No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Diffusionsprozesse digitaler Interventionen erfolgreich gestalten: Hintergrund und Gestaltungsempfehlungen
Zusammenfassung
Im Dezember 2019 wurden in Deutschland Digitale Gesundheitsanwendungen (DiGA) in die Regelversorgung aufgenommen und können somit durch die gesetzlichen Krankenkassen erstattet werden, um PatientInnen bei der Behandlung von Erkrankungen oder Beeinträchtigungen zu unterstützen. Inzwischen gibt es 48 DiGA (Stand: Oktober 2023) im Verzeichnis des Bundesinstituts für Arzneimittel und Medizinprodukte (BfArM), die vor allem in den Bereichen mentale Gesundheit, Hormone und Stoffwechsel sowie Muskeln, Knochen und Gelenke eingesetzt werden. In diesem Artikel beschreibt die Fachgruppe „Digital Health“ der Gesellschaft für Informatik e. V. (GI) die aktuellen Entwicklungen rund um die DiGA sowie das derzeitige Stimmungsbild zu Themen wie Nutzerzentrierung, Akzeptanz von PatientInnen und Behandelnden sowie Innovationspotenzial. Zusammenfassend haben DiGA in den letzten 3 Jahren eine positive Entwicklung in Form eines langsam steigenden Angebots verschiedener DiGA und Leistungsbereiche erfahren. Nichtsdestotrotz sind in einigen Bereichen noch erhebliche regulatorische Weichenstellungen notwendig, um DiGA langfristig in der Regelversorgung zu etablieren. Zentrale Herausforderungen bestehen u. a. in der Nutzerzentrierung oder in der nachhaltigen Verwendung der Anwendungen.
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.
Background
Integrated care is said to improve the way in which care is delivered. To support integrated care by ensuring close collaboration between involved stakeholders, information and communication technologies, especially telemedicine, are needed. Despite their potential, most telemedicine solutions never make it from pilot project stage to full implementation into usual care. Especially in integrated care scenarios, understanding of the barriers hampering successful telemedicine implementation and application is limited.
Objective and method
Four rapid scoping reviews were carried out to cover the following broad sets of barriers in telemedicine implementation: technical, behavioural, economical and organisational barriers. The identified barriers and obstacles were categorised into problem areas with sub-categories and, afterwards, combined in order to identify future research potentials for telemedicine implementation.
Results
A total of 118 studies were included for further analysis. The findings suggest that the individuals’ characteristics, as well as the surrounding social and health care system, are the most important barriers for telemedicine-supported integrated care. The information system development and application, as well as missing data and evidence for the effectiveness of telemedicine and integrated care, are hampering successful implementation.
Discussion
The consolidated problem areas deepen the understanding on how barriers for telemedicine solutions in integrated care settings are interrelated. Conclusively, this helps to successfully develop and implement telemedicine-supported integrated care.
Background:
Only a few telemedicine applications have made their way into regular care. One reason is the lack of acceptance of telemedicine by potential end users.
Objective:
The aim of this systematic review was to identify theoretical predictors that influence the acceptance of telemedicine.
Methods:
An electronic search was conducted in PubMed and PsycINFO in June 2018 and supplemented by a hand search. Articles were identified using predefined inclusion and exclusion criteria. In total, two reviewers independently assessed the title, abstract, and full-text screening and then individually performed a quality assessment of all included studies.
Results:
Out of 5917 potentially relevant titles (duplicates excluded), 24 studies were included. The Axis Tool for quality assessment of cross-sectional studies revealed a high risk of bias for all studies except for one study. The most commonly used models were the Technology Acceptance Model (n=11) and the Unified Theory of Acceptance and Use of Technology (n=9). The main significant predictors of acceptance were perceived usefulness (n=11), social influences (n=6), and attitude (n=6). The results show a superiority of technology acceptance versus original behavioral models.
Conclusions:
The main finding of this review is the applicability of technology acceptance models and theories on telemedicine adoption. Characteristics of the technology, such as its usefulness, as well as attributes of the individual, such as his or her need for social support, inform end-user acceptance. Therefore, in the future, requirements of the target group and the group's social environment should already be taken into account when planning telemedicine applications. The results support the importance of theory-guided user-centered design approaches to telemedicine development.
Healthcare systems in western countries are continuously working to achieve efficient resource allocation and to improve access to quality medical care. The implementation of standardised care processes promises better integration and coordination of care across several healthcare providers. In this context, an increasing use of the term patient pathway is recognised within official documents provided by health authorities and within scientific publications in recent years. However, a common understanding, distinguishing the term from other pathway approaches such as care-or clinical pathways, is missing. By means of a scoping review we analysed 132 publications in order to clarify key concepts and the understanding of patient pathways. Six common themes in the literature were identified and results show that individualisation and care continuity are essential descriptive characteristics. Using this motivation, we discuss the main implications for research and practice by the example of comprehensive cancer care in the European Union.
Background
Innovation theory has focused on the adoption of new products or services by individuals and their market-driven diffusion to the population at large. However, major health sector innovations typically emerge from negotiations between diverse stakeholders who compete to impose or at least prioritise their preferred version of that innovation. Thus, while many digital health interventions have succeeded in terms of adoption by a substantial number of providers and patients, they have generally failed to gain the level of acceptance required for their integration into national health systems that would promote sustainability and population-wide application. The area of innovation considered here relates to a growing number of success stories that have created considerable enthusiasm among donors, international agencies, and governments for the potential role of ICTs in transforming weak national health information systems in middle and low income countries. This article uses a case study approach to consider the assumptions, institutional as well as technical, underlying this enthusiasm and explores possible ways in which outcomes might be improved.
Methods
Literature review and case study analysis.
Results
The two systems considered have had considerable success in terms of gaining and maintaining government support and addressing the concerns of providers without compromising their core elements. In Uganda, the system has flourished in spite of severe resource constraints, using a participatory approach that has encouraged a high level of community engagement. In China, concern with past failures generated the political will to build a high quality surveillance system, using the latest technology and drawing on a highly skilled human resource base.
Conclusions
Both example stress the importance of recognising the political, social and historical context within which information systems have to function. Implementers need to focus as much on the perceptions, attitudes and needs of stakeholders as on the technology. Implementers should distinguish between factors which may influence engagement at an institutional level and those aimed at supporting and supervising individuals within those institutions. Finally, we would suggest that designing interoperability into systems at the outset, rather than assuming that this can be achieved at some point in the future, may prove far easier in the longer term.
Communities are at many different stages of readiness for implementing programs, and this readiness is a major factor in determining whether a local program can be effectively implemented and supported by the community. The Community Readiness Model was developed to meet research needs, (e.g., matching treatment and control communities for an experimental intervention) as well as to provide a practical tool to help communities mobile for change. The model defines nine stages of community readiness ranging from "no awareness" of the problem to "professionalization" in the response to the problem within the community. Assessment of the stage of readiness is accomplished using key informant interviews, with questions on six different dimensions related to a communitys readiness to mobilize to address a specific issue. Based on experiences in working directly with communities, strategies for successful effort implementation have been developed for each stage of readiness. Once a community has achieved a stage of readiness where local efforts can be initiated, community teams can be trained in use of the community readiness model. These teams can then develop specific, culturally appropriate efforts that use local resources to guide the community to more advanced levels of readiness, eventually leading to long-term sustainability of local community efforts. This article presents the history of the development of the model, the stages of readiness, dimensions used to assess readiness, how readiness is assessed and strategies for change at each level of readiness.
Background
The development of integrated care is a complex and long term process. Previous research shows that this development process can be characterised by four phases: the initiative and design phase; the experimental and execution phase; the expansion and monitoring phase and the consolidation and transformation phase. In this article these four phases of the Development Model for Integrated Care (DMIC) are validated in practice for stroke services, acute myocardial infarct (AMI) services and dementia services in the Netherlands.
Methods
Based on the pre-study about the DMIC, a survey was developed for integrated care coordinators. In total 32 stroke, 9 AMI and 43 dementia services in the Netherlands participated (response 83%). Data were collected on integrated care characteristics, planned and implemented integrated care elements, recognition of the DMIC phases and factors that influence development. Data analysis was done by descriptive statistics, Kappa tests and Pearson’s correlation tests.
Results
All services positioned their practice in one of the four phases and confirmed the phase descriptions. Of them 93% confirmed to have completed the previous phase. The percentage of implemented elements increased for every further development phase; the percentage of planned elements decreased for every further development phase. Pearson’s correlation was .394 between implemented relevant elements and self-assessed phase, and up to .923 with the calculated phases (p < .001). Elements corresponding to the earlier phases of the model were on average older. Although the integrated care services differed on multiple characteristics, the DMIC phases were confirmed.
Conclusions
Integrated care development is characterised by a changing focus over time, often starting with a large amount of plans which decrease over time when progress on implementation has been made. More awareness of this phase-wise development of integrated care, could facilitate integrated care coordinators and others to evaluate their integrated care practices and guide further development. The four phases model has the potential to serve as a generic quality management tool for multiple integrated care practices.
Background
An ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities?
Methods
We conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption.
Results
Of the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption.
Conclusions
Rural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”).
Patients' engagement in healthcare is at the forefront of policy and research practice and is now widely recognized as a critical ingredient for high-quality healthcare system. This study aims to analyze the current academic literature (from 2002 to 2012) about patient engagement by using bibliometric and qualitative content analyses. Extracting data from the electronic databases more likely to cover the core research publications in health issues, the number of yearly publications, the most productive countries, and the scientific discipline dealing with patient engagement were quantitatively described. Qualitative content analysis of the most cited articles was conducted to distinguish the core themes. Our data showed that patient engagement is gaining increasing attention by all the academic disciplines involved in health research with a predominance of medicine and nursing. Engaging patients is internationally recognized as a key factor in improving health service delivery and quality. Great attention is up to now paid to the clinical and organizational outcomes of engagement, whereas there is still a lack of an evidence-based theoretical foundation of the construct as well as of the organizational dimensions that foster it.
Information technology (IT) acceptance research has yielded many competing models, each with different sets of acceptance determinants. In this paper, we (1) review user acceptance literature and discuss eight prominent models, (2) empiri- cally compare the eight models and their exten- sions, (3) formulate a unified model that integrates elements across the eight models, and (4) empiri- cally validate the unified model. The eight models reviewed are the theory of reasoned action, the technology acceptance model, the motivational model, the theory of planned behavior, a model combining the technology acceptance model and the theory of planned behavior, the model of PC utilization, the innovation diffusion theory, and the social cognitive theory. Using data from four organizations over a six-month period with three points of measurement, the eight models ex- plained between 17 percent and 53 percent of the variance in user intentions to use information technology. Next, a unified model, called the Unified Theory of Acceptance and Use of Tech- nology (UTAUT), was formulated, with four core determinants of intention and usage, and up to four moderators of key relationships. UTAUT was then tested using the original data and found to outperform the eight individual models (adjusted
Valid measurement scales for predicting user acceptance of computers are in short supply. Most subjective measures used in practice are unvalidated, and their relationship to system usage is unknown. The present research develops and validates new scales for two specific variables, perceived usefulness and perceived ease of use, which are hypothesized to be fundamental determinants of user acceptance. Definitions for these two variables were used to develop scale items that were pretested for content validity and then tested for reliability and construct validity in two studies involving a total of 152 users and four application programs. The measures were refined and streamlined, resulting in two six-item scales with reliabilities of .98 for usefulness and .94 for ease of use. The scales exhibited high convergent, discriminant, and factorial validity. Perceived usefulness was significantly correlated with both self-reported current usage (r=.63, Study 1) and self-predicted future usage (r =.85, Study 2). Perceived ease of use was also significantly correlated with current usage (r=.45, Study 1) and future usage (r=.59, Study 2). In both studies, usefulness had a significantly greater correlation with usage behavior than did ease of use. Regression analyses suggest that perceived ease of use may actually be a causal antecedent to perceived usefulness, as opposed to a parallel, direct determinant of system usage. Implications are drawn for future research on user acceptance.
A qualitative approach was used to explore the readiness of a rural community for the implementation of telehealth services. There were four domains of interest: patient, practitioner, public and organization. Sixteen semistructured telephone interviews (three to five in each domain) were carried out with key informants and recorded on audio-tape. Two community awareness sessions were held, which were followed by five audio-taped focus groups (with five to eight people in each) in the practitioner, patient and public domains. In addition, two in-depth interviews were conducted with community physicians. Analysis of the data suggested that there were four types of community readiness: core, engagement, structural and non-readiness. The level of readiness varied across domains. There were six main themes: core readiness; structural readiness; projection of benefits; assessment of risk; awareness and education; and intra-group and inter-group dynamics. The results of the study can be used to investigate the readiness of rural and remote communities for telehealth, which should improve the chance of successful implementation.
Telemedicine implementations often remain in the pilot phase and do not succeed in scaling-up to robust products that are used in daily practice. We conducted a qualitative literature review of 45 conference papers describing telemedicine interventions in order to identify determinants that had influenced their implementation. The identified determinants, which would influence the future implementation of telemedicine interventions, can be classified into five major categories: (1) Technology, (2) Acceptance, (3) Financing, (4) Organization and (5) Policy and Legislation. Each category contains determinants that are relevant to different stakeholders in different domains. We propose a layered implementation model in which the primary focus on individual determinants changes throughout the development life cycle of the telemedicine implementation. For success, a visionary approach is required from the multidisciplinary stakeholders, which goes beyond tackling specific issues in a particular development phase. Thus the right philosophy is: 'start small, think big'.
Nearly half a century ago, telemedicine was disregarded for being an unwieldy, unreliable, and unaffordable technology. Rapidly evolving telecommunications and information technologies have provided a solid foundation for telemedicine as a feasible, dependable, and useful technology. Practitioners from a variety of medical specialties have claimed success in their telemedicine pursuits. Gradually, this new modality of healthcare delivery is finding its way into the mainstream medicine. As a multidisciplinary, dynamic, and continually evolving tool in medicine, researchers and users have developed various definitions for telemedicine. The meaning of telemedicine encapsulated in these definitions varies with the context in which the term was applied. An analysis of these definitions can play an important role in improving understanding about telemedicine. In this paper we present an extensive literature review that produced 104 peer-reviewed definitions of telemedicine. These definitions have been analyzed to highlight the context in which the term has been defined. The paper also suggests a definition of modern telemedicine. The authors suggest that telemedicine is a branch of e-health that uses communications networks for delivery of healthcare services and medical education from one geographical location to another. It is deployed to overcome issues like uneven distribution and shortage of infrastructural and human resources. We expect that this study will enhance the level of understanding and meaning of telemedicine among stakeholders, new entrants, and researchers, eventually enabling a better quality of life.
As long as telemedicine is not implemented and scaled up successfully, its promises of increased access to care and decreased costs cannot be kept. Extant literature already identified factors to be addressed when implementing a telemedicine solution but lacks clear guidance on how to support successful telemedicine implementation and scaling up. The aim of this paper is to identify and combine evidence on barriers and success factors from different countries. Structuring the results in different layers helps describing the context of telemedicine initiatives within the FraTelIni framework. Aspects for
improvement and responsible stakeholders are named, resulting in general recommendations to be followed. Such, a conclusive picture on that topic can be drawn which actively addresses stakeholders and their tasks on different levels to support
successful telemedicine initiatives.
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.
Telemedicine is said to change the way care is delivered. Nevertheless, it still faces barriers to overcome the pilot stage and reach a majority of patients in regular care. Although research widely exists on telemedicine barriers in isolated settings, a systematic overview to summarize key scientific contributions is missing. This paper aims to close this gap with a systematic review of already existing reviews. In sum, 98 barriers for telemedicine implementation were found and categorized depending on the factors triggering the barriers. These factors include patient, healthcare provider, culture and disease (people-related); health sector, standards/guidelines, legal framework, finance, organization and methodology (process-related); and technology (object-related). Recommendations for researchers and practitioners were drawn to overcome the barriers identified.
Telemedicine is said to change the way care is delivered. Nevertheless, it still faces barriers to overcome the pilot stage and reach a majority of patients in regular care. Missing consideration of user-centred design processes is one major reason for this development as individuals are a key component for the technology’s success. Therefore, we aim to provide recommendations for a user-centred design process, which is, in turn, crucial to successfully implementing telemedicine innovations. To reach this aim, we identified individual-related barriers for telemedicine with an umbrella review. Furthermore, we related the barriers to the Unified Theory of Acceptance and Use of Technology (UTAUT2) proposed by Venkatesh and colleagues. A theoretical explanation helps to generate a broader understanding of what prevents individual acceptance of telemedicine innovations. The provided recommendations are supposed to support researchers and practitioners planning future telemedicine solutions.
Das deutsche Gesundheitswesen ist zahlreichen Reformbemühungen ausgesetzt, die meist das Ausgabenwachstum dämpfen bzw. eine stabile Finanzierung erreichen sollen. Mit den Instrumenten der Neuen Institutionenökonomik analysiert Dennis Häckl den gesellschaftlichen Nutzen der Telemedizin und geht auf Barrieren bei der Einführung und Verbreitung dieser Technologie ein. Als ein zentrales Hindernis lässt sich hierbei das Auseinanderfallen von privaten Kosten und gesellschaftlichem Nutzen bei der Anwendung der Telemedizin festhalten. Der Autor untersucht aktuelle Reformansätze wie Integrierte Versorgung und Disease-Management-Programme in ihrer Wirkung auf die Einführung von Innovationen und erarbeitet Anforderungen an die Ausgestaltung der Rahmenbedingungen im Gesundheitswesen.
Innovativehealthcareservicesandtechnologiesshowgreatpromises for reducing individual and societal burdens, but predominantly fail to attract sufficient end user acceptance and usage. This renders the aspect of technology adoption as key weakness of most health technology development endeavors, but also as most promising area for implementing changes that can dramatically increase the likelihood of project success. The purpose of this paper is to discuss some core assumptions of a user-centered process framework for technology adoption that addresses three major weaknesses of many current adoption models: First, the inadequate consideration of the process character of health technology adoptions. Second, the restricted view of human motivation, information processing, and behavior as being primarily rational and utilitarian in nature. And third, the insufficient attention to situational and social influences, and the role of individual differences. Theoretical, methodological, user inclusion-related and communication-related implications of the proposed prespective changes are discussed.
Aims:
We aim to describe tele-audiology services conducted to facilitate audiological management for children in both the rural and urban context and to determine the strengths, challenges and clinical implications of such services.
Methods:
A scoping review was conducted by searching for peer-reviewed publications from five databases. Inclusion criteria and search strategies were outlined.
Results:
Of the 23 studies that met the inclusion criteria, reliability of automated testing was comparable to conventional testing; however, these studies were based primarily on screening programmes. Eight (35%) of the 23 papers were concordance studies evaluating feasibility and validity of tele-audiology systems when compared with conventional testing, while one study (4%) evaluated a tele-audiology service. A further four studies (17%) evaluated the feasibility of introducing telehealth methods to evaluate middle ear pathology. Tele-auditory brainstem response was investigated in three studies (13%) and another five (22%) used smartphone and/or iPad technology to screen hearing. Only two studies (9%) evaluated the feasibility of providing intervention through telehealth methods. All included studies demonstrated improved access to and coverage of rural areas. Services such as video otoscopy and synchronous (online) hearing testing in remote areas were successfully implemented. Challenges included lack of diagnostic studies, inadequate training of staff and the need to standardize protocols and procedures in order to ensure that tele-audiology services are provided in a standardized and valid manner.
Conclusion:
Tele-audiology services are feasible and can be useful in identifying auditory pathology for children in rural and remote areas.
Purpose
– Integrating health, social and informal care and seeking for new effective collaborations is a major topic in many countries, and requires innovation and improvement in current practices. Conceptual quality management models can facilitate practice improvement. However, a generic quality management model for integrated care was lacking. The purpose of this paper is to describe the results of multiple studies that resulted in a validated generic quality management model for integrated care. The Development Model for Integrated Care (DMIC) is the basis for a digital tool for self-evaluation and is being used in multiple ways in a large number of integrated care settings.
Design/methodology/approach
– A literature review, a Delphi study and concept mapping study were executed to identify the essential ingredients of integrated care. A next step was an expert study on the development process of integrated care over time. Lastly, a survey study in 84 integrated care networks was performed to empirically validate the model. Based on the model, a digital self-assessment tool was created to apply the model in practice.
Findings
– The studies showed that integrated care is a complex and multi-component concept but generic elements can be assessed. The literature and expert study resulted in a set of 89 elements of integrated care. The elements were grouped in nine clusters; “quality care”, “performance management”, “inter-professional teamwork”, “delivery system”, “roles and tasks”, “patient-centredness”, “commitment”, “transparent entrepreneurship” and “result-focused learning”. Four developmental phases named “the initiative and design phase”, “the experimental and execution phase”, “the expansion and monitoring phase” and “the consolidation and transformation phase” were found. The findings showed that the model is applicable for multiple integrated care settings.
Research limitations/implications
– The DMIC has the potential to serve as a research framework for integrated care, and the use as an evaluation tool on multiple levels. Further research is suggested about more explicitly involving the perspectives of clients, research on the involvement of multiple stakeholders and their professional backgrounds and the use of the model in other countries.
Practical implications
– The DMIC is the basis of a digital web-based assessment tool, which is being used in the Netherlands in multiple integrated care settings. Applying the tool helps in assessing the current state of integrated care practice and defining suggestions for further improvement and development. It is also being used to benchmark multiple settings and is adopted in guidelines or care standards for integrated care.
Originality/value
– A generic conceptual and validated model that can be supportive for integrated care practices, policy and research was lacking. The results of the summarized studies in this paper present such a conceptual model for integrated care and gives suggestions for further use in an international audience. Results in a Canadian study showed that the model can also be used in other settings and countries. This contributes to the opportunities for use of the model in integrated care practice, policy and research also in other countries.
Background:
Australians in rural and remote areas live with far poorer health outcomes than those in urban areas. Telehealth services have emerged as a promising solution to narrow this health gap, as they improve the level and diversity of health services delivery to rural and remote Australian communities. Although the benefits of telehealth services are well studied and understood, the uptake has been very slow.
Materials and methods:
To understand the underpinning issues, we conducted a literature review on barriers to telehealth adoption in rural and remote Australian communities, based on the published works of Australian clinical trials and studies.
Results:
This article presents our findings using a comprehensive barrier matrix. This matrix is composed of four stakeholders (governments, technology developers and providers, health professionals, and patients) and five different categorizations of barriers (regulatory, financial, cultural, technological, and workforce). We explain each cell of the matrix (four stakeholders×five categories) and map the reported work into the matrix.
Conclusions:
Several exemplary barrier cases are also described to give more insights into the complexity and dilemma of adopting telehealth services. Finally, we outline recent technological advancements that have a great potential to overcome some of the identified barriers.
There has been increasing interest in using video telehealth to deliver evidence-based psychotherapies (EBPs). Telehealth may have numerous advantages over standard in-person care, including decreasing patients’ and providers’ costs and increasing system coverage area. However, little is known regarding the effectiveness of EBPs via video telehealth. This review had two goals, including a review of the existing literature and ongoing research on using video telehealth technologies to deliver EBPs as well as an informal survey of telehealth experts to discuss the special considerations and challenges present in adapting practices to video telehealth. Together, findings suggest that telehealth practices could represent an important component of the future of psychotherapy and clinical practice, especially in dissemination and implementation of EBPs in traditionally underserved areas and populations.
This article classifies 30 OECD healthcare systems according to a deductively generated typology by Rothgang and Wendt [1]. This typology distinguishes three core dimensions of the healthcare system: regulation, financing, and service provision, and three types of actors: state, societal, and private actors. We argue that there is a hierarchical relationship between the three dimensions, led by regulation, followed by financing and finally service provision, where the superior dimension restricts the nature of the subordinate dimensions. This hierarchy rule limits the number of theoretically plausible types to ten. To test our argument, we classify 30 OECD healthcare systems, mainly using OECD Health Data and WHO country reports. The classification results in five system types: the National Health Service, the National Health Insurance, the Social Health Insurance, the Etatist Social Health Insurance, and the Private Health System. All five types belong to the group of healthcare system types considered theoretically plausible. Merely Slovenia does not comply with our assumption of a hierarchy among dimensions and typical actors due to its singular transformation history.
This scoping review of the telehealth literature over the past year was conducted to provide a snapshot of some of the current developments in the field. As with any scoping review, only a subset of papers was examined, and the rigorous methods of a systematic review are not applied.
We surveyed selected dimensions of the current literature, specifically targeting telehealth or eHealth interventions at the patient (or micro) level in this scoping review. Considering the lack of clarity around the terms like mHealth, eHealth, telehealth, and telemedicine, efforts were made understand and harmonize the terminology as part of the review process.
A total of 171 papers that matched the search criteria were culled from the literature. After discussion and debate, a total of 26 papers were retained and classified into at least one of 5 conceptual categories that were derived form a concept analysis. The five categories are Preventive and Therapeutic Effects; Health Service Utilization; Challenges & Opportunities for Enhanced User Centered Design; Low-powered studies/inconclusive evidence; and Future trends in telehealth. Each of these 5 concept categories are discussed to provide a better understanding of present opportunities, challenges, and the overall prospects for telehealth advancement.
The field is expanding and maturing rapidly. There is a need for larger scale studies that balance rigor while reducing translational latency. Additional attention to implementation science methods is recommended as global telehealth projects accelerate.
Getting an innovation adopted is difficult; a common problem is increasing the rate of its diffusion. Diffusion is the communication of an innovation through certain channels over time among members of a social system. It is a communication whose messages are concerned with new ideas; it is a process where participants create and share information to achieve a mutual understanding. Initial chapters of the book discuss the history of diffusion research, some major criticisms of diffusion research, and the meta-research procedures used in the book. This text is the third edition of this well-respected work. The first edition was published in 1962, and the fifth edition in 2003. The book's theoretical framework relies on the concepts of information and uncertainty. Uncertainty is the degree to which alternatives are perceived with respect to an event and the relative probabilities of these alternatives; uncertainty implies a lack of predictability and motivates an individual to seek information. A technological innovation embodies information, thus reducing uncertainty. Information affects uncertainty in a situation where a choice exists among alternatives; information about a technological innovation can be software information or innovation-evaluation information. An innovation is an idea, practice, or object that is perceived as new by an individual or an other unit of adoption; innovation presents an individual or organization with a new alternative(s) or new means of solving problems. Whether new alternatives are superior is not precisely known by problem solvers. Thus people seek new information. Information about new ideas is exchanged through a process of convergence involving interpersonal networks. Thus, diffusion of innovations is a social process that communicates perceived information about a new idea; it produces an alteration in the structure and function of a social system, producing social consequences. Diffusion has four elements: (1) an innovation that is perceived as new, (2) communication channels, (3) time, and (4) a social system (members jointly solving to accomplish a common goal). Diffusion systems can be centralized or decentralized. The innovation-development process has five steps passing from recognition of a need, through R&D, commercialization, diffusions and adoption, to consequences. Time enters the diffusion process in three ways: (1) innovation-decision process, (2) innovativeness, and (3) rate of the innovation's adoption. The innovation-decision process is an information-seeking and information-processing activity that motivates an individual to reduce uncertainty about the (dis)advantages of the innovation. There are five steps in the process: (1) knowledge for an adoption/rejection/implementation decision; (2) persuasion to form an attitude, (3) decision, (4) implementation, and (5) confirmation (reinforcement or rejection). Innovations can also be re-invented (changed or modified) by the user. The innovation-decision period is the time required to pass through the innovation-decision process. Rates of adoption of an innovation depend on (and can be predicted by) how its characteristics are perceived in terms of relative advantage, compatibility, complexity, trialability, and observability. The diffusion effect is the increasing, cumulative pressure from interpersonal networks to adopt (or reject) an innovation. Overadoption is an innovation's adoption when experts suggest its rejection. Diffusion networks convey innovation-evaluation information to decrease uncertainty about an idea's use. The heart of the diffusion process is the modeling and imitation by potential adopters of their network partners who have adopted already. Change agents influence innovation decisions in a direction deemed desirable. Opinion leadership is the degree individuals influence others' attitudes
Aims and objectives:
The primary aim is to provide insight into client characteristics and characteristics of home telecare contacts, which may influence the adoption of home telecare. Secondary aim is to examine the applicability of four perceived attributes in Rogers' diffusion of innovations theory, which may influence the adoption: relative advantage, compatibility, complexity and observability.
Background:
Western countries face strongly increasing healthcare demands. At the same time, a growing nursing shortage exists. The use of home telecare may be instrumental in improving independence and safety and can provide support to older and chronically ill people, but a precondition for its uptake is that clients consider it as a useful and helpful technological tool.
Design:
A survey conducted among clients of seven home care organisations in the Netherlands connected to a home telecare system.
Methods:
In 2007, a postal questionnaire was distributed to 468 older or chronically ill clients: 254 responded (54%). The data were analysed by regression techniques, employing a theoretical model.
Results:
This study showed that clients' perceived attributes - relative advantage, compatibility, complexity and observability - have a significant effect on adoption of home telecare explaining 61% of the variance. The chance of adoption is higher when a client already receives long-term personal and/or nursing care, he/she lives alone and when there are fixed daily contacts via the home telecare system. The perception of possible benefits can still be enhanced.
Conclusions:
The concept of perceived attributes, derived from Rogers' diffusion of innovation theory, has been useful to explain clients' adoption of home telecare.
Relevance to clinical practice:
Home care organisations can best focus on clients already in care and people living alone, in offering home telecare. Nurses, who aim to enhance the client's adoption of home telecare, have to take into account clients' perceived attributes of such new technology.
Deliverable 3.4 personalised blueprint for telemedicine deployment: validated and tested version, momentum - European momentum for mainstreaming telemedicine deployment in daily practice
- L K Jensen
- U Knarvik
- C D Pedersen
- W Tangene
- D Whitehouse
R (Hrsg) Information technology based methods for health behaviours, studies in health technology and informatics
- L Otto
- L Harst
- P Timpel
- B Wollschlaeger
- P Richter
- H Schlieter
2017) EUROPEAN guide on quality improvement in comprehensive cancer control, CanCon - Cancer Control Joint Action. Scientific Institute of Public Health/National Institute of Public Health
- T Albreht
- R Kiasuwa
- M Van Der Bulcke
- H Schlieter
- A Sunyaev
- R Breitschwerdt
- M Sedlmayr
- V Karnowski