Frontiers in health services最新文献

{"title":"Hospital managers' experiences of conducting a root cause analysis: a case study following a sentinel event.","authors":"Silje Liepelt, Ralf Kirchhoff","doi":"10.3389/frhs.2025.1566335","DOIUrl":"https://doi.org/10.3389/frhs.2025.1566335","url":null,"abstract":"<p><strong>Background: </strong>Root cause analysis (RCA) is a method used in healthcare to systematically identify and address underlying causes of adverse or sentinel events to enhance patient safety and mitigate risks. This study explores hospital managers' experiences of conducting an RCA process following a sentinel event in which a baby unexpectedly died during labor at a Norwegian hospital in 2021.</p><p><strong>Method: </strong>The study employed a qualitative, exploratory single-case design, which involved conducting nine semi-structured interviews and analyzing documents such as the Norwegian RCA guideline, the final RCA report, and internal procedures and standards. The interviews were conducted between May and August 2021. Thematic analysis was used to organize and interpret the transcribed data. The research addressed the following question: <i>What were the hospital managers</i>' <i>experiences with conducting a root cause analysis?</i></p><p><strong>Results: </strong>Two main themes emerged. The first theme<i>, challenges of and strategies for ensuring compliance with the Norwegian RCA Method,</i> captures the wide range of challenges managers experience, ranging from practical application to communication breakdowns, role ambiguity, and meeting regulatory compliance. The second theme, <i>emotional burden and support</i>, underscores the emotional strain managers endured as they navigated the grief of the personnel involved, communicating with the bereaved family, and collaborated with external agencies during the investigation.</p><p><strong>Conclusion: </strong>The findings highlight the need for more precise role definitions, better resources, and stronger emotional support systems to strengthen RCA processes. Although national RCA guidelines provide a valuable framework, real-world constraints and unique circumstances often require adaptive approaches. This study emphasizes managers' pivotal role in bridging the gap between regulatory expectations and organizational realities, underscoring the need for both practical and emotional support to ensure effective RCA implementation in sentinel events.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1566335"},"PeriodicalIF":1.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The GP's a stranger: an interpretive phenomenological analysis exploring patient experiences of changed access to primary care in the management of long-term conditions.","authors":"Sandra Walker, Tansy Daniel, Mediha Yildizcan, Jennifer Karen Roddis","doi":"10.3389/frhs.2025.1473680","DOIUrl":"https://doi.org/10.3389/frhs.2025.1473680","url":null,"abstract":"<p><strong>Introduction: </strong>Self-management is promoted as a mechanism for those with long-term health conditions to manage their condition day-to-day. Changes in access to primary care in the UK have led to an increased patient burden and reduced access to care.</p><p><strong>Methods: </strong>This exploratory study considered the impact of such changes for those managing long term physical and mental health conditions. An interpretative phenomenological analysis approach was adopted. Interviews were conducted with eight individuals affected by long-term physical and/or mental health conditions.</p><p><strong>Results: </strong>One overarching superordinate theme was identified as significant to all participants: The GP's a stranger. This superordinate theme was fundamental to five lower order themes: Role of GP; Fighting to gain access; Dismissed, depersonalised and devalued; Resourcefulness borne of desperation, and \"There was something wrong\", which offered insights into the experiences of participants.</p><p><strong>Discussion: </strong>Those living with long-term conditions often know when they need to seek additional healthcare support however they shared multiple barriers to accessing this support when needed and reported that the lack of relationship with any health care professional in primary care affected their ability to trust any care advice they were given. Considerations of a new way of operating within a changed paradigm of primary care are explored.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1473680"},"PeriodicalIF":1.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning from the Kenyan experiment: key takeaways for implementing managed equipment services in developing countries.","authors":"Ephantus Njagi, Keneth Iloka, Sasha Wawira, Laban Thiga, Nicholas Muraguri","doi":"10.3389/frhs.2025.1361261","DOIUrl":"https://doi.org/10.3389/frhs.2025.1361261","url":null,"abstract":"<p><strong>Background: </strong>In 2015, the Kenyan government signed 7-year contracts with 5 Original Equipment Manufacturers (OEMs) to improve healthcare accessibility and equity. The OEMs were to supply, install, maintain, and replace equipment and provide user training for 98 hospitals across Kenya's 47 counties through a Managed Equipment Services (MES) arrangement. This paper highlights the planning, procurement, and implementation of Kenya's first comprehensive MES arrangement.</p><p><strong>Methods: </strong>Retrospective review of the implementation process drawing data from program databases, reports, and other relevant sources.</p><p><strong>Results: </strong>The MES program was successfully implemented in Kenya for the first time to upscale specialised health infrastructure and expand critical healthcare services across the 47 counties. Previously unavailable services in the county's hospitals, such as dialysis, were set up in 49 hospitals, critical care units in 11 hospitals, and theatre, sterilisation, and imaging services were expanded in 98 hospitals. The program provided reliable equipment installation and maintenance, increased healthcare workers' capacity through training, and created a more conducive working environment. Key lessons learned include importance of defining detailed equipment specifications, ensuring comprehensive stakeholder engagement, and allowing sufficient time for assessment and implementation. Challenges encountered were prolonged procurement process, insufficient stakeholder buy-in, and delays in implementation.</p><p><strong>Conclusions: </strong>We have described our experience of planning, procurement, and implementation processes and the lessons learned from a large and comprehensive MES project in Kenya. The MES process is intricate and time-consuming, requiring a team of skilled professionals. Prior to beginning the MES design, a well-planned hospital assessment can alleviate potential obstacles. Despite financial limitations, MES arrangement has the potential to enhance significantly healthcare services, particularly in low- and middle-income nations.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1361261"},"PeriodicalIF":1.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of nurses' work-related mental health during the COVID-19 pandemic: a paired follow-up study.","authors":"Cicilia Nagel, Kerstin Nilsson","doi":"10.3389/frhs.2025.1583357","DOIUrl":"https://doi.org/10.3389/frhs.2025.1583357","url":null,"abstract":"<p><p>Nurses are essential pillars of society, providing care for the sick. It is crucial for society to ensure that nurses have favorable working conditions, as they face a heightened risk of negative psychological conditions such as depression, anxiety, stress, and emotional exhaustion due to the demanding nature of their work. The strain on healthcare staff, particularly during the COVID-19 pandemic, has underscored these challenges. This study aimed to identify predictors of work-related mental health issues in nurses' work environments. In 2017, a questionnaire was distributed to 9,219 Swedish nurses, with 4,962 responses received. The questionnaire was redistributed during the pandemic in 2020, and 3,107 nurses responded. However, due to missing data and some nurses previously reporting a mental health diagnosis, only 2,030 questionnaires were included in the study. Among these, 143 nurses reported experiencing work-related mental health problems. The data was analyzed by logistic regression analysis, and 6 out of the 24 statements investigated were statistically significant (<i>p</i> < 0.05), i.e., there was a longitudinal association between nurses' work situation and their mental health problems. The six statements were \"I do not feel I get enough rest/recuperation between work shifts\", \"The work pace in my daily work is too high\", \"I do not feel I have enough support from my coworkers\", \"I do not experience joy in my daily work\", \"I do not feel like my daily work is meaningful\", and \"I do not get enough opportunities at work to utilize my skills and knowledge\".</p><p><strong>Conclusions: </strong>This study revealed that work pace, recovery, support from colleagues, joy, meaningfulness, and development opportunities at work are particularly important for nurses' mental health. Actions in those areas are needed for nurses to have a sustainable work situation.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1583357"},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fidelity, not adaptation, is essential for implementation.","authors":"Dean L Fixsen","doi":"10.3389/frhs.2025.1575179","DOIUrl":"https://doi.org/10.3389/frhs.2025.1575179","url":null,"abstract":"<p><p>Fidelity is not yet a requirement when developing an evidence-based innovation or when attempting to use an innovation in typical settings. Currently, users are encouraged to adapt innovations to fit existing practitioner skills and organization situations. Instead of adapting innovations, the essential components of an innovation need to be established in the original research and the essential components need to be used in practice with the support of implementation processes so that promised outcomes can be realized. Fidelity is an assessment of the presence and strength of the essential components that define the independent variable (the innovation) and is directly linked to outcomes. A test of any fidelity assessment is a high correlation (0.70+) with outcomes. The functional relationship between fidelity and outcomes ensures that the essential components are effective and ensures that a reliable fidelity assessment is available. Implementation is the planned process of putting something into effect. Evidence that an innovation has been put into effect is provided by the fidelity assessment. High fidelity scores indicate that the essential components of the innovation are in place and good outcomes are expected. A test of any planned process is fidelity of the use of the innovation. At present fidelity assessments are missing or inadequate and, therefore, there is a notable lack of evidence that an independent variable is present.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1575179"},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators and barriers in managing older chronic heart failure patients in community health care centers: a qualitative study of medical personnel's perspectives using the socio-ecological model.","authors":"Yan Lou, Min Zhang, Yun Zou, Le Zhao, Yangfan Chen, Yongzhen Qiu","doi":"10.3389/frhs.2025.1483758","DOIUrl":"https://doi.org/10.3389/frhs.2025.1483758","url":null,"abstract":"<p><strong>Background: </strong>Community health care centers (CHCs) plays a crucial role in ensuring timely diagnosis and effective management of congestive chronic heart failure (CHF) in older patients. Understanding the current status of CHF management in CHCs can therefore be effective in reducing the disease burden of CHF.</p><p><strong>Objectives: </strong>This study evaluates the current state of CHF services in community healthcare facilities and identifies key facilitators and obstacles faced by medical personnel in China.</p><p><strong>Methods: </strong>This interpretive study applied the social ecological model (SEM) and used a semi-structured interview guide for data collection. Each interview lasted 45-60 min. Thematic analysis was used to analyze the data.</p><p><strong>Results: </strong>This study involved 30 participants. Facilitators and barriers were identified within the five domains of the SEM. (1) Individual level: medical staff lack knowledge and experience in CHF management while patients' need for greater health education. (2) Interpersonal level: insufficient support from the patients' family and lack of trust in CHCs and staff. (3) Organizational level: inadequate medical knowledge and training programs for medical staff, shortage of medical staff and limited teamwork and few health promotion channels. (4) Community level: Lack of regular screening and follow-up, medical equipment and an information technology-assisted monitoring system. (5) Public policy level: lack of policy support, funding subsidies, national guidelines adapted to the local context and low medical insurance reimbursement rate.</p><p><strong>Conclusion: </strong>There are many impediments to chronic disease management in the community, so it is vital to improve public understanding of CHF, as well as to improve the quality of community health equipment and services, to improve reciprocal referral mechanisms between hospitals and the community, and to develop policies on chronic disease management for CHF.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1483758"},"PeriodicalIF":1.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics, health care utilization and cost of patients hospitalized with heart failure.","authors":"Hanna Winkler, Dorothee Riedlinger, Andrea Figura, Liane Schenk, Martin Möckel, Thomas Reinhold","doi":"10.3389/frhs.2025.1571367","DOIUrl":"https://doi.org/10.3389/frhs.2025.1571367","url":null,"abstract":"<p><strong>Background: </strong>Hospitalizations in patients with heart failure are common and their frequency increases with severity of disease. To provide optimal care to these high-risk patients, it is important to know their characteristics and health care utilization patterns.</p><p><strong>Methods: </strong>This secondary data analysis of the EMANet data set used data from the hospital information system (HIS) of eight hospitals from the center of Berlin to identify patients with heart failure having had at least one hospital treatment during the year 2016. To evaluate the cumulative costs and associated health care utilization in patients with heart failure in 2016 HIS data was linked to individual health claims data from one statutory health insurance fund.</p><p><strong>Results: </strong>We analyzed health claims data from 970 patients with heart failure (43.4% female; mean age 74.4 years). The mortality rate per year was high at 23.9%. Total annual health care costs from the perspective of the statutory health insurance fund amounted to € 33,668 per patient in 2016. About 69% of total costs arose from hospital treatments. On average, patients spent 37 days in hospital. Ten days of these were caused by unplanned cardiovascular hospitalizations. The utilization of continuous outpatient care by a general practitioner or a cardiologist and a continuous prescription of guideline-based medication is associated with a reduction in the loss of lifetime due to hospitalizations or death.</p><p><strong>Conclusions: </strong>Patients hospitalized with heart failure have a high burden of morbidity and mortality, which results in a high level of health care costs. A large increase in health care costs and resource use relates to increasing severity of heart failure. Continuous outpatient care may reduce the burden of disease as well as health care costs.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1571367"},"PeriodicalIF":1.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient experiences and contextual appropriateness of universal screening for depression and suicide risk in HIV care: a qualitative study in Tanzania.","authors":"Kim Madundo, Mirlene Perry, Judith Mwobobia, Ismail Shekibula, Elizabeth F Msoka, Clotilda S Tarimo, Victor Katiti, Blandina T Mmbaga, David B Goldston, Michael V Relf, Brandon A Knettel","doi":"10.3389/frhs.2025.1557348","DOIUrl":"https://doi.org/10.3389/frhs.2025.1557348","url":null,"abstract":"<p><strong>Introduction: </strong>Depression and suicidal thoughts and behaviour are remarkably common among people living with HIV worldwide, leading to a higher burden of disease, poor HIV care engagement, and death. Suicidal behaviour is criminalized in 20 countries worldwide, including Tanzania, where context-appropriate interventions are lacking.</p><p><strong>Methods: </strong>We describe the experiences of patients who were screened for depression and suicidal ideation by HIV clinic nurses, and how the socio-cultural context influences these experiences. This screening was the initial procedure in a randomized controlled clinical trial and parent study aimed at reducing suicide and depression and improving HIV care engagement in Kilimanjaro, Tanzania. We conducted in-depth interviews (IDIs) with 20 people living with HIV. Interviews were held 3 months post-enrollment of participants. Data was collected from July to November 2023. We referred to a brief screener developed for the trial, combining the PHQ-2 for depression and one question on suicidal ideation. IDIs focused on the experiences and appropriateness of being screened for depression and suicidal ideation, factors influencing these challenges, and opinions on the illegality of suicidal behaviour in Tanzania. Data was analyzed using Nvivo 14. Thematic analysis approach was utilized to identify, review and, label codes. Differences were resolved by the first three and final authors.</p><p><strong>Results: </strong>Our findings revealed high appreciation for the screening and occasional initial discomfort. Stigma, misinformation, and poverty contributed to mental health challenges. Patients favoured abolishment of laws against suicide due to their hindering support-seeking and impracticality for individuals in mental health crises.</p><p><strong>Discussion: </strong>In a mental health resource-limited setting, these findings highlight the need for targeted and integrated non-specialist screenings and interventions and outsourcing HIV and mental health support beyond healthcare facilities. Further research is needed to assess the sustainability of screening.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1557348"},"PeriodicalIF":1.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated frailty and intrinsic capacity care model for community-dwelling older adults in Singapore: a rapid qualitative study of anticipated implementation barriers and enablers using the Consolidated Framework for Implementation Research and its Outcomes Addendum.","authors":"Mimaika Luluina Ginting, Grace Sum, Sinead Zhen Wang, Yew Yoong Ding, Laura Tay","doi":"10.3389/frhs.2025.1563686","DOIUrl":"https://doi.org/10.3389/frhs.2025.1563686","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Older adults are at increased risk of experiencing multimorbidity and care dependency due to declines in their physiological reserves. Optimizing the intrinsic capacity and functional ability of individuals is important to enable healthy aging. We engaged potential implementers of an integrated, community-based model for frailty and intrinsic capacity care, adapted from the World Health Organization Integrated Care for Older People framework, to assess the anticipated barriers and enablers to implementation within Singapore's healthcare context.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The updated Consolidated Framework for Implementation Research (CFIR) and its Outcomes Addendum was adopted as the conceptual framework. Qualitative data were collected through focus group discussions (FGDs). We used a rapid qualitative inquiry approach, incorporating a combination of Rapid Research, Evaluation and Appraisal Lab sheet, the Rapid Identification of Themes from Audio recordings, and mind-mapping techniques for data synthesis, analysis, and interpretation. The framework approach was applied to structure and explore the qualitative data for triangulation across FGDs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Five FGDs were conducted with 22 potential implementers (doctors, nurses, physio/occupational therapists, and community partners) between July and August 2023. We identified 24 CFIR determinants covering five domains (innovation, outer setting, inner setting, individuals, and implementation process). Enablers included intersectoral collaboration (partnership and connections), trialability (innovation trialability), alignment with overarching goal (mission alignment), and removal of hurdles and sufficient support (tailoring strategies). Barriers included complexity (innovation complexity), affordability (innovation cost), tradeoffs (relative priority), synergy among multiple programs (compatibility), resource intensity (available resources), fragmented understanding of the care model across providers (communication), physical spaces' design (physical infrastructure), limited time and resources (innovation deliverers' opportunity), gaps in clients' capability (capability), and non-compliance (motivation). Policy contexts and directives (policies and laws), theoretical benefits (innovation evidence base), comprehensiveness and patient-centeredness (design), enhanced service access (relative advantage), proposed task allocation (work infrastructure), information access (information technology infrastructure), capability building (access to knowledge and information), innovation deliverers' capability, motivation, and accessibility (innovation recipients' opportunity) were both barriers and enablers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The findings demonstrated agreement with the innovation and suggested implementation readiness at clinical and service levels. However, addressing key barriers and leveraging existing enablers are necessary f","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1563686"},"PeriodicalIF":1.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extending care beyond the clinic: integrating patient-reported outcomes in chronic pain management through human factors engineering.","authors":"Sadaf Kazi, Robin Littlejohn, Kelly M Smith, Deanna-Nicole Busog, Joseph Blumenthal, Shrey Mathur, Zach McGill, Doug DeBold, Aaron Zachary Hettinger, Kristen E Miller","doi":"10.3389/frhs.2025.1474699","DOIUrl":"https://doi.org/10.3389/frhs.2025.1474699","url":null,"abstract":"<p><strong>Objectives: </strong>Tapering prescription opioid pain medication through evidence-based guidelines can help in combating the opioid epidemic. Integrating clinical decision support (CDS) into the clinical workflow of tapering can help in translating guidelines to formulate and implement a tapering plan that manages pain symptoms while minimizing withdrawal, and optimally engages with the patient. The purpose of our project was to develop patient- and clinician-facing CDS in the area of chronic pain management in one integrated application (app) called Tapering And Patient Reporting outcomes for Chronic Pain Management (TAPR-CPM) App.</p><p><strong>Methods: </strong>We leveraged human factors methodologies and a user-centered design (UCD) approach through guideline review, stakeholder interviews, ethnographic workflow analysis, process mapping, design workshops, and usability testing. Participants included patients with chronic noncancer pain, their family members, pain management physicians, primary care physicians, and health IT developers who focus on patient- and provider-facing technologies.</p><p><strong>Results: </strong>Based on interview findings and workflow analysis, the provider-facing app had five sections: Patient Context, Taper Settings, Create Taper Plan, Withdrawal and Non-opioid Pain Plan, and Summary Dashboard. The patient-facing app had three sections: Maintaining a Pain Journal, Sharing Pain Scores with Provider, and Connecting to Resources about Opioid Tapering.</p><p><strong>Conclusions: </strong>This project leveraged a multi-method approach based in human factors and UCD to develop the TAPR-CPM app. Engaging with a diverse set of stakeholders including patients, caregivers, primary care providers, pain specialists, and health information technology developers was critical to develop a user-friendly experience with accessible technology to support patient engagement and provider decision-making.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1474699"},"PeriodicalIF":1.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}