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Open Access 01-12-2019 | Care | Research article

Sharing Frailty-related information in perioperative care: an analysis from a temporal perspective

Authors: Daniel Fürstenau, Claudia Spies, Martin Gersch, Amyn Vogel, Rudolf Mörgeli, Akira-Sebastian Poncette, Ursula Müller-Werdan, Felix Balzer

Published in: BMC Health Services Research | Issue 1/2019

Abstract

Background

Especially patients older than 65 years undergoing surgery are prone to develop frailty-related complications that may go far beyond the index hospitalization (e.g., cognitive impairment following postoperative delirium). However, aging-relevant information are currently not fully integrated into hospitals’ perioperative processes.

Methods

We introduce a temporal perspective, which focuses on the social construction of time, to better understand existing barriers to the exchange of frailty-related data, targeting complexity research. Our chosen context is perioperative care provided by a tertiary hospital in Germany that has implemented a special track for patients over 65 years old undergoing elective surgery. The research followed a participatory modelling approach between domain and modelling experts with the goal of creating a feedback loop model of the relevant system relationships and dynamics.

Results

The results of the study show how disparate temporal regimes, understood as frameworks for organizing actions in the light of time constraints, time pressure, and deadlines, across different clinical, ambulant, and geriatric care sectors create disincentives to cooperate in frailty-related data exchanges. Moreover, we find that shifting baselines, meaning continuous increases in cost and time pressure in individual sectors, may unintentionally reinforce – rather than discourage – disparate temporal regimes.

Conclusions

Together, these results may (1) help to increase awareness of the importance of frailty-related data exchanges, and (2) impel efforts aiming to transform treatment processes to go beyond sectoral boundaries, taking into account the potential benefits for frail patients arising from integrated care processes using information technology.

DESTATIS. Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) Diagnosen, Prozeduren, Fallpauschalen und Case Mix der vollstationären Patientinnen und Patienten in Krankenhäusern [Internet]. Stat. Bundesamt, Fachserie 12 R. 6.4. 2014 [cited 2017 Mar 29]. Available from:https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankenhaeuser/FallpauschalenKrankenhaus2120640167004.pdf?__blob=publicationFile

Xue Q-L. The Frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1):1–15. https://doi.org/10.1016/j.cger.2010.08.009.

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.

Buckinx F, Rolland Y, Reginster J-Y, Ricour C, Petermans J, Bruyère O. Burden of frailty in the elderly population: perspectives for a public health challenge. Arch Public Heal. 2015;73(1):1–7. https://doi.org/10.1186/s13690-015-0068-x.

Morley JE, Vellas B, Abellan van Kan G, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–97. https://doi.org/10.1016/j.jamda.2013.03.022.

Buttery AK, Busch MA, Gaertner B, Scheidt-Nave C, Fuchs J. Prevalence and correlates of frailty among older adults: findings from the German health interview and examination survey. BMC Geriatr. 2015;15:1–9. https://doi.org/10.1186/s12877-015-0022-3.

Amrock LG, Deiner S. The implication of frailty on preoperative risk assessment. Curr Opin Anesthesiol. 2014;27(3):330–35. https://doi.org/10.1097/ACO.0000000000000065.

Buigues C, Juarros-Folgado P, Fernández-Garrido J, Navarro-Martínez R, Cauli O. Frailty syndrome and pre-operative risk evaluation: A systematic review. Arch Gerontol Geriatr. 2015;61(3):309–21. https://doi.org/10.1016/j.archger.2015.08.002.

Lin H-S, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16:157-169. https://doi.org/10.1186/s12877-016-0329-8.

10.

Shem Tov L, Matot I. Frailty and anesthesia. Curr Opin Anesthesiol. 2017;30(3):409-17. https://doi.org/10.1097/ACO.0000000000000456.

11.

Currie WL, Guah MW. Conflicting institutional logics: a national programme for IT in the organisational field of healthcare. J Inf Technol. 2007;22(3):235–47.

12.

Constantinides P, Barrett M. Negotiating ICT development and use: the case of a telemedicine system in the healthcare region of Crete. Inf Organ. 2006;16(1):27–55. https://doi.org/10.1016/j.infoandorg.2005.07.001.

13.

Aanestad M, Jensen TB. Building nation-wide information infrastructures in healthcare through modular implementation strategies. J Strateg Inf Syst. 2011;20(2):161–76. https://doi.org/10.1016/j.jsis.2011.03.006.

14.

Plsek PE, Greenhalgh T. The challenge of complexity in health care. BMJ Br Med J. 2001;323:625–628. https://doi.org/10.1136/bmj.323.7313.625.

15.

Chiasson M, Davidson E. Pushing the contextual envelope: developing and diffusing information systems theory for health information systems research. Inf Organ. 2004;14(3):155–88.

16.

Currie W, Pouloudi N, Whitley EA. Entangled Stakeholder Roles and Perceptions in Health Information Systems: A Longitudinal Study of the U.K. NHS N3 Network. J Assoc Inf Syst. 2016;17(2):107–61.

17.

Klöcker PN, Bernnat R, Veit DJ. Stakeholder behavior in national eHealth implementation programs. Heal Policy Technol. 2015;4(2):113–120. https://doi.org/10.1016/j.hlpt.2015.02.010.

18.

Wessel L, Gersch M, Harloff E. Talking past each other - a discursive approach to the formation of societal-level information pathologies in the context of the electronic health card in Germany. Bus Inf Syst Eng. 2017;59:23–40. https://doi.org/10.1007/s12599-016-0462-0.

19.

Ostrom E. Beyond markets and states: polycentric governance of complex economic systems. Am Econ Rev. 2010;100(3):641–72.

20.

Schröder S. Ökonomische Analyse und Bewertung integrierter Versorgungssysteme im Gesundheitswesen - Ansätze einer methodischen Erweiterung aus diffusionstheoretischer Perspektive. Dissertation. Berlin: Freie Universität Berlin; 2015. Available from: https://refubium.fu-berlin.de/handle/fub188/7896.

21.

Furstenau D, Wessel L, Gersch M. How organizational path constitution prepares digital infrastructure innovation: a case study of integrated care. Proceedings of the 22nd Americas Conference on Information Systems, AMCIS 2016, San Diego, CA, USA, August 11-14, 2016.

22.

Wessel L, Gersch M. From ICT to integrated care: the performative cohesion of organizing visions. Proceedings of the 23rd European Conference on Information Systems, ECIS 2015, Münster, Germany, May 26-29, 2015.

23.

Aanestad M, Jensen TB. Collective mindfulness in post-implementation IS adaptation processes. Inf Organ. 2016;26(1-2):13–27. https://doi.org/10.1016/j.infoandorg.2016.02.001.

24.

Aanestad M, Grisot M, Hanseth O, Vassilakopoulou P. Information infrastructures for ehealth. Information infrastructures within European health care: working with the installed base. Cham: Springer Open; 2017. https://doi.org/10.1007/978-3-319-51020-0_2.

25.

Hanseth O, Bygstad B. Flexible generification: ICT standardization strategies and service innovation in health care. Eur J Inf Syst. 2015;24(6):645–63. https://doi.org/10.1057/ejis.2015.1.

26.

Pfeffer J. Power in organizations. London: Pitman Pub; 1981.

27.

Palvia P, Lowe K, Nemati H, Jacks T. Information technology issues in healthcare: hospital CEO and CIO perspectives. Commun Assoc Inf Syst. 2012;30:293–312. https://doi.org/10.17705/1CAIS.03019.

28.

Paul RJ, Ezz I, Kuljis J. Healthcare information systems: a patient-user perspective. Heal Syst. 2012;1(2):85–95.

29.

Boonstra A, Boddy D, Ball S. Stakeholder management in IOS projects: analysis of an attempt to implement an electronic patient file. Eur J Inf Syst. 2008;17(2):100–11.

30.

Cavazza M, Jomni C. Stakeholders involvement by HTA organizations: why is so different? Health Policy (New York). 2012;105(2-3):236–45. https://doi.org/10.1016/j.healthpol.2012.01.012.

31.

Tai-Seale M, McGuire TG, Zhang W. Time allocation in primary care office visits. Health Serv Res. 2007;42(5):1871–94. https://doi.org/10.1111/j.1475-6773.2006.00689.x.

32.

Tai-Seale M, McGuire T, Colenda C, Rosen D, Cook MA. Two-minute mental health care for elderly patients: inside primary care visits. J Am Geriatr Soc. 2007;55(12):1903–11. https://doi.org/10.1111/j.1532-5415.2007.01467.x.

33.

Schreyögg J, Stargardt T, Tiemann O, Busse R. Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries. Health Care Manag Sci. 2006;9(3):215–23.

34.

Busetto L, Kiselev J, Luijkx KG, Steinhagen-Thiessen E, Vrijhoef HJM. Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved. BMC Health Serv. Res. 2017;17(1):180-94. https://doi.org/10.1186/s12913-017-2105-7.

35.

Boothroyd RA, Evans ME, Chen H-J, Boustead R, Blanch AK. An exploratory study of conflict and its management in systems of care for children with mental, emotional, or behavioral problems and their families. J Behav Health Serv Res. 2015;42(3):310–23. https://doi.org/10.1007/s11414-014-9448-1.

36.

Bergson H. Time and free will: an essay on the immediate data of consciousness. North Chelmsford: Courier Corporation; 2001.

37.

Thompson EP. Time, work-discipline, and industrial capitalism. Past & Present. 1967;38(1):56–97.

38.

Luhmann N. The future cannot begin: temporal structures in modern society. Soc Res. 1976;43(1):130–52.

39.

Rosa H. Social acceleration: A new theory of modernity. New York: Columbia University Press; 2013.CrossRef

40.

Yin RK. Case study research: design and methods. 5th ed. Thousand Oaks: Sage Publications; 2013.

41.

Basco-Carrera L, Warren A, van Beek E, Jonoski A, Giardino A. Collaborative modelling or participatory modelling? A framework for water resources management. Environ Model Softw. 2017;91(1-3):95–110. https://doi.org/10.1016/j.envsoft.2017.01.014.

42.

Perlow LA. The time famine: toward a sociology of work time. Adm Sci Q. 1999;44(1):57–81.

43.

Sterman JD. Business dynamics: systems thinking and modeling for a complex world. Boston: Irwin/McGraw-Hill; 2000.

44.

Locke K, Golden-Biddle K, Feldman MS. Perspective--making doubt generative: rethinking the role of doubt in the research process. Organ Sci. 2008;19(6):907–18. https://doi.org/10.1287/orsc.1080.0398.

45.

Senge PM. The fifth discipline: The art & practice of the learning organization. New York: Broadway Business; 1990.

46.

Repenning NP, Sterman JD. Capability traps and self-confirming attribution errors in the dynamics of process improvement. Adm Sci Q. 2002;47(1):265–95. https://doi.org/10.2307/2667031.

47.

Strech D. Der Abbau von Überversorgung als Teil der ärztlichen Berufsethik. Z Gerontol Geriatr. 2014;47(1):17–22. https://doi.org/10.1007/s00391-013-0590-9.

Title: Sharing Frailty-related information in perioperative care: an analysis from a temporal perspective
Authors: Daniel Fürstenau
Claudia Spies
Martin Gersch
Amyn Vogel
Rudolf Mörgeli
Akira-Sebastian Poncette
Ursula Müller-Werdan
Felix Balzer
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Care
Published in: BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-019-3890-y

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Springer Medicine

Sharing Frailty-related information in perioperative care: an analysis from a temporal perspective

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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