ABSTRACT
Clinical research outcomes depend on the correct definition of the research protocol, the data collection strategy, and the data management plan. Furthermore, researchers often need to work within challenging contexts, as is the case in tuberculosis services, where human and technological resources for research may be scarce. Electronic Data Capture Systems mitigate such risks and enable a reliable environment to conduct health research and promote result dissemination and data reusability. The proposed solution is based on needs pinpointed by researchers, considering the need for an accommodating solution to conduct research in low-resource environments. The REDbox framework was developed to facilitate data collection, management, sharing, and availability in tuberculosis research and improve the user experience through user-friendly, web-based tools. REDbox combines elements of the REDCap and KoBoToolbox electronic data capture systems and semantics to deliver new valuable tools that meet the needs of tuberculosis researchers in Brazil. The framework was implemented in five cross-institutional, nationwide projects to evaluate the users' perceptions of the system's usefulness and the information and user experience. Seventeen responses (representing 40% of active users) to an anonymous survey distributed to active users indicated that REDbox was perceived to be helpful for the particular audience of researchers and health professionals. The relevance of this article lies in the innovative approach to supporting tuberculosis research by combining existing technologies and tailoring supporting features.
Subject(s)
Semantics , User-Computer Interface , Humans , Data Collection , Health Personnel , BrazilABSTRACT
OBJECTIVE: to identify indicators that can be used in the management of Mental Health Services. METHOD: an integrative review in which we adopted the Population, Concept, and Context strategy to formulate the following Guiding Question: "Which indicators can be used for the management of mental health services?". RESULTS: a total of 22 articles were included and divided into two main groups: countries with initial high income (54%) as well as low- and middle-income countries (46%). We identified 5 studies that had experienced the use of indicators, 5 studies that had reported partial implementation, 9 studies that did not report use or implementation, 1 study on the indicator selection process, 1 as an implementation pilot, and a final study with a discussion for implementation. High-income countries also find it difficult to implement mental health indicators. The main difficulties in adopting the use of indicators are lack of basic mental health services, financial resources, legislation, political interest, and guidelines for its management. CONCLUSION: it is unusual to find a descriptive comparison of quality monitoring programs at the system level in the technical-scientific literature related to mental health indicators.
Subject(s)
Mental Health Services , Humans , IncomeABSTRACT
Objective: to identify indicators that can be used in the management of Mental Health Services. Method: an integrative review in which we adopted the Population, Concept, and Context strategy to formulate the following Guiding Question: "Which indicators can be used for the management of mental health services?". Results: a total of 22 articles were included and divided into two main groups: countries with initial high income (54%) as well as low- and middle-income countries (46%). We identified 5 studies that had experienced the use of indicators, 5 studies that had reported partial implementation, 9 studies that did not report use or implementation, 1 study on the indicator selection process, 1 as an implementation pilot, and a final study with a discussion for implementation. High-income countries also find it difficult to implement mental health indicators. The main difficulties in adopting the use of indicators are lack of basic mental health services, financial resources, legislation, political interest, and guidelines for its management. Conclusion: it is unusual to find a descriptive comparison of quality monitoring programs at the system level in the technical-scientific literature related to mental health indicators.
Objetivo: identificar indicadores que possam ser utilizados na gestão dos Serviços de Saúde Mental. Método: revisão integrativa em que adotou-se a estratégia População, Conceito e Contexto para formular a seguinte questão norteadora: "Quais indicadores podem ser usados para a gestão dos serviços de saúde mental?". Resultados: um total de 22 artigos foram incluídos e divididos em dois grupos principais: países com renda inicial alta (54%), bem como países de baixa e média renda (46%). Identificamos 5 estudos que experimentaram o uso de indicadores, 5 estudos que relataram implementação parcial, 9 estudos que não relataram uso ou implementação, 1 estudo sobre o processo de seleção de indicadores, 1 como piloto de implementação e um estudo final com uma discussão para implementação. Os países de alta renda também têm dificuldade para implementar indicadores de saúde mental. As principais dificuldades na adoção do uso de indicadores são a falta de serviços básicos de saúde mental, recursos financeiros, legislação, interesse político e diretrizes para sua gestão. Conclusão: é incomum encontrar uma comparação descritiva de programas de monitoramento de qualidade no nível de sistema na literatura técnico-científica relacionada a indicadores de saúde mental.
Objetivo: identificar indicadores que se puedan utilizar en la gestión de Servicios de Salud Mental. Método: revisión integradora en la que adoptamos la estrategia Población, Concepto y Contexto para formular la siguiente Pregunta Orientadora: "¿Qué indicadores se pueden utilizar para la gestión de servicios de salud mental?". Resultados: se incluyó un total de 22 artículos y se los dividió en dos grupos principales: países con ingresos altos iniciales (54%) y países con ingresos bajos y medios (46%). Identificamos 5 estudios que habían experimentado el uso de indicadores, 5 estudios que habían reportado implementación parcial, 9 estudios que no reportaron uso o implementación, 1 estudio sobre el proceso de selección de indicadores, 1 como piloto de implementación y un estudio final con una discusión para la implementación. Los países de ingresos altos también tienen dificultades para implementar indicadores de salud mental. Las principales dificultades para adoptar el uso de indicadores son la falta de servicios básicos de salud mental, recursos económicos, legislación, interés político y directrices para su gestión. Conclusión: es inusual encontrar una comparación descriptiva de los programas de monitoreo de la calidad a nivel de sistema en la literatura técnico-científica relacionada con indicadores de salud mental.
Subject(s)
Health Services Administration , Health Status Indicators , Health Strategies , Quality Indicators, Health Care , Basic Health Services , Financial Resources in Health , Mental Health ServicesABSTRACT
BACKGROUND: Interoperability of health information systems is a challenge due to the heterogeneity of existing systems at both the technological and semantic levels of their data. The lack of existing data about interoperability disrupts intra-unit and inter-unit medical operations as well as creates challenges in conducting studies on existing data. The goal is to exchange data while providing the same meaning for data from different sources. OBJECTIVE: To find ways to solve this challenge, this research paper proposes an interoperability solution for the tuberculosis treatment and follow-up scenario in Brazil using Semantic Web technology supported by an ontology. METHODS: The entities of the ontology were allocated under the definitions of Basic Formal Ontology. Brazilian tuberculosis applications were tagged with entities from the resulting ontology. RESULTS: An interoperability layer was developed to retrieve data with the same meaning and in a structured way enabling semantic and functional interoperability. CONCLUSIONS: Health professionals could use the data gathered from several data sources to enhance the effectiveness of their actions and decisions, as shown in a practical use case to integrate tuberculosis data in the State of São Paulo.
ABSTRACT
BACKGROUND: Tuberculosis (TB) is an infectious disease and is among the top 10 causes of death in the world, and Brazil is part of the top 30 high TB burden countries. Data collection is an essential practice in health studies, and the adoption of electronic data capture (EDC) systems can positively increase the experience of data acquisition and analysis. Also, data-sharing capabilities are crucial to the construction of efficient and effective evidence-based decision-making tools for managerial and operational actions in TB services. Data must be held secure and traceable, as well as available and understandable, for authorized parties. OBJECTIVES: In this sense, this work aims to propose a blockchain-based approach to build a reusable, decentralized, and de-identified dataset of TB research data, while increasing transparency, accountability, availability, and integrity of raw data collected in EDC systems. METHODS: After identifying challenges and gaps, a solution was proposed to tackle them, considering its relevance for TB studies. Data security issues are being addressed by a blockchain network and a lightweight and practical governance model. Research Electronic Data Capture (REDCap) and KoBoToolbox are used as EDC systems in TB research. Mechanisms to de-identify data and aggregate semantics to data are also available. RESULTS: A permissioned blockchain network was built using Kaleido platform. An integration engine integrates the EDC systems with the blockchain network, performing de-identification and aggregating meaning to data. A governance model addresses operational and legal issues for the proper use of data. Finally, a management system facilitates the handling of necessary metadata, and additional applications are available to explore the blockchain and export data. CONCLUSIONS: Research data are an important asset not only for the research where it was generated, but also to underpin studies replication and support further investigations. The proposed solution allows the delivery of de-identified databases built in real time by storing data in transactions of a permissioned network, including semantic annotations, as data are being collected in TB research. The governance model promotes the correct use of the solution.
Subject(s)
Blockchain , Tuberculosis , Brazil , Computer Security , Data Management , HumansABSTRACT
Doctors, nurses, and other healthcare professionals use software that affects the patients. Directly Observed Treatment, Short-course is the name given to the tuberculosis control strategy recommended by the World Health Organization. The main goal of this work is to propose a protocol for evaluating the impact of healthcare software supporting Directly Observed Treatment, Short-course on patients, healthcare professionals, and services. The proposed protocol consists of a set of instruments and steps. The instruments are reliable and validated existing questionnaires to be applied before and after using the software tool. The literature points out the need for standards on the software assessment. This is particularly critical when software affects patients directly. The present protocol is a universal tool to assess the impact of software used to support the fight against the tragedy of tuberculosis where a rigorous evaluation of IT in healthcare is highly recommended and of great importance.
Subject(s)
Health Impact Assessment/statistics & numerical data , Health Personnel/psychology , Patient Satisfaction , Telemedicine/standards , Clinical Protocols , Directly Observed Therapy , Humans , Surveys and Questionnaires , Telemedicine/methodsABSTRACT
Assessment of health information systems consider different aspects of the system itself. They focus or on the professional who will use the software or on its usability or on the software engineering metrics or on financial and managerial issues. The existent approaches are very resources consuming, disconnected, and not standardized. As the software becomes more critical in the health organizations and in patients, becoming used as a medical device or a medicine, there is an urgency to identify tools and methods that can be applied in the development process. The present work is one of the steps of a broader study to identify standardized protocols to evaluate the health information systems as medicines and medical devices are evaluated by clinical trials. The goal of the present work was to evaluate the effect of the introduction of an information system for monitoring tuberculosis treatment (SISTB) in a Brazilian municipality from the patients' perspective. The Patient Satisfaction Questionnaire and the Hospital Consumer Assessment of Healthcare Providers and Systems were answered by the patients before and after the SISTB introduction, for comparison. Patients from an outpatient clinic, formed the control group, that is, at this site was not implanted the SISTB. Descriptive statistics and mixed effects model were used for data analysis. Eighty-eight interviews were conducted in the study. The questionnaire's results presented better averages after the system introduction but were not considered statistically significant. Therefore, it was not possible to associate system implantation with improved patient satisfaction. The HIS evaluation need be complete, the technical and managerial evaluation, the safety, the impact on the professionals and direct and/or indirect impact on patients are important. Developing the right tools and methods that can evaluate the software in its entirety, from the beginning of the development cycle with a normalized scale, are needed.
Subject(s)
Antitubercular Agents/administration & dosage , Clinical Protocols , Health Information Systems/organization & administration , Patient Satisfaction , Tuberculosis/drug therapy , Adult , Ambulatory Care Facilities , Antitubercular Agents/therapeutic use , Brazil , Directly Observed Therapy , Female , Humans , Male , Middle Aged , Quality Improvement , Research Design , Socioeconomic Factors , Software DesignABSTRACT
BACKGROUND: Regional networking between services that provide mental health care in Brazil's decentralized public health system is challenging, partly due to the simultaneous existence of services managed by municipal and state authorities and a lack of efficient and transparent mechanisms for continuous and updated communication between them. Since 2011, the Ribeirao Preto Medical School and the XIII Regional Health Department of the Sao Paulo state, Brazil, have been developing and implementing a web-based information system to facilitate an integrated care throughout a public regional mental health care network. CASE PRESENTATION: After a profound on-site analysis, the structure of the network was identified and a web-based information system for psychiatric admissions and discharges was developed and implemented using a socio-technical approach. An information technology team liaised with mental health professionals, health-service managers, municipal and state health secretariats and judicial authorities. Primary care, specialized community services, general emergency and psychiatric wards services, that comprise the regional mental healthcare network, were identified and the system flow was delineated. The web-based system overcame the fragmentation of the healthcare system and addressed service specific needs, enabling: detailed patient information sharing; active coordination of the processes of psychiatric admissions and discharges; real-time monitoring; the patients' status reports; the evaluation of the performance of each service and the whole network. During a 2-year period of operation, it registered 137 services, 480 health care professionals and 4271 patients, with a mean number of 2835 accesses per month. To date the system is successfully operating and further expanding. CONCLUSION: We have successfully developed and implemented an acceptable, useful and transparent web-based information system for a regional mental healthcare service network in a medium-income country with a decentralized public health system. Systematic collaboration between an information technology team and a wide range of stakeholders is essential for the system development and implementation.
