Stroke is one of third most common causes of death and the main cause for permanent disabilities. The Tyrol Stroke Pathway covers, all steps from stroke onset to outpatient rehabilitation.
The main objective of this paper is to describe how the paper-based documentation in the outpatient rehabilitation can be implemented in an eHealth service for integrated care.
First a state analysis followed by a requirement analysis was performed. An interactive mock-up was designed for further discussion with the stakeholders. After the implementation of the system the evaluation was performed in two steps: feedback from a virtual test phase and a pilot operation was analyzed.
First experiences during the virtual test phase with key stakeholders of the therapy pathway showed a high level of acceptance. Users reported an improvement in the communication and documentation processes.
Initial results illustrate how a shift from paper-based documentation to an integrated eHealth service can improve communication and documentation in an independent therapy network.
To read the full-text of this research,
you can request a copy directly from the authors.
ResearchGate has not been able to resolve any citations for this publication.
ResearchGate has not been able to resolve any references for this publication.
Article Full-text available November 2007 · Yonsei Medical Journal
To evaluate the relationship between depressive symptoms and health care costs in outpatients with chronic medical illnesses in Korea, we screened for depressive symptoms in 1,118 patients with a chronic medical illness and compared the severity of somatic symptoms and health care costs.
Data were compared between outpatients with depressive symptoms and those without depressive symptoms.
... [Show full abstract] Depression and somatic symptoms were measured by Zung's Self-rating Depression Scale (SDS) and Patient Health Questionnaire (PHQ)-15, respectively. We also investigated additional data related to patients' health care costs (number of visited clinical departments, number of visits made per patients, and health care costs). A total of 468 patients (41.9%) met the criteria for depressive disorder.
A high rate of severe depressive symptoms was found in elderly, female and less-educated patients. A positive association between the severity of somatic symptoms and depressive symptoms was also identified. The effects of depressive symptoms in patients with chronic illnesses on three measures of health services were assessed by controlling for the effects of demographic variables and the severity of somatic symptoms. We found that the effects of depressive symptoms on the number of visited departments and number of visits made per patients were mediated by the severity of somatic symptoms. However, for health care costs, depressive symptoms had a significant main effect. Furthermore, the effect of gender on health care costs is moderated by the degree of a patient's depressive symptoms.
In summary, there is clearly a need for increased recognition and treatment of depressive symptoms in outpatients with chronic medical illnesses. View full-text June 2009 · Revista de salud publica (Bogota, Colombia)
Determining Costa Ricans' behaviour patterns when using health services.
The Costa Rican Health Survey was used. Central tendency, dispersion, percentages, frequencies, Ji-Square and Kruskal-Walis test measurements were analysed.
Area of residence and income level were the predisposing factors in both out-patient and emergency services whereas educational level was so in terms of hospitalisation
... [Show full abstract] service. Health insurance status and the area of residence were the enabling factors associated with using out-patient and hospitalisation services. The need factors associated with outpatient services were the individuals' perceived state of health, having remained in bed at least until noon and suffering some chronic disease; chronic disease was associated with hospitalisation and remaining in bed when using the emergency service.
Most variables postulated by Andersen and Newman's model as being determinants for using health services were present in Costa Rica. Nevertheless, the significance of its factors varied between outpatient, hospitalisation and emergency services. Read more Article Full-text available February 2005 · Cerebrovascular Diseases
An early supported discharge service (ESD) appears to be a promising alternative to conventional care. The aim of this trial was to compare the use of health services and costs with traditional stroke care during a one-year follow-up.
Three hundred and twenty patients were randomly allocated either to ordinary stroke unit care or stroke unit care combined with ESD which was coordinated by a
... [Show full abstract] mobile team. The use of all health services was recorded prospectively; its costs were measured as service costs and represent a combination of calculated average costs and tariffs. Hospital expenses were measured as costs per inpatient day and adjusted for the DRG.
There was a reduction in average number of inpatient days at 52 weeks in favour of the ESD group (p = 0.012), and a non-significant reduction in total mean service costs in the ESD group (EUR 18,937/EUR 21,824). ESD service seems to be most cost-effective for patients with a moderate stroke.
Acute stroke unit care combined with an ESD programme may reduce the length of institutional stay without increasing the costs of outpatient rehabilitation compared with traditional stroke care. View full-text Article Full-text available May 2014 · BMC Health Services Research
The Dutch mental healthcare sector has to decrease costs by reducing intramural capacity with one third by 2020 and treating more patients in outpatient care. This transition necessitates enabling patients to become as self-supporting as possible, by customising the residential care they receive to their needs for self-development. Theoretically, modularity might help mental healthcare
... [Show full abstract] institutions with this. Modularity entails the decomposition of a healthcare service in parts that can be mixed-and-matched in a variety of ways, and combined form a functional whole. It brings about easier and better configuration, increased transparency and more variety without increasing costs. Aim: this study aims to explore the applicability of the modularity concept to the residential care provided in Assisted Living Facilities (ALFs) of Dutch mental healthcare institutions.
A single case study is carried out at the centre for psychosis in Etten-Leur, part of the GGz Breburg IMPACT care group. The design enables in-depth analysis of a case in a specific context. This is considered appropriate since theory concerning healthcare modularity is in an early stage of development. The present study can be considered a pilot case. Data were gathered by means of interviews, observations and documentary analysis.
At the centre for psychosis, the majority of the residential care can be decomposed in modules, which can be grouped in service bundles and sub-bundles; the service customisation process is sufficiently fit to apply modular thinking; and interfaces for most of the categories are present. Hence, the prerequisites for modular residential care offerings are already largely fulfilled. For not yet fulfilled aspects of these prerequisites, remedies are available.
The modularity concept seems applicable to the residential care offered by the ALF of the mental healthcare institution under study. For a successful implementation of modularity however, some steps should be taken by the ALF, such as developing a catalogue of modules and a method for the personnel to work with this catalogue in application of the modules. Whether implementation of modular residential care might facilitate the transition from intramural residential care to outpatient care should be the subject of future research. View full-text Article Full-text available July 2018 · BMC Health Services Research
Native Hawaiians and Pacific Islanders (NHPIs) are one of the fasting growing racial groups in the United States (US). NHPIs have a significantly higher disease burden than the US population as a whole, yet they remain underrepresented in research. The purpose of this study is to examine factors associated with health care utilization among NHPIs.
Drawing from the 2014
... [Show full abstract] NHPI-National Health Interview Survey, we used stereotype logistic regressions to examine utilization of emergency department (ED) and outpatient services among 2172 individuals aged 18 and older.
NHPIs with chronic diseases were twice as likely to be multiple ED users and nearly four times as likely to be frequent-users of outpatient services. Social support played a protective role in preventing multiple use of ED. Having a usual source of care made it more than eight times as likely to be a frequent-user of outpatient services. Use of eHealth information increased the odds of using ED and outpatient services. Ability to afford health care increased the odds of using outpatient services. There was no association between health insurance coverage and use of ED and outpatient services among NHPIs.
This research provides the first available national estimates of health services use by NHPIs. Efforts to improve appropriate use of health services should consider leveraging the protective factors of social support to reduce the odds of frequent ED use, and having a usual source of care to increase use of outpatient services. View full-text Article Full-text available July 2017
Northern Health in British Colombia (BC) has 7 large telehealth service providers and several individual telehealth projects that form part of the health service. Telehealth in BC is for clinical, educational, and administrative purposes. Videoconferencing (mobile or desktop) is the primary tool. Clinical sessions use patient carts, which include devices that allow collection and observation of
... [Show full abstract] patient indicators. Tele-triage and home-monitoring is steadily increasing.
In BC, telegeriatrics is part of the out-patients ambulatory care patients unit at The University Hospital of Northern British Columbia, Prince George. Consultations take place at smaller sites (more than 20 locations in the BC area). There are challenges to ensuring an integrated sustained system relate to systemic and technology issues.
Limited published information found on best practices, however, work with telehealth service representatives in BC identified key influences which included 4 key areas which lead to a review to improve utility across the province. View full-text Article Full-text available May 2016 · Journal of Health Services Research & Policy
Variation in patterns of referral from primary care can lead to inappropriate overuse or underuse of specialist resources. Our aim was to review the literature on strategies involving primary care that are designed to improve the effectiveness and efficiency of outpatient services.
A scoping review to update a review published in 2006. We conducted a systematic literature
... [Show full abstract] search and qualitative evidence synthesis of studies across five intervention domains: transfer of services from hospital to primary care; relocation of hospital services to primary care; joint working between primary care practitioners and specialists; interventions to change the referral behaviour of primary care practitioners and interventions to change patient behaviour.
The 183 studies published since 2005, taken with the findings of the previous review, suggest that transfer of services from secondary to primary care and strategies aimed at changing referral behaviour of primary care clinicians can be effective in reducing outpatient referrals and in increasing the appropriateness of referrals. Availability of specialist advice to primary care practitioners by email or phone and use of store-and-forward telemedicine also show potential for reducing outpatient referrals and hence reducing costs. There was little evidence of a beneficial effect of relocation of specialists to primary care, or joint primary/secondary care management of patients on outpatient referrals. Across all intervention categories there was little evidence available on cost-effectiveness.
There are a number of promising interventions which may improve the effectiveness and efficiency of outpatient services, including making it easier for primary care clinicians and specialists to discuss patients by email or phone. There remain substantial gaps in the evidence, particularly on cost-effectiveness, and new interventions should continue to be evaluated as they are implemented more widely. A move for specialists to work in the community is unlikely to be cost-effective without enhancing primary care clinicians' skills through education or joint consultations with complex patients. View full-text December 2002 · Informe Epidemiológico do Sus
The regular notification of hospital discharges for outpatient accompaniment is a routine difficult to implement in the health services. Many times there are lost opportunities for preventive actions that could avoid complications and sequele of diseases. The need of disaggregated information on hospital morbidity led to the development of a methodology that utilizes the Hospital Information
... [Show full abstract] System from the Unified Health System (SIH-SUS) as the source of epidemiological information, for the city of São José dos Campos, in the state of São Paulo, Brazil. The objective was to subsidize decentralized actions of epidemiological surveillance and evaluation of outpatient services. The territory delimitation of the municipal health system and the introduction of the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (CID-10) were important conditions for the development of the methodology. Listings of monthly notification of hospital discharges were established in the health units. The database of SIH-SUS may also be used as a complementary source of epidemiological information, in addition to the traditional sources used for epidemiological surveillance and evaluation of health services. Read more December 2010 · Journal of Telemedicine and Telecare
We assessed the effects of a care coordination home-telehealth (CCHT) programme on health service utilization. The subjects (n = 387 for each group) were US veterans diagnosed with diabetes and followed for 48 months. The service utilization measures were numbers of all-cause inpatient stays and outpatient visits during the follow-up period. We used generalized linear mixed models to estimate the
... [Show full abstract] adjusted effects of the CCHT programme on service use over time. Compared with the controls, the CCHT clients were less likely to be admitted for inpatient care during the first (P < 0.001) and second (P < 0.01) six-month follow-up period, and were consistently more likely to visit outpatient clinics (P < 0.001) during the whole 48-month follow-up period. The likelihood of increase in outpatient utilization tended to decline over time. The findings suggest that the CCHT programme helped to reduce overall inpatient and outpatient use by the clients over the 48-month follow-up period. Read more November 2015 · Salud publica de Mexico
Econometric analysis that seeks to measure the cost impact of a private insurer's own network upon outpatient care for its policyholders, own network refers to vertical integrated providers. The purpose is to assess whether greater use of its own network reduces the costs that the insurer incurred, according to what specialized literature suggests.
Materials and methods:
... [Show full abstract] on a multiple linear regression on data from a private insurer. The dependent variable is per capita cost of outpatient services. The explanatory variables are adherence to the own network and a number of variables to specify better the model.
With all other factors constant, in relation to covering the costs of outpatient care, it is noted that policyholders with high adhesion to their own network are less expensive than whose with low adhesion.
The decision-making process about what services and what grade should be applied to each person by special conditions of the offer as the aggregation of human resources in own offices under formal rules has an impact on health care costs. Particular supply conditions cause variations in how resources are used. Read more March 2016 · International Journal of STD & AIDS
Data on the pattern and cost of health service use by HIV patients are required for evaluations of the cost-effectiveness of new drugs and technologies as well as being essential for service planning. The aim of this study was to identify the utilisation patterns and cost of hospital care for HIV patients in a single centre in Ireland in 2012. Data on the frequency and non-drug costs of all
... [Show full abstract] hospital resources used by HIV patients were extracted from a hospital activity-based costing system. Cost data were analysed using a generalised linear model. A total of 328 patients, 3672 patient months, were included in this study. Patients had a mean of 4.4 scheduled infectious disease outpatient appointments per patient year; 37% of patients also used another outpatient service, 15% in-patient services, 4% day-case service and 18% emergency department services in 2012. Patients with very advanced HIV disease continue to incur a disproportionate amount of the total cost of providing care. This study provides baseline utilisation and cost data for use of both infectious-disease and non-infectious disease hospital services and will be useful for service planning in light of the likely increases in resource demands. Read more August 1985 · [Kango gijutsu]: [Nursing technique] Read more Last Updated: 19 Apr 2022 Looking for the full-text?
You can request the full-text of this article directly from the authors on ResearchGate.