Conference PaperPDF Available

Bringing Care Quality to Life: Towards Quality Indicator-Driven Pathway Modelling For Integrated Care Networks

Authors:
  • Research Group Digital Health at Technische Universität Dresden

Abstract and Figures

Integrated care is a promising approach to create connectivity, alignment, and collaboration in a network of health care providers, especially for people with long-term and complex conditions. It aims at improving care quality, but a common, standardised quality management approach for such networks is still missing. In this context, care pathways are recognised as important quality management tools. They define key goals of care and organise actions to achieve them. However, their utilisation in terms of quality management is lacking methodological support. The article provides the conceptual foundations as part of a design-oriented research project that aims to develop a method for the utilisation of care pathways for quality management purposes in inte-grated care settings. Therefore, the realm of process quality in integrated care is analysed and structured by means of a classification framework. Moreover, relevant concepts for the integration of quality indicators in care pathways are analysed and represented with a semi-formal domain ontology. These conceptualisations prepare the next steps in the project’s research agenda. These comprise the development and evaluation of an indicator-driven care pathway modelling lan-guage and its application for quality management in integrated care. This approach could make quality of integrated care more transparent and manageable.
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ECIS 2019 Track: Health Information Technology and IS for Healthcare
BRINGING CARE QUALITY TO LIFE:
TOWARDS QUALITY INDICATOR-DRIVEN PATHWAY
MODELLING FOR INTEGRATED CARE NETWORKS
Peggy Richter
Tec hn is ch e Universität Dresden, Germany
Contact: peggy.richter2@tu-dresden.de
ManuscriptID: 1396
The research group Care4Saxony
is funded by the European Social
Fund (ESF) and the Free State of
Saxony.
information systems experts
Visit HeLiCT:
Extending existing
pathway modelling
language BPMN4CP by a
quality perspective
Methodological support
for development and
implementation of care
pathways in a
comprehensive network
of care providers
Demonstration and
evaluation of the
artefact (method)
Results
Integrated care as an approach for ensuring and improving the quality of care,
patient satisfaction and system efficiency, especially against the background of an
increasing prevalence of chronically ill and multimorbid patients
Currently there is no commonly used, comprehensive approach for the quality
management in integrated care settings
Method
Background and Motivation
Classification framework for process quality in integrated care settings (àRQ1)
Health care need: staying healthy, getting better, living with illness/
disability, end-of-life care
Quality goal: effectiveness, safety, patient-centeredness, continuity
Levels of analysis: micro, meso, macro
Domain ontology preparing method development/ language extension (àRQ2)
There are quality indicators available, but their implementation in the care process has deficits
Integrated care pathways as essential tool for the provision of integrated care (process-oriented view)
Outlook
Objective
To utilise care pathways
for quality management
in integrated care
RQ1: How can process-
relevant quality
indicators for health care
networks be identified
and classified?
RQ2: What are the
relevant concepts for the
integration of quality
indicators in care
pathway process models?
Evaluate in application domain
-Integrated stroke care
-Integrated cancer care
Design Science Research
Design Cycle
Environment
Application domain
(Healthcare domain)
-People: health care
providers, patients, …
-Organisational systems:
care facilities, care
networks, …
-Tech nical systems: hospital
information systems, …
-Problems & opportunities:
quality goals/ guidelines
not systematically
translated into care
pathways; missing
methodological and
technological support for
integration of quality
indicators in care
processes, …
Field testing
of method;
application
support
Requirements
for method
development
Knowledge Base
Foundations
-Scientific theories and
methods:
conceptualisation of
health care quality (esp.
process quality),
conceptualisation of
integrated care,
performance-, process-
and indicator modelling
-Experiences & expertise,
artefacts & processes:
state-of-the-art of
application domain (e. g.
existing care pathways,
clinical quality indicator
development methods;
medical guidelines as basis
for quality and pathway
specifications)
Relevance
Cycle
Grounding
Additions to
knowledge
base
Rigor
Cycle
DSR framework according to Hevner et al. (2004) and Hevner (2007)
Conceptual foundations
(addressed in the RIP paper):
-Process quality framework
(RQ1)
-Domain ontology (RQ2)
Build design artefact
(Overall research project):
Quality indicator-based
development and monitoring
method for care pathways
References
Hevner, A. R. (2007) “A Three Cycle View of Design Science
Research.” Scandinavian Journal of Information Systems 19
(2), 8792.
Hevner, A. R., March, S. T., Park, J. and Ram, S. (2004).
“Design science in information systems research.”
Management Information Systems Quarterly 28 (1), 75106.
Icon made by Freepik from www.flaticon.com
Figures: Network figure from Albreht
et al. (2017), p. 80; Icons made by
Freepik from www.flaHcon.com
... This approach is reasonable since the adaption of an existing modelling language with domain-specific concepts is expected to be less expensive than the invention of a new one [15]. The relevance for the language extension is reasoned in additional requirements from the environment which are yet not addressed, i. e. pathway-related QIs required in the context of quality management initiatives in the stroke and cancer care context [16] (supporting the DSR relevance cycle according to Hevner [17]). We conducted interviews with domain experts to gain insights into these two care domains and to validate requirements for the language extension. ...
... In order to conceptualize the quality perspective in relation to care pathways, the pathway ontology proposed by Braun et al. [38] was extended. Therefore, the identified indicator ontologies as described in section 3, own previous research on the conceptualization of process quality in healthcare [16], and the user-centred requirements identified in section 4.2 were used. The evolved domain ontology is depicted in Figure 2. Care pathway based on [38] and extended with a quality perspective, represented using the OWL Lite ontology [48]. ...
Conference Paper
Care pathways (CPs) are used as a tool to organize complex care processes and to foster the quality management in general. However, the quality management potentials have not been sufficiently exploited yet, since the development, documentation, and controlling of quality indicators (QIs) for quality management purposes are not fully integrated to the process standards defined by CPs. To support the integration of a quality perspective in CPs, the paper addresses the questions which and how quality concepts can be integrated into the process documentation in order to support managers, health service providers, and patients. Therefore, we extended the widely accepted modelling language “Business Process Model and Notation” (BPMN) with a quality perspective. The conceptualization is grounded on a systematic literature review on (quality) indicator modelling. Together with previous work on the conceptualization of QIs in health care, it provided the basis for a comprehensive domain requirements analysis. Following a design-oriented research approach, the requirements were evaluated and used to design a BPMN extension by implementing the quality indicator enhancements as BPMN meta model extension. All design decisions were evaluated in a feedback workshop with a domain expert experienced in quality management and certification of cancer centres on national and international level. The approach is demonstrated with an example from stroke care. The proposed language extension provides a tool to be used for the governance of care processes based on QIs and for the implementation of a more real-time, pathway-based quality management in health care.
... What is the analytical focus and methodological orientation of the contributions [68][69][70]? Which health information technologies and which user groups Table 3. Interim results of content analysis Category of contribution to care pathways or pathway-supporting HIS: Examples Evaluation and assessment of pathway-supporting HIS: -Studies on effectiveness, efficiency and user experience [11,46,[48][49][50][51] -Usage analyses for coordination around communication [48,50,52,53] Data-driven path modelling and integration of data-based predictive models: -Modelling methods or tools for deriving care pathways from electronic case record data [47,50,[54][55][56] -Development of data-based predictive models (data & process mining, machine learning, deep learning) for medical decision support [47,50,56,57] -Data-based analysis and decision models from data pathway-supporting HIS for care and hospital management [55,58] Conventional modelling of care pathways: -Development of process-oriented modelling languages for care pathways [59] -Presentation of modelling tools for supply pathways [47] Conceptual integration of the management perspective: -Intersection analysis of expertise from information systems, operational research and industrial engineering for problem solving in connection with supply paths [60] -Method conception for embedding quality management in care pathways [61] -Path-based data analysis for tactical and strategic hospital management [62] Care pathways as a structuring aid of HISR: -Analyses of the status quo of the digital transformation [63,64] -Studies on the potential analysis of telemedical measures [65] -Studies on the personalisation of HIS services [66] and technology support [11] are the focus [69,70]? In what relation are theories of ISR and health care discussed [68]? ...
Chapter
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Care pathways and implementing information systems increasingly permeate the discipline of Health Information Systems Research (HISR). It explores the conception, modelling, realisation and impact of pathway-supporting HIS and strives for the best possible harmonisation of interdisciplinary goals from technology, medicine and public health research. A systematic literature review with qualitative content analysis is dedicated to this integrating character. It examines the interdisciplinary network of objectives associated with care pathways and pathway-supporting HIS in the HISR literature of the past decade. The research-in-progress paper presented here describes the background, methodology and interim content analysis results. Alternative questions and analysis strategies to this status are outlined in conclusion as a basis for discourse. In this way, adjustments to the research strategy of this project will be sought in a targeted exchange with researchers from the HISR.
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Chapter
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Care pathways and supporting health information systems (HIS) have been permeate the discipline of Health Information Systems Research (HISR) over years. Traditional objectives of workflow assistance are increasingly extended by interdisciplinary goals from technology, medicine, management and public health research. A systematic literature review is dedicated to this integrating character. It examines the interdisciplinary mesh of objectives associated with care pathways and pathway-supporting HIS in the HISR literature. From 47 identified articles, 6 thematic themes were derived. Their consolidation supports in particular design and development processes as it describes the solution space of future pathway-supporting HIS addressing requirements stated by multiple stakeholders.
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