Spirometry for Improved Indigenous and Rural Respiratory Outcomes (SPIRO): A Learning Heath Systems Approach
Notice bibliographique
Résumé
BACKGROUND: (one sentence)The purpose of the SPIRO Project is to increase access to and use of spirometry (the gold standard to diagnose and manage chronic obstructive pulmonary disease), with a specific focus on improving the health outcomes of people in remote, rural, and First Nations communities in the Northern Health (NH) and Vancouver Coastal Health (VCH) authorities in British Columbia (BC), Canada. APPROACH: The goal of SPIRO is to utilize an integrated, equity-focused, learning health system (LHS) approach to provide spirometry and associated respiratory care services to remote, rural, and Indigenous communities in BC, specifically in the health care jurisdictions of NH and VCH. Our focus is on improving health outcomes of people with COPD. The LHS approach has four key steps: ) Formation of Learning Community; 2) Practice to Data; 3) Data to Knowledge; and 4) Knowledge to Practice. The SPIRO Team supports the health authorities with each step, with specific attention to identifying questions for the Practice to Data step, and designing and evaluating implementation projects to improve access to and use of spirometry. Within each of these steps, we employ a mixed-methods approach, which includes embedded case studies, electronic medical record (EMR) synthesis, qualitative interviews, social network analysis, and administrative health data modelling. We follow the principles of community-based research and Indigenous health research including OCAP (Ownership, Control, Access, Possession) principles. RESULTS: Formation of Learning Community: We have formed a 40+ member team, comprised of patients, clinicians, researchers, First Nation health organizations, community members, industry partners, and health care decision-makers. Patients were identified from the VCH Legacy for Airway Health, through social media, and through clinicians. Patient partners have an approved Patient Engagement Plan, attend team meetings, and also have separate meetings to discuss process and results. Clinician members include family physicians, respirologists, and respiratory therapists. Researchers have expertise in COPD, LHS, implementation science, health equity, economic modelling, administrative health data analysis, team science, and First Nations research methods. Decision-makers represent NH and VCH at high levels of authority, and First Nations health delivery organizations. Practice to Data: Our team has confirmed the priority questions to complete the Practice to Data step. We completed an initial study which estimated the prevalence of COPD in remote, rural, and First Nations communities, based on administrative health records and random-sampled clinical studies. This enabled us to estimate the need for spirometry in these locations. We have also identified several care gaps, including: ) the lack of EMR data related to spirometry; 2) the fragmentation and health inequities of respiratory care services in the province, and 3) the barriers to accessing spirometry at the individual, practitioner and health system levels. IMPLICATIONS: By exploring the current state of spirometry services in remote, rural, and First Nations communities, SPIRO will generate evidence-based, integrated interventions to increase accessibility of testing, appropriate education during testing, continuous education for physicians in rural practice, and culturally safe care for First Nation communities. Our next step will be the Data to Knowledge Phase, where evidence-based and data-driven solutions will be identified and tested in real world settings in rural, remote, and First Nations communities. Our learnings will be applicable to the provinces and territories in Canada and globally where access to and use of spirometry are limited.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,018 | 0,016 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,005 | 0,005 |
| Communication savante | 0,005 | 0,003 |
| Science ouverte | 0,004 | 0,010 |
| Intégrité de la recherche | 0,002 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».