Browsing by Division "MED - School of Medicine"

Due to the lack of research at the intersection of IT and behavioral health economics we investigate results-based incentives for health promotion in organizations by questioning (1) whether and why employees accept them, (2) which functional affordances of IT enable their implementation and, finally, (3) whether they have positive effects on the health promotion behavior of employees. The current presentation addresses the first two research questions and describes a first build-and-evaluate cycle according to design-science research methodology. For that purpose, the delay of gratification framework is used as justificatory knowledge to inform the design of results-based incentive models for health promotion in organizations (RIMHPO) and their enabling IT artifacts. In a second step, an empirical study was conducted to assess one particular RIMHPO-based program and to gather further feedback on the design principles. The expected results of the current work are finally discussed with regard to policy implications.

Background: The complex, multidimensional nature of healthcare quality makes provider and treatment decisions based on quality difficult. Patient-reported outcome (PRO) measures can enhance patient centricity and involvement. The proliferation of PRO measures, however, requires a simplification to improve comprehensibility. Composite measures can simplify complex data without sacrificing the underlying information. Objective and methods: We propose a five-step development approach to combine different PRO into one composite measure (PRO-CM): (i) theoretical framework and metric selection, (ii) initial data analysis, (iii) rescaling, (iv) weighting and aggregation, and (v) sensitivity and uncertainty analysis. We evaluate different rescaling, weighting, and aggregation methods by utilizing data of 3145 hip and 2605 knee replacement patients, to identify the most advantageous development approach for a PRO-CM that reflects quality variations from a patient perspective. Results: The comparison of different methods within steps (iii) and (iv) reveals the following methods as most advantageous: (iii) rescaling via z-score standardization and (iv) applying differential weights and additive aggregation. The resulting PROCM is most sensitive to variations in physical health. Changing weighting schemes impacts the PRO-CM most directly, while it proves more robust towards different rescaling and aggregation approaches. Conclusion: Combining multiple PRO provides a holistic picture of patients’ health improvement. The PRO-CM can enhance patient understanding and simplify reporting and monitoring of PRO. However, the development methodology of a PROCM needs to be justified and transparent to ensure that it is comprehensible and replicable. This is essential to address the well-known problems associated with composites, such as misinterpretation and lack of trust.

Objectives In 2019, the German government established the Hospital Future Fund, allocating 4.3 billion Euros, to support investments in the digital infrastructure of hospitals. The DigitalRadar consortium was commissioned by the German Ministry of Health in 2020 to develop a holistic digital maturity model and evaluate the current state of digitalization and the impact of the funding program. To date, the nationwide digitalization of German hospitals has remained a relatively understudied phenomenon. This study aims to address this gap in knowledge by examining the influence of various factors identified by the DigitalRadar maturity model on the digital maturity of hospitals in Germany. In doing so, it seeks to elucidate the implications these findings have for the development of a digital, patient-centred, safe, and high-quality hospital landscape in the country. Methods The model was developed through a scoping review of digital maturity models, requirements set forth in the Hospital Future Act, analysis of components from existing models and feedback from a sounding board. Ultimately, the model includes 234 questions (items) categorized into 7 dimensions of digitalization. It was piloted in 12 hospitals and revised accordingly. 1,624 hospitals (91% of all German hospitals) participated in this self-assessment, as participation was mandatory to receive funding. Results The average DigitalRadar score on a 100-point scale is 33. Maturity is comparatively high in the structures and systems dimension, but low in the clinical processes, exchange of information, telemedicine and patient participation dimensions, suggesting that data exchange is hampered by a lack of interoperability. Drivers of digital maturity are teaching status, size, connectivity, and level of emergency services. Conclusions The transparency gained allows hospitals and regulators to identify areas for improvement and develop digital strategies. Additionally, it enables researchers to analyse, for example, the correlation between digitalization and the quality of care, as well as the mechanisms of action of large-scale funding programs for hospital digitization.

Philippe Forest's first autofictional novel, L'Enfant éternel (The eternal child), centers on the terminal illness and eventual death of the author's daughter, Pauline. While scholarly attention has been directed toward the role of the text in caring for the child, this essay addresses the absence of care for Pauline's parents and their marginalization throughout her end-of-life hospitalization. Focusing on questions of genre, agency, and legacy, I argue that the text allows for a rewriting of the previous, negative experience of care in a way that incorporates the father into care provision. This corrective rewriting understands literature as palliative in its own right, capable of retaining identity, restoring relationships, and facilitating holistic care that "adds life" to all concerned.

Background: Primary headaches, including migraine and tension-type headaches (TTH), are widespread and have a social, physical, mental, and economic impact. They occur mainly during productive years (ie, between ages of 25 and 55). One of the key components of treatment are behavior interventions such as lifestyle modification. Scalable conversational agents (CAs) offer the potential to deliver behavior interventions at low threshold. To our knowledge, there is no evidence on behavioral interventions delivered by CAs for the treatment of headaches. Objective: This study aimed (1) to develop and test a smartphone-based coaching intervention (BalanceUP) for people suffering from frequent headaches, delivered by a conversational agent (CA), and designed to improve mental well-being by various behavior change techniques, and (2) to evaluate the effectiveness by comparing the intervention and control group, and to assess the engagement and acceptance of participants using BalanceUP. Methods: In a randomized controlled trial, adults with frequent headaches were recruited from a non-clinical setting and allocated to either a CA intervention (BalanceUP) or control condition. The effect of the treatment on changes on primary outcome mental well-being (PHQ ADS), and secondary outcomes (psychosomatic symptoms, stress, headache-related self-efficacy, intention to change behavior, presentism and absenteeism, pain coping) were assessed using Linear Mixed Models and Cohen d. Primary and secondary outcomes were assessed pre- and post-intervention, engagement during and acceptance post-intervention. Results: A total of 198 participants (mean age 38.7, SD 12.14; 86.9% women) were recruited online and in collaboration with experts and allocated to the intervention (n=110), and control group (n=88). Post-intervention, the intention to threat (ITT) analysis revealed very strong evidence for improved well-being (treatment: est/beta –3.28, 95% CI –5.07 to –1.48) with moderate between-group effects (Cohen d=–0.66, 95% CI –0.99 to –0.33) in favor of the intervention group. We also found strong evidence for reduced somatic symptoms, perceived stress, absenteeism/presentism, as well as improved headache management self-efficacy, application of behavior change techniques, and pain coping skills, with effects ranging from medium to large (d=0.43 to d=1.05). 65% of participants used the coaching as intended by engaging throughout the coaching and completing the outro. Conclusions: BalanceUP was well accepted, results suggest that a coaching delivered by a CA can be effective in reducing headache sufferers’ burden by improving their well-being. Clinical Trial: German Clinical Trials Register DRKS00017422; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00017422, Swiss Ethics BASEC-Nr. Req-2021-01365

self-assessment; self-evaluation - As one part of the Sino-Swiss Management Training Program, the province of Sichuan was included in an action learning program. The objective was to increase the administrative capacity of the provincial government to master the further development of the province. Topics were: 1. Sustainable development of eco-tourism 2. Water Environmental Management in the Minjiang and Tuojiang River Drainage Areas 3. Construction of Ecological Shelterbelt in the Upper Reaches of the Yangtze River This report demonstrates some of the outcomes of the project, using both figures and narratives as illustrations.

Written during a crisis, this volume betrays an awareness that the field of ‘literature and medicine’ is at a crossroads. It anticipates the many directions that researchers can take, but also records the anxieties involved in not knowing what lies ahead. We take three steps in this Afterword, which may pave the way for future forays into this area. First, we sketch how the particular ‘medical’ event of the pandemic has transformed literature as medium, art form, and practice. By identifying the thematic and formal trends, we also signal the necessary methodological adjustments that we will have to take to assess these critically. Second, with a view to these changes and the necessary opening up of the field of medicine and literature that the pandemic has made visible, we draw attention to the thematic and formal trends that may be helpful in this endeavour. With a view to the volume chapters, we identify the possible directions that can be intensified in the future. Finally, under the heading ‘Medicine and Literature, quo vadis’, we indicate some of the ways in which, we strongly believe, scholars across Medical and Health Humanities, literature and medicine, and humanities in general, might be going.