Browsing by Author "Liu, Joanne"
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- ItemAssessing the Quality of Teleconsultations in a Store-And-Forward Telemedicine Network - Long-Term Monitoring Taking into Account Differences between Cases.(2014-11-12) Wootton, Richard; Liu, Joanne; Bonnardot, LaurentWe have previously proposed a method for assessing the quality of individual teleconsultation cases this paper proposes an additional step to allow the long term monitoring of quality The basic scenario is a teleconsultation system aka an e referral system or a tele expertise system where the referrer posts a question about a clinical case the question is relayed to an appropriate expert and the chosen expert provides an answer The people running this system want assurances that it is stable i e they want routine quality assurance information about the output from the process This requires two things It needs a method of assessing the quality of individual patient consultations And it needs a method for taking into account differences between patients so that these quality assessments can be compared longitudinally Building on the previously proposed methodology the present paper proposes two techniques for measuring the difficulty posed by a particular teleconsultation The first is an indirect method similar to a willingness to pay economic estimation The second is a direct method Using these two methods with real data from a telemedicine network showed that the first method was feasible but did not produce useful results in a pilot trial The second method while more laborious was also feasible and did produce useful results Thus when output quality is measured an allowance can be made for the characteristics of the case submitted This means that fluctuations in output quality can be attributed to variations in the process network or to variations in the raw materials queries submitted to the network Long term quality assurance should assist those providing telemedicine services in low resource settings to ensure that the services are operated effectively and efficiently despite the constraints and complexities of the environment
- ItemAssessing the quality of teleconsultations in a store-and-forward telemedicine network.(2014-07-31) Wootton, Richard; Liu, Joanne; Bonnardot, LaurentStore and forward telemedicine in resource limited settings is becoming a relatively mature activity However there are few published reports about quality measurement in telemedicine except in image based specialties and they mainly relate to high and middle income countries In 2010 M decins Sans Fronti res MSF began to use a store and forward telemedicine network to assist its field staff in obtaining specialist advice To date more than 1000 cases have been managed with the support of telemedicine from a total of 40 different countries We propose a method for assessing the overall quality of the teleconsultations provided in a store and forward telemedicine network The assessment is performed at regular intervals by a panel of observers who independently respond to a questionnaire relating to a randomly chosen past case The answers to the questionnaire allow two different dimensions of quality to be assessed the quality of the process itself and the outcome defined as the value of the response to three of the four parties concerned i e the patient the referring doctor and the organization It is not practicable to estimate the value to society by this technique The feasibility of the method was demonstrated by using it in the MSF telemedicine network where process quality scores and user value scores appeared to be stable over a 9 month trial period This was confirmed by plotting the cusum of a portmanteau statistic the sum of the four scores over the study period The proposed quality assessment method appears feasible in practice and will form one element of a quality assurance program for MSF s telemedicine network in future The method is a generally applicable one which can be used in many forms of medical interaction
- ItemCanadian doctor is new president of MSF International. Interview by Lauren Vogel.(2013-09-17) Liu, Joanne
- ItemThe Development of a Multilingual Tool for Facilitating the Primary-Specialty Care Interface in Low Resource Settings: the MSF Tele-Expertise System.(2014-09-10) Bonnardot, Laurent; Liu, Joanne; Wootton, Elizabeth; Amoros, Isabel; Olson, David; Wong, Sidney; Wootton, RichardIn 2009 M decins Sans Fronti res MSF started a pilot trial of store and forward telemedicine to support field workers One network was operated in French and one in English a third Spanish network was brought into operation in 2012 The three telemedicine pilots were then combined to form a single multilingual tele expertise system tailored to support MSF field staff We conducted a retrospective analysis of all telemedicine cases referred from April 2010 to March 2014 We also carried out a survey of all users in December 2013 A total of 1039 referrals were received from 41 countries of which 89 were in English 10 in French and 1 in Spanish The cases covered a very wide range of medical and surgical specialties The median delay in providing the first specialist response to the referrer was 5 3 h interquartile range 1 8 16 4 The survey was sent to 294 referrers and 254 specialists Of these 224 were considered as active users 41 Out of the 548 users 163 30 answered the survey The majority of referrers 79 reported that the advice received via the system improved their management of the patient The main concerns raised by referrers and specialists were the lack of support or promotion of system at headquarters level and the lack of feedback about patient follow up Because of the size of the MSF organization it is clear that there is potential for further organizational adoption
- ItemQuality Assurance of Teleconsultations in a Store-and-Forward Telemedicine Network - Obtaining Patient Follow-up Data and User Feedback.(2014-12-16) Wootton, Richard; Liu, Joanne; Bonnardot, LaurentUser surveys in telemedicine networks confirm that follow up data are essential both for the specialists who provide advice and for those running the system We have examined the feasibility of a method for obtaining follow up data automatically in a store and forward network We distinguish between follow up which is information about the progress of a patient and is based on outcomes and user feedback which is more general information about the telemedicine system itself including user satisfaction and the benefits resulting from the use of telemedicine In the present study we were able to obtain both kinds of information using a single questionnaire During a 9 month pilot trial in the M decins Sans Fronti res telemedicine network an email request for information was sent automatically by the telemedicine system to each referrer exactly 21 days after the initial submission of the case A total of 201 requests for information were issued by the system and these elicited 41 responses from referrers a response rate of 20 The responses were largely positive For example 95 of referrers found the advice helpful 90 said that it clarified their diagnosis 94 said that it assisted with management of the patient and 95 said that the telemedicine response was of educational benefit to them Analysis of the characteristics of the referrers who did not respond and their cases did not suggest anything different about them in comparison with referrers who did respond We were not able to identify obvious factors associated with a failure to respond Obtaining data by automatic request is feasible It provides useful information for specialists and for those running the network Since obtaining follow up data is essential to best practice one proposal to improve the response rate is to simplify the automatic requests so that only patient follow up information is asked for and to restrict user feedback requests to the cases being assessed each month by the quality assurance panel
- ItemA Retrospective Analysis of Pediatric Cases Handled by the MSF Tele-Expertise System.(2014-12-24) Martinez Garcia, Daniel; Bonnardot, Laurent; Olson, David; Roggeveen, Harriet; Karsten, Jaap; Moons, Peter; Schaefer, Myrto; Liu, Joanne; Wootton, RichardWe conducted a retrospective analysis of all pediatric cases referred by M decins Sans Fronti res MSF field doctors via the MSF telemedicine system during a 4 year period from April 2010 A total of 467 pediatric cases were submitted representing approximately 40 of all telemedicine cases The median age of the patients was 4 years The median response time i e the interval between the case being submitted and the first response from a specialist was 13 h interquartile range 4 32 h We selected a random sample of 12 pediatric cases in each of four age categories for detailed analysis by an experienced MSF pediatrician In the 48 randomly selected cases the mean rating for the quality of information provided by the referrer was 2 8 on a scale from 1 very poor to 5 very good and the mean rating for the appropriateness of the response was 3 3 same scale More than two thirds of the responses were considered to be useful to the patient and approximately three quarters were considered to be useful to the medical team The usefulness of the responses tended to be higher for the medical team than for the patient and there was some evidence that usefulness to both groups was lower in newborns and adolescent patients The telemedicine system allows the quality of the medical support given to medical teams in the field to be controlled objectively as there is a record of all cases and answers Telemedicine has an important role in supporting the aims of medical humanitarian organizations such as MSF