Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies.
Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies.
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DOI：
10.1186/s13012-018-0780-3
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发表时间：
2018-06-26
期刊：
影响因子：
--
通讯作者：
Wodchis WP
中科院分区：
文献类型：
--
作者：
Steele Gray C;Barnsley J;Gagnon D;Belzile L;Kenealy T;Shaw J;Sheridan N;Wankah Nji P;Wodchis WP
信息通信技术（ICT）是基于社区的初级卫生保健综合模式的关键推动者；然而，人们对如何利用现有技术支持新的综合护理模式知之甚少。为了解决这一差距，我们利用一项国际综合模型研究的数据，探索如何使用信息通信技术来支持综合护理活动，以及其采用的组织和环境障碍和推动因素。我们采用嵌入式比较多案例研究方法，使用来自九种基于社区的综合初级卫生保健模式实施研究的数据，即为具有复杂健康需求的老年人实施综合护理 (iCOACH) 研究。研究人员对来自加拿大的六个案例进行了研究，其中安大略省和魁北克省各三个，新西兰三个。作为案例研究的一部分，我们于 2015 年 2 月至 2017 年 3 月对管理人员和一线医疗保健提供者进行了访谈。采用定性描述方法对 137 次访谈的数据进行编码，并生成词表来指导分析。尽管模型和背景不同，但我们发现每个案例中 ICT 系统支持的活动类型的描述惊人地相似。信息通信技术系统最常用于支持跨专业团队通过信息共享进行护理协调等活动。然而，由于跨组织和专业边界的数据访问问题以及系统功能限制（例如缺乏互操作性），提供商有效共享患者数据的能力受到限制。即使在创新的护理模式中，在我们的案例中，管理者和提供者也主要使用技术来实现传统的工作方式。技术限制阻碍了技术的更多创新使用，而这些技术可能支持改善护理服务所需的颠覆。我们认为，技术创新使用的障碍与三个因素有关：(1) 信息访问障碍，(2) 可用技术的功能有限，以及 (3) 组织和提供商的惰性。
Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption. We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis. Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability. Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
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通讯作者：
Lowery JC
影响因子：
2.4
作者：
Breton M;Gray CS;Sheridan N;Shaw J;Parsons J;Wankah P;Kenealy T;Baker R;Belzile L;Couturier Y;Denis JL;Wodchis WP
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Wodchis WP
影响因子：
6.6
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通讯作者：
Kues, IW
DOI：
10.1016/j.ijmedinf.2014.04.005
发表时间：
2014-08-01
影响因子：
4.9
作者：
Byrne, Colene M.;Mercincavage, Lauren M.;Cromwell, Tim
通讯作者：
Cromwell, Tim
影响因子：
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作者：
Boyd, Cynthia M.;Fortin, Martin
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