Browsing by Author "Bele, Sumedh"

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    Barriers and enablers to implementing a virtual tertiary-regional Telemedicine Rounding and Consultation (TRAC) model of inpatient pediatric care using the Theoretical Domains Framework (TDF) approach: a study protocol
    (2019-01-11) Bele, Sumedh; Cassidy, Christine; Curran, Janet; Johnson, David W; Saunders, Chad; Bailey, J.A. M
    Abstract Background Over-occupancy at the two tertiary pediatric care hospitals in Alberta, Canada is steadily increasing with simultaneous decline in occupancy of pediatric beds at regional hospitals. Over-occupancy negatively impacts timeliness and potentially, the safety of patient care provided at these two tertiary hospitals. In contrast, underutilization of pediatric beds at regional hospitals poses the risk of losing beds provincially, dilution of regional pediatric expertise and potential erosion of confidence by regional providers. One approach to the current situation in provincial pediatric care capacity is development of telemedicine based innovative models of care that increase the population of patients cared for in regional pediatric beds. A Telemedicine Rounding and Consultation (TRAC) model involves discussing patient care or aspects of their care using telemedicine by employing visual displays, audio and information sharing between tertiary and regional hospitals. To facilitate implementation of a TRAC model, it is essential to understand the perceived barriers among its potential users in local context. The current study utilizes qualitative methodologies to assess these perceived clinician barriers to inform a future pilot and evaluation of this innovative virtual pediatric tertiary-regional collaborative care model in Alberta. Methods We will use a qualitative descriptive design guided by the Theoretical Domain Framework (TDF) to systematically identify the tertiary and regional clinical stakeholder’s perceived barriers and enablers to the implementation of proposed TRAC model of inpatient pediatric care. Semi-structured interviews and focus groups with pediatricians, nurses and allied health professionals, administrators, and family members will be conducted to identify key barriers and enablers to implementation of the TRAC model using TDF. Appropriate behaviour change techniques will be identified to develop potential intervention strategies to overcome identified barriers. These intervention strategies will facilitate implementation of the TRAC model during the pilot phase. Discussion The proposed TRAC model has the potential to address the imbalance between utilization of regional and tertiary inpatient pediatric facilities in Alberta. Knowledge generated regarding barriers and enablers to the TRAC model and the process outlined in this study could be used by health services researchers to develop similar telemedicine-based interventions in Canada and other parts of the world.
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    Factors affecting implementation of patient-reported outcome and experience measures in a pediatric health system
    (2023-03-09) McCabe, Erin; Rabi, Sarah; Bele, Sumedh; Zwicker, Jennifer D.; Santana, Maria J.
    Abstract Background The use of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in pediatric clinical practice can enhance clinical care and bring children and families’ perspectives into evaluations of healthcare services. Implementing these measures is complex and requires a thorough assessment of the context of implementation The purpose of this study is to describe the barriers and facilitators to PROMs and PREMs implementation and to recommend strategies for implementing these measures in a pediatric health system. Methods We used a qualitative descriptive approach to analyse data from interviews to understand the experiences of PROMs and PREMs users across different pediatric settings in a single Canadian healthcare system. Results There were 23 participants representing a variety of roles within the healthcare system and pediatric populations. We found five main factors that affected implementation of PROMs and PREMs in pediatric settings: 1) Characteristics of PROMs and PREMs; 2) Individual’s beliefs; 3) Administering PROMs and PREMs; 4) Designing clinical workflows; and 5) Incentives for using PROMs and PREMs. Thirteen recommendations for integrating PROMs and PREMs in pediatric health settings are provided. Conclusions Implementing and sustaining the use of PROMs and PREMs in pediatric health settings presents several challenges. The information presented will be useful for individuals who are planning or evaluating the implementation of PROMs and PREMs in pediatric settings.
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    Investigating the Implementation of Pediatric Patient-reported Outcome and Experience Measures in Alberta
    (2022-07-25) Bele, Sumedh; Santana Maria J; Paolucci Elizabeth O; Quan H; Johnson David W
    Patient- and Family-Centered Care (PFCC) is grounded in mutually beneficial partnerships among healthcare providers, patients, and families to promote a collaborative way of planning, delivering, and evaluating healthcare. Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) play a crucial role in promoting and supporting PFCC. However, implementation of PROMs and PREMs is lagging compared to the adult population. Alberta Health Services (AHS) has established a Patient First Strategy, an organization-wide initiative to improve PFCC practices, but pediatric PROMs and PREMs are not regularly used in clinical care in Alberta. The current thesis investigates the uptake, barriers, and feasibility of integrating PROMs and PREMs in Alberta's pediatric healthcare systems to facilitate their province-wide implementation.This thesis work was conducted in three phases. The first phase includes two systematic reviews. The first systematic review was conducted to synthesize evidence on the impact of implementing PROMs in pediatric clinical care. The findings of this review show that integrating PROMs in routine pediatric clinical care positively impacts Health-related Quality of Life (HRQoL) and increases satisfaction among patients, parents and healthcare providers. The second systematic review was conducted to identify pediatric PREMs, synthesize the evidence on their use in pediatric healthcare settings, and understand their characteristics. This systematic review identified 49 pediatric PREMs currently used in pediatric health systems worldwide. There was a great diversity in the types of PREMs, their characteristics and mode of administration.The second phase of this thesis was a mixed-methods study. PROMs and PREMs are not regularly implemented in pediatric health systems in Alberta. Therefore, a mixed-methods study was conducted to understand the current uptake of pediatric PROMs and PREMs in Alberta and the challenges associated with their implementation in routine pediatric clinical care in Alberta. This study identified 33 PROMs and 6 PREMs showing huge diversity in the types of pediatric PROMs and PREMs currently used in Alberta and their mode of administration. The qualitatively identified challenges were associated with patients, family caregivers, and clinicians. The absence of system-level support, such as integration within electronic medical records systems, is considered a significant system-level challenge. The third phase of this thesis was a case study of implementing PROMs in outpatient pediatric asthma clinics. This phase consisted of two studies. The first study employed a Theoretical Domains Framework (TDF) - guided qualitative inquiry to identify barriers and enablers to implementing PROMs at the outpatient asthma clinics. This study identified 16 barriers to behavioral change required to integrate PROMs into routine clinical care for asthma. These barriers are associated with personal, clinical, non-clinical, and system-level factors. Seventeen enablers to integrating PROMs in asthma clinics were also identified. These enablers ranged from healthcare providers' personal commitment to providing PFCC to optimism about the positive impact of PROMs. The second study in this phase utilized a quantitative survey to assess the feasibility of integrating Pediatric Quality of Life InventoryTM (PedsQLTM) PROM in asthma clinics using the KidsPRO program, an innovative electronic health program. The findings of this study showed that implementing PROMs in the pediatric outpatient asthma clinics is feasible.All the findings of this research provide global, provincial and local level evidence for AHS to support their plans to implement PROMs and PREMs to deliver PFCC in the pediatric health systems in Alberta.
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    Patient-identified priorities for successful partnerships in patient-oriented research
    (2022-09-07) Santana, Maria J.; Duquette, D’Arcy; Fairie, Paul; Nielssen, Ingrid; Bele, Sumedh; Ahmed, Sadia; Barbosa, Tiffany; Zelinsky, Sandra
    Abstract Albertans4HealthResearch, supported by the Alberta Strategy for Patient-Oriented Research Patient Engagement Team, hosted a virtual round table discussion to develop a list of considerations for successful partnerships in patient-oriented research. The group, which consists of active patient partners across the Canadian province of Alberta and some research staff engaged in patient-oriented research, considered advice for academic researchers on how to best partner with patients and community members on health research projects. The group identified four main themes, aligned with the national strategy for patient-oriented research (SPOR) patient engagement framework, highlighting important considerations for researchers from the patient perspective, providing practical ways to implement SPOR’s key principles: inclusiveness, support, mutual respect, and co-building. This commentary considers the process behind this engagement exercise and offers advice directly from active patient research partners on how to fulfill the operational patient engagement mandate. Academic research teams can use this guidance when considering how to work together with patient partners and community members.
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    Patient-reported outcome measures in pediatric asthma care: using theoretical domains framework to explore healthcare providers’ perceptions
    (2022-08-19) Bele, Sumedh; Rabi, Sarah; Zhang, Muning; Oddone Paolucci, Elizabeth; Johnson, David W.; Quan, Hude; Santana, Maria J.
    Abstract Background Patient-reported outcome measures (PROMs) play an important role in promoting and supporting patient and family-centered care. Implementing interventions like PROMs in routine clinical care require key stakeholders to change their behavior. The aim of this study was to utilize the Theoretical Domains Framework (TDF) to identify barriers and enablers to the implementation of PROMs in pediatric outpatient asthma clinics from healthcare providers’ perspective. Methods This TDF-guided qualitative descriptive study is part of a larger multi-phase project to develop the KidsPRO program, an electronic platform to administer, collect, and use PROMs in pediatrics. Semi-structured qualitative interviews were conducted with 17 participants, which included pediatricians, nurses, allied health professionals and administrative staff from outpatient asthma clinics. All the interviews were transcribed, deductively coded, inductively grouped in themes, and categorized into barriers and enablers. Results We identified 33 themes within 14 TDF domains, which were further categorized and tabulated into 16 barriers and 17 enablers to implementing PROMs in asthma clinics. Barriers to behavioral change were attributed to personal, clinical, non-clinical, and other system-level factors; they ranged from limited awareness of PROMs to language barriers and patient’s complex family background. Enablers ranged from a personal commitment to providing patient and family-centered care to administering PROMs electronically. Conclusion This implementation of science-based systematic inquiry captured the complexity of PROMs implementation in pediatric outpatient clinical care for asthma. Considering the consistency in barriers and enablers to implementing PROMs across patient populations and care settings, many findings of this study will be directly applicable to other pediatric healthcare settings.
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    Uptake of pediatric patient-reported outcome and experience measures and challenges associated with their implementation in Alberta: a mixed-methods study
    (2023-07-18) Bele, Sumedh; Rabi, Sarah; Zhang, Muning; Ahmed, Sadia; Paolucci, Elizabeth O.; Johnson, David W.; Quan, Hude; Santana, Maria J.
    Abstract Background Implementing Patient-reported Outcome Measures (PROMs) and Patient-reported Experience Measures (PREMs) is an effective way to deliver patient- and family-centered care (PFCC). Although Alberta Health Services (AHS) is Canada's largest and fully integrated health system, PROMs and PREMs are yet to be routinely integrated into the pediatric healthcare system. This study addresses this gap by investigating the current uptake, barriers, and enablers for integrating PROMs and PREMs in Alberta's pediatric healthcare system. Methods Pediatric clinicians and academic researchers with experience using PROMs and PREMs were invited to complete a quantitative survey. Additionally, key stakeholders were qualitatively interviewed to understand current challenges in implementing pediatric PROMs and PREMs within AHS. Quantitative data gathered from 22 participants were descriptively analyzed, and qualitative data from 14 participants were thematically analyzed. Results Participants identified 33 PROMs and 6 PREMs showing diversity in the types of pediatric PROMs and PREMs currently being used in Alberta and their mode of administration. The qualitatively identified challenges were associated with patients, family caregivers, and clinicians. The absence of system-level support, such as integration within electronic medical records, is considered a significant system-level challenge. Conclusions The significant variation in the types of PROMs and PREMs used, the rationale for their use, and their mode of administration demonstrate the diverse and sporadic use of these measures in Alberta. These findings highlight the need for province-wide uniform implementation of pediatric PROMs and PREMs in Alberta. Our results could benefit healthcare organizations in developing evidence-based PROM and PREM implementation strategies in pediatrics.