how survey-based well-being evaluations are linked to clinical health indicators (i...

Background To successfully design, develop, implement, and deliver digital health services that provide value, they should be cocreated with patients. However, occasionally, the value may also be codestructed. In the field of health care, the concepts of value cocreation and codestruction still need to be better established within emerging digital...

BACKGROUND To successfully design, develop, implement, and deliver digital health services that provide value, they should be cocreated with patients. However, occasionally, the value may also be codestructed. In the field of health care, the concepts of value cocreation and codestruction still need to be better established within emerging digital...

Asiakkaiden ja potilaiden jatkuvasti monipuolistuvat ja lisääntyvät tarpeet sekä hoitojen ja palveluiden suurenevat kustannukset yhdessä rajallisten resurssien kanssa vaativat uudenlaista toimintakulttuuria, jossa hyvinvointialueiden tulee kohdentaa terveyspalvelut niistä eniten hyötyville. Tämän toimintakulttuurin muutoksen aikaansaamiseksi tarvit...

Background Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nose and paranasal sinuses lasting ≥12 weeks. CRS may exist with (CRSwNP) or without (CRSsNP) nasal polyps. The aim was to evaluate conditions associated with CRS in a randomized hospital cohort. We hypothesized that comorbidities and surgical procedures differ between...

Background: Digital mental health interventions often face low behavioral engagement and challenges in translation from research to real-life environments. These problems could be alleviated by evaluating digital interventions as services that consist of numerous elements that the user interacts with over time. We advance here the user journey meth...

Hyvinvoinnin kuvaaminen kokonaisvaltaisesti vaatii monia erilaisia indikaattoreita. On hyvä ymmärtää, mitä lisäarvoa indikaattorit tuovat suhteessa toisiinsa, ja mitä eroja mittareilla on hyvinvoinnista muodostuvan kuvan kannalta. Tämän tutkimuksen tavoitteena oli tarkastella: 1) miten koetun hyvinvoinnin eri mittarit kattavat hyvinvoinnin eri ulot...

( Acta Obstet Gynecol Scand AOGS . 2023; 102: 406–419) Patient-reported measures (PRMs) can be an important tool in assessing and capturing a patient’s perspective care in maternal medicine. By using PRMs, health care providers can measure the overall health and well-being of patients while they receive obstetric treatment, allowing more patient-ce...

Purpose The paper investigates whether we can build consensus on wellness domains and create a more universal conceptual framework for wellness. Design A modified ranking type of Delphi method. Participants Two separate panels consisting of 23 Finnish and 11 international experts. Methods Panels were asked to rate the importance of 61 systematic...

Aims Lack of consensus on wellness has led to a vast number of different conceptualisations, which hinder international efforts to monitor individual-level wellness and social progress comparably. This study aimed to aid in the harmonisation of the concept by contributing to the scarce research on laypeople’s views on wellness. The study investigat...

Background To achieve the Quadruple Aim of improving population health, enhancing the patient experience of care, reducing costs and improving professional satisfaction requires reorganisation of health care. One way to accomplish this aim is by integrating healthcare services on different levels. This systematic review aims to determine whether it...

Objective This article aims to summarize performance indicators used in telephone triage services research, and make recommendations for the selection of valid indicators to measure the performance of telephone triage. We describe what kind of frameworks, performance indicators, or variables have been used for evaluating telephone triage performanc...

Objectives Value-based healthcare (VBHC) is considered the most promising guiding principle for a new generation of health service production. Many countries have attempted to apply VBHC to managerial and clinical decision-making. However, implementation remains in its infancy and varies between countries. The objective of the study is to help heal...

Digital healthcare services have been implemented increasingly during and after the COVID-19 pandemic. They have been expected to improve access, reduce inefficiencies, improve the quality of care, lower the cost of healthcare, and provide more personalised care. This study focuses on digital visits: digital health care services that replace a gene...

A feasible system for measuring patient outcomes of rehabilitation is required for assessing the real-world cost-effectiveness of rehabilitation. This study aims to assess the feasibility of measuring outcomes of rehabilitation among elderly individuals with early-stage Alzheimer's. We used the principles of Design Science to construct a set of met...

Introduction Implementing Kaizen can improve productivity in healthcare but maintaining long-term results has proven challenging. This study aimed to assess improved performance achieved and sustained by Kaizen events and find explanatory factors for the persistence or decline of long-term results. Methods Kaizen events were conducted in 26 specia...

Background Asthma with NSAID‐exacerbated respiratory disease (NERD) is associated with uncontrolled or severe asthma. NERD patients are more prone to severe allergic reactions and their asthma exacerbations lead to hospitalisations twice as often compared to patients with non‐NERD‐asthma. NERD patients are prone to recurrent nasal polyposis requiri...

BACKGROUND Many chronic heart failure (HF) patients experience a reduced health status leading to readmission after hospitalization despite receiving conventional care. Telemonitoring approaches aim to improve the early detection of HF decompensations and prevent readmissions. However, knowledge about the impact of telemonitoring on preventing read...

Background Many patients with chronic heart failure (HF) experience a reduced health status, leading to readmission after hospitalization despite receiving conventional care. Telemonitoring approaches aim to improve the early detection of HF decompensations and prevent readmissions. However, knowledge about the impact of telemonitoring on preventin...

BACKGROUND Helsinki University Hospital has developed a digital care pathway (DCP) for people with multiple sclerosis (MS) to improve the care quality. DCP was designed for especially newly diagnosed patients to support adaptation to a chronic disease. OBJECTIVE This study investigated the MS DCP user behavior and its impact on patient education-m...

Background Systematically using standard patient-reported measures (PRMs) in clinical routines is trending. The International Consortium for Health Outcomes Measurement (ICHOM) has developed condition-specific standard sets of patient-centred measures, one of which is the Pregnancy and Childbirth Standard (PCB) set, where standard PRMs are included...

Objective: This study systematically identifies different wellness domains, explores whether we are reaching any consensus, and presents an archetype of a wellness model. Methods: Studies were selected for review if they proposed a model for assessing individuals’ wellness, the model was generic (i.e., non-context or disease-specific), designed for...

Objectives The aim of this study was to evaluate the cost of surgical treatment for primary ulnar nerve entrapment (UNE) borne by the public sector in Finland. Design Registry-based cost description study. Setting Primary and secondary care throughout Finland. Participants We identified all the patients diagnosed with primary UNE in the whole po...

This is a retrospective chart review of 55 persons (mean age 11 years, range 2–28 years) diagnosed with fetal alcohol spectrum disorder (FASD) in one Finnish central hospital. The aim was to determine typical problems and interventions and estimate their costs during different periods of childhood between ages 0 and 16. During the first year, 29/38...

Purpose: The aim of this study was to compare the costs of two different telemedicine-assisted tonsillitis care pathways with traditional face-to-face visits at the Department of Otorhinolaryngology - Head and Neck Surgery (ORL-HNS) at Helsinki University Hospital. Methods: We characterized and analyzed the patient flows and their individual epi...

Objective To study the effect of the childbirth experience on the likelihood and interval to a subsequent live birth. Design Retrospective analysis of a 7-year cohort. Setting Childbirths in Helsinki University Hospital delivery units. Participants All parturients giving birth to a term and living baby from a single pregnancy in Helsinki Univers...

Background: People living in nursing homes face the risk of visiting the emergency department (ED). Outreach services are developing to prevent unnecessary transfers to ED. Aims: We aim to assess the performance of acute care services provided to people living in nursing homes or long-term homecare, focusing on ED transfer prevention, safety, co...

Introduction Patient‐reported measures (PRMs) are becoming popular as they might influence clinical decisions, help to deliver patient‐centered care, and improve health care quality. However, the limited knowledge and consensus about the acceptability of implementing PRMs in maternity care hinder their widespread use in clinical practice, and evide...

Background High costs of cancer, and especially the increase in treatment costs, have raised concerns about the financial sustainability of publicly funded health care systems around the world. As cancers get more prevalent with age, treatment costs are expected to keep rising with aging populations. The objective of the study is to analyze the cha...

Introduction While there is growing interest in applying patient‐reported measures (PRMs) in clinical routine, limited collective evidence of the impact of PRMs hinder their widespread use in specific contexts, such as maternity care. Our objective was to synthesize existing emperical evidence on the impact of implementing PRMs in routine maternity...

Purpose This article aims to describe the thinking behind MASSE, a project in Finland that helps address the fragmentation of care and patient journey disruptions for long-term care. It outlines the conceptualization of an information technology (IT)-assisted solution and presents preliminary findings and research problems in this ongoing project....

Background: The aim was to evaluate the relative proportion of Non-steroidal anti-inflammatory drug exacerbated respiratory disease (NERD) and other comorbidities, and their impact on the burden of outpatient visits due to allergic rhinitis (AR), non-allergic rhinitis (NAR), acute rhinosinusitis (ARS), and chronic rhinosinusitis with nasal polyps...

Smart devices such as self-trackers are being used by an ever-increasing number of exercisers to self-monitor their health. Users' interactions in social media can co-create and co-destruct the value and has a substantial impact on services. To investigate Oura Ring users' value creation behavior in the online context, we focus on customer-dominant...

Background Childbirth experience has been shown to depend on the mode of delivery. However, it is unclear how labour induction influences the childbirth experience in different modes of delivery. Thus, we assessed the childbirth experience among mothers with spontaneous and induced labours. Design A retrospective cohort study. Setting Childbirths...

Background The choice of what patient outcomes are included in clinical quality registries is crucial for comparable and relevant data collection. Ideally, a uniform outcome framework could be used to classify the outcomes included in registries, steer the development of outcome measurement, and ultimately enable better patient care through benchma...

Objective To review the evidence on the economic evaluations of workplace-based interventions that are designed to reduce prolonged periods of occupational sitting. Design An integrative review. Data sources The search was conducted in 11 databases, including PubMed, Scopus, PsychINFO, NHS-EED, Cumulative Index to Nursing and Allied Health Litera...

Background: Value-based healthcare (VBHC) is considered the most promising guiding principle for a new generation of health service production. Many countries have attempted to apply VBHC to managerial and clinical decision-making. However, implementation remains in its infancy and varies between countries. The objective of the study is to help hea...

Objectives: The aim of this study was to analyse the relation between the used labour pain relief and childbirth experience measured by Visual Analogue Scale (VAS). Design: A retrospective cohort study. Setting: Childbirth in five Helsinki University Hospital delivery units from 2012 to 2018. Primary outcome measure: Childbirth experience me...

Background Revision endoscopic sinus surgery (ESS) is often considered for chronic rhinosinusitis (CRS) if maximal conservative treatment and baseline ESS prove insufficient. Emerging research outlines the risk factors of revision ESS. However, accurately predicting revision ESS at the individual level remains uncertain. This study aims to examine...

Background and objectives: Despite the rapid spread of Lean management in health care, few organizations have achieved measurable overall performance improvements with Lean. What differentiates these organizations from those that struggle with realizing the potential benefits of Lean management is unclear. In this qualitative study we explore meas...

Background Lean management is growing in popularity in the healthcare sector worldwide, yet healthcare organizations are struggling with assessing the maturity of their Lean implementation and monitoring its change over time. Most existing methods for such assessments are time consuming, require site visits by external consultants, and lack frontli...

This article aims to answer how a commissioning body can steer health services based on value in an environment where the commissioner is responsible for the health services of a population with varying health service needs. In this design science study, we constructed a value-based steering model consisting of three parts: (1) the principles of st...

Background Substantial variation in health care costs for malignant pleural mesothelioma (MPM) has previously been identified. Materials and Methods We analyzed the changes in health care costs in MPM in Finland during 2002–2012. Finland has low-threshold public health care and a mandatory Workers' Compensation scheme that covers all occupational-...

A universal mask use was instituted in healthcare during COVID-19 pandemic in 2020. The extensive growth in the consumption of surgical masks and respirators brought new challenges. Healthcare workers had to get accustomed to wearing the facemasks continuously, raising concerns on the patient, occupational, and environmental safety. The aim of this...

Background The importance and potential benefits of introducing patient reported measures (PRMs) into health care service have been widely acknowledged, yet the experience regarding their implementation into practice is limited. There is a considerable paucity of research in adopting PRMs in maternity care routine. This study, which utilizes the PR...

Background: Uncontrolled chronic rhinosinusitis (CRS) needing consideration of surgery is a growing health problem yet its risk factors at individual level are not known. Our aim was to examine risk factors of revision endoscopic sinus surgery (ESS) at the individual level by using artificial intelligence. Methods: Demographic and visit variables w...

Background Healthcare organizations around the world are striving to achieve transformational performance improvement, often through adopting process improvement methodologies such as Lean management. Indeed, Lean management has been implemented in hospitals in many countries. But despite a shared methodology and the potential benefit of benchmarki...

Objectives This study investigated the costs of 2-hour multiprofessional in situ hospital trauma team simulation training and its effects on teams’ non-technical skills using the T-NOTECHS instrument. Background Simulation is a feasible and effective teaching and learning method. Calculating the costs of simulated trauma team training in medical e...

Background Reliable benchmarking in Lean healthcare requires widely relevant and applicable domains for outcome metrics and careful attention to contextual levels. These levels have been poorly defined and no framework to facilitate performance benchmarking exists. Methods We systematically searched the Pubmed, Scopus, and Web of Science databases...

Background: The importance and potential benefits of introducing patient reported measures (PRMs) into health care service have been widely acknowledged, yet the experience regarding their implementation into practice is limited. There is a considerable paucity of research in adopting PRMs in maternity care. This study, which utilizes the PRMs incl...

Background When the commissioner of healthcare services is responsible for all health services of a certain population, the commissioner is incentivized to steer service producers towards better value (i.e. outcomes relative to costs). Value-based healthcare provides a setting for creating better value, but it is currently limited to some patient s...

Purpose This study aims to report the design and testing of a maturity model for information and knowledge management in the public sector, intended for use in frequent monitoring, trend analysis and in-depth analysis of the contemporary information and knowledge management practices of an organization. Design/methodology/approach A design science...

Background: Visits to the primary diabetes care provider play a central role in diabetes care. Therefore, patients should attend their primary diabetes care providers whenever a visit is necessary. Parameters that might affect whether this condition is fulfilled include accessibility (in terms of travel distance and travel time to the practice), a...

Objective To explore women’s decisional conflict in the pathway of prenatal screening and testing (PreST) in Finland and to evaluate a counseling service. Methods Self-completion surveys were conducted at two medical settings (screening and further testing) of PreST. Decisional Conflict Scale (DCS) was the main measure. Different types of statisti...

Objective: In recent years research has identified important predictors for nursing home admission (NHA). However, as far as we know, the previous risk models use complex variable sets from many sources and the output is a single risk value. The objective of this study was to develop an NHA risk model with a variable set from single data source and...

Objective A short questionnaire which can be applied for assessing patient satisfaction in different contexts and different countries is to be developed. Methods Six items addressing tangibles, reliability, responsiveness, assurance, empathy, and communication were analysed. The first five items stem from SERVQUAL (SERVice QUALity), the last stems...

Adverse drug effects are a serious problem in hospital patient care [1]. The use of Enterprise Digital Assistants (=EDA) proved succesfull in HUS hospital pharmacy. The quality of order picking was better with EDAs. In 2018 75% of order rows and over 1 milloin packages in are picked with EDAs. There is a growing need for more detailed information o...

Background Oncology and haematology are shifting from inpatient to outpatient care, requiring new care delivery models. This study compares preferences of oncology patients treated by named nurses in a traditional specialty-focused day hospital and haematology patients treated without named nurses in a modularised day hospital. Methods Questionnai...

The relationships between caregiver burden as measured with the Burden Scale for Family Caregivers–short form and 6 characteristics of caregivers caring for patients with dementia were investigated for caregivers from England (n = 36), Finland (n = 42), and Greece (n = 46) using survey data. In all 3 countries, caregiver burden increases with physi...

Every service production system can be described by the categories explicated by the Service Machine template. This template is like a lens which allows one to see the things which we could not see otherwise. This helps in understanding the service production system better. The development of the Service Machine template is not always a straight fo...

A set of generic thinking tools is required to understand and develop a concept. New concepts are always built upon existing knowledge bases. In this chapter, we discuss various generic thinking tools used for designing and developing the concept of Service Machine. As a service production system designer, one should understand various definitions...

We elaborate the metaphorical concept of Service Machine. An analogy between a Service Machine and a physical machine has been discussed with the help of a typical physical machine. A Service Machine is based on a fundamental demand-supply –constellation: what needs to be done and what can be done with the available means and circumstances. It must...