Theoretical frameworks and tools to support processes for future healthcare ecosystems

Abstract

An evidence ecosystem and a learning healthcare system are connected as sub-systems of a symbiotic healthcare ecosystem in this thesis. Theoretical frameworks and tools are thereafter presented to support processes for organizations participating in such a symbiotic ecosystem. For the learning practice, a framework is provided to evaluate the best practice. This information could be exchanged as mirroring information for other practices. Furthermore, a framework is presented to design processes to continuously maintain clinical practice guidelines and systematic reviews. This framework is thereafter extended with the role and performance of priority-setting assessments in the context of maintenance strategies when there are insufficient resources available to maintain everything. To further support organizations aiming to develop and use a priority-setting assessment, a frame of reference identifying three components (that is process, function, and outcome) was provided and a tool was developed as a function component. Once it is known which guidelines and systematic reviews have enough priority to be maintained, the subsequent processes need to be efficient. An example is provided of how efforts by systematic review authors can be re-used to develop a guideline segment more efficiently. Nonetheless, all efforts are in vain if the product cannot be applied by the end-user. Thus, finally, the end-user in clinical practice is connected to the evidence translator. For this, considerations and guidance are given to translate difficult to interpret data about diagnostic test performance to a more easily understandable format.