Qualitative methods in a learning healthcare system: Balancing rigour and the need for rapid analysis and dissemination

Qualitative methods are used to capture stakeholder perspectives within learning healthcare systems (LHS), but there is a need to specify methods that balance rigour and pragmatic approaches to inform quality improvement (QI). Utilizing examples from two QI projects within the OTNY LHS, we illustrate methods and strategies that build team capacity and flexibility to respond to an evolving LHS. Method(s): Qualitative methods were tailored to fit each project's timelines and goals, to inform both practice and research. Tools to facilitate rapid cycle feedback included interview/focus group summary templates, aggregate summaries that synthesize findings by stakeholder group, case matrix templates for rapid extraction and systematic categorization of data along topic areas, and dissemination materials adapted for stakeholder audience and project phases. Strategies to maintain rigour included processes for data reduction and interpretation, a multi-disciplinary approach for analysis, frequent consensus-based meetings, data triangulation, and member checks. Result(s): Rapid cycle approaches yielded interim results that reshaped research questions or identified critical gaps. Case summary analysis exploring the impact of COVID-19 revealed limited information on telehealth challenges amongst OTNY participants, necessitating a shift in recruitment and interview focus. For another project, analytic methods were sequenced to rapidly inventory suggestions from interview summaries on how to enhance OTNY practice to better address racism, while subsequent thematic analysis of transcripts captured participants' experiences of racism for context. Challenges included concurrent alignment of data collection and analysis, tailoring summary templates to maximize utility for rapid analysis, and maintaining flexibility to respond to evolving findings and LHS stakeholder input. Conclusion(s): The diverse methods and strategies illustrated by these projects offer guidance for balancing.

Using the framework for reporting adaptations and modifications for evidence-based interventions (FRAME) for reporting adaptations to coordinated specialty care during the COVID-19 pandemic

Throughout the COVID-19 pandemic, OnTrackNY teams provided coordinated specialty care (CSC) in a radically shifted environment. This presentation describes adaptations to OnTrackNY's model implemented during the pandemic. Method(s): OnTrackNY providers were recruited to participate in indepth, qualitative interviews conducted using phone and video platforms. The project team co-developed the qualitative interview guides with OnTrack Central trainers for each of the six team member roles. A coding team used the FRAME to identify the top three role-based adaptations to the OnTrackNY model from transcripts of qualitative interviews. Result(s): Twenty-three providers (n = 3-4 providers per role) discussed challenges and adaptations of providing CSC services during the pandemic. Use of telehealth was a major adaptation applied across all roles. Adaptations to outreach included narrowing community outreach to inpatient and emergency settings, increasing communication with referral sources, increasing contact with newly referred participants and families. Peer specialist adaptations include conducting physically-distanced groups, discussing current events and expanding online resources for engagement. SEES adaptations included monitoring evolving employment opportunities, conducting mock job interviews remotely, and supporting online learning. Adaptations to PCP/RN roles included sending equipment home for monitoring heath, changing methods and frequency of administering medication, and providing education regarding COVID-19 and vaccination. Adaptations to the Primary Clinician role included increasing informal 'check-ins', using screen sharing to complete assessments and safety plans, and addressing increased stress due to the pandemic. Conclusion(s): Adaptations to CSC were common with providers most frequently making changes to format and setting of care delivery and content modifications. Future work will examine implications of adaptations and OnTrackNY fidelity indicators.

The integration of principles of co-creation for promoting quality improvement within a learning healthcare system providing coordinated specialty care for people with FEP

Co-creation places key stakeholders at the centre of development processes for quality improvement projects to reduce gaps between research and practice. We describe an Amplify OnTrackNY project that used principles of community-based participatory research to meaningfully partner with individuals with lived experience and describe lessons learned. Method(s): Two individuals with lived experience were hired and coled decision-making about project selection and design. The project examined OnTrackNY provider, participant, and family perspectives on the impact of COVID-19 on service delivery. To enhance the lived experience perspective, we hired two OnTrackNY graduates and a family member, and created mechanisms for team building and integration, and co-planning sessions. All team members contributed to the development of research questions, co-facilitated interviews/ focus groups, and participated in data analysis and dissemination. Result(s): Team members conducted focus groups and semi-structured interviews with 13 participants and five family members, presented results to various stakeholder groups, and are contributing to scientific publications. To ensure participation, our flexible working structure focused on promoting equity and building trust. Dedicated time ensured opportunities for meetings focused on mutual support, sharing, capacity building, and training in qualitative methods. Individuals with lived experience were in decision-making roles, created content, and led project activities embodying principles of power-sharing, reciprocity, and mutual learning. Orienting new team members to the office culture required extra effort. Conclusion(s): Provided sufficient time and infrastructure, it is feasible to meaningfully involve individuals with lived experience in quality improvement projects. Co-creation ensures that important perspectives are incorporated from the outset and procedures improve the relevance and uptake of research findings in the real world.

Hypermedia communication in COVID-19 times. Good practices in the Cuban press

Focused on the field of hypermedia journalism due to its possibilities of monitoring through teleworking, and because of the emphasis that the country is placing on the increasing use of ICTs, a team of researchers with diverse profiles, with representation in all regions of Cuba, identified 35 experiences of hypermedia journalism published in the Cuban public media until June 5th, 2020. From this sample, 20 proposals were selected using the nominal group technique in virtual variant, to which a more detailed analysis was carried out, based on 13 criteria identified among the international recommendations for dealing with the pandemic in the press. Both the analysis of the sample, as well as a discussion forum held with journalists from all over the archipelago from the publication of the report resulting from this research, yielded interesting guidelines about the positive communicative practices detected, potentially applicable in the productive dynamics of Cuban public media. © 2022, Centro Nacional de Informacion de Ciencias Medicas. All rights reserved.

Advances and setbacks in health gender gaps and the respective SDGs in the postpandemic

Quarantines implemented to face COVID-19 has affected workers in very different ways, and especially women, who make up the majority of the workforce in health facilities in the world, and their role as health personnel adds a triple burden: longer shifts at work, assistance in the education of children and domestic work in the home;But they are also part of the informal sector of the economy, which has turned out to be one of the most affected by the imposed social quarantine, which has had very negative consequences at the socio-economic level, especially affecting those workers who do not enjoy protection mechanisms. Social. Those women who were able to continue working, in many cases had to improvise a teleworking station at home, which is an unplanned situation, without preparation and for which many countries lack specific regulations. These new teleworkers had not been prepared for this, they had not agreed on this condition with their employers and they do not have optimal working conditions for this modality and although teleworking is considered suitable for women insofar as it could help to reconcile life. The truth is that many women are reluctant to adopt it. Another angle of the problem is constituted by the indirect effects of quarantine on family life, which presents an unusual increase in domestic violence, with a particular impact on violence against women. gender, finding that 243 million women and girls between 15-49 years of age have been subjected to sexual or psychological violence in the last 12 months.

Warrior Women of the 21st Century: The Role of Female First Responders in the COVID-19 Crisis

Millions of women around the world are part of the essential workforce on the front lines of COVID-19. Globally, women constitute the majority of health and social sector workers who have not stopped their work due to the pandemic. From agriculture to first responders and everything in between, women are playing a huge role in keeping their communities safe and resilient against COVID-19. These women face increasing burdens: they are overrepresented at work in health systems, they continue to do most of the unpaid care work in the home, they face high risks of economic insecurity, and they face greater risks of violence, exploitation, abuse or harassment during times of crisis and quarantine. In addition, due to the persistent gender inequalities, which have even worsened during the COVI-19 crisis, in many dimensions, the jobs, businesses, income and living standards of women, who may be more exposed than men to the economic consequences and, therefore, they become more vulnerable. The COVID 19 pandemic has prompted immediate public policy responses by governments to support spending needs in the health sector and mitigate economic effects to first responders. In addition to ensuring economic stabilization and adequate support for men and women, where possible a gender lens should be incorporated in the design and implementation of emergency policy responses. To do so, governments benefit from having in place a well-functioning system of gender budgeting and gender impact assessments, ready access to quality sex-disaggregated data and gender indicators, and skills and expertise on how to provide a swift response.

Special Session 38 New realities for the health of working women in the new normal

Session introduction The crisis unleashed by the COVID-19 pandemic has disrupted the world of work, asymmetrically affecting men and women. Women have had a special impact by having the highest participation in the prioritized sectors of the economy (health, education, food) and this has had an influence on further widening inequities between genders, and especially in terms of their health. In this session we will address some of these aspects from a sectorized and global perspective.

Hypercoagulability detected by seer sonorheometry in COVID-19 patients at hospital admission

Background : Hospitalized COVID-19 patients often show a hypercoagulable profile, mainly elevated fibrinogen and D-dimer, associated with worse outcomes in terms of ICU admission, thrombotic events and mortality. Increased clot stiffness on whole blood viscoelastic testing (VET) is another hypercoagulable profile observed in COVID-19 patients. Sonic Estimation of Elasticity by Resonance (SEER) sonorheometry (Quantra ® system) is a novel ultrasound based VET technology. Aims : To characterize the hemostatic status of COVID-19 patients with standard and viscoelastic testings and its association with disease severity. Methods : Blood samples from adult COVID-19 patients at hospital admission were analyzed with a panel of tests including markers of inflammation, coagulation and Quantra VET parameters. Fisher ' s exact test was used to statistically compare the moderate and severe/ critical disease groups. Results : The cohort of 37 patients showed a mean age (SD) of 59.6 (16) years, with 23 of them in the moderate disease group and 14 in the severe/critical disease group. Markers of inflammation were elevated in 44-84% of patients, while of coagulation tests, only fibrinogen (79%) and D-dimer (60%) levels were elevated. Clot stiffness (CS), as well as the contribution of platelets (PCS) and fibrinogen (FCS) measured by Quantra, were also above normal values at 64.3, 50 and 78.6%, respectively. These parameters were the only ones significantly associated with the severe/critical disease group (Table 1), where most of the adverse outcome were observed. According to this result, the median of these parameters was significantly different between the two groups ( P = 0.011/0.029/0.008). TABLE 1 Parameters of coagulation in COVID-19 patients at hospital admission: proportion (%) above the upper limit of normal (ULN). Test ULN All (%) Moderate (%) Severe/Critical (%) P value Platelet count (×10 3 /μL) 450 1/37 (2.7) 0/23 (0.0) 1/14 (7.1) 0.378 Fibrinogen (mg/dL) 400 27/34 (79.4) 14/20 (70.0) 13/14 (92.9) 0.198 D-dimer (μg/L) 500 22/37 (59.5) 12/23 (52.2) 10/14 (71.4) 0.314 CT (s) 164 1/37 (2.7) 1/23 (4.3) 0/14 (0.0) 1.000 CSL (%) 99 8/26 (30.8) 2/13 (15.4) 6/13 (46.2) 0.202 CS (hPa) 33.2 12/37 (32.4) 3/23 (13.0) 9/14 (64.3) 0.003 PCS (hPa) 29.8 9/36 (25.0) 2/22 (9.1) 7/14 (50.0) 0.014 FCS (hPa) 3.7 21/37 (56.8) 10/23 (43.5) 11/14 (78.6) 0.048 Conclusions : The study of global hemostatic status using Quantra can be a powerful tool for the analysis of COVID-19 patients at admission, helping in risk stratification and triage decisions of patients. This profile, characterized by incresased clot stiffness from both platelet and fibrinogen contribution, was most prevalent in patients with severe/critical disease, and could therefore be established as a new prognostic marker.