Background: Accumulated electronic data from a wide variety of clinical settings has been processed using a range of informatics methods to determine the sequence of care activities experienced by patients. The “as is” or “de facto” care pathways derived can be analysed together with other data to yield clinical and operational information. It seems likely that the needs of both health systems and patients will lead to increasing application of such analyses. A comprehensive review of the literature is presented, with a focus on the study context, types of analysis undertaken, and the utility of the information gained.Methods: A systematic review was conducted of literature abstracting sequential patient care activities (“de facto” care pathways) from care records. Broad coverage was achieved by initial screening of a Scopus search term, followed by screening of citations (forward snowball) and references (backwards snowball). Previous reviews of related topics were also considered. Studies were initially classified according to the perspective captured in the derived pathways. Concept matrices were then derived, classifying studies according to additional data used and subsequent analysis undertaken, with regard for the clinical domain examined and the knowledge gleaned.Results: 254 publications were identified. The majority (n = 217) of these studies derived care pathways from data of an administrative/clinical type. 80% (n = 173) applied further analytical techniques, while 60% (n = 131) combined care pathways with enhancing data to gain insight into care processes.Discussion: Classification of the objectives, analyses and complementary data used in data-driven care pathway mapping illustrates areas of greater and lesser focus in the literature. The increasing tendency for these methods to find practical application in service redesign is explored across the variety of contexts and research questions identified. A limitation of our approach is that the topic is broad, limiting discussion of methodological issues.Conclusion: This review indicates that methods utilising data-driven determination of de facto patient care pathways can provide empirical information relevant to healthcare planning, management, and practice. It is clear that despite the number of publications found the topic reviewed is still in its infancy.

Gallstones affect 20% of the Western population and will grow in clinical significance as obesity and metabolic diseases become more prevalent. Gallbladder removal (cholecystectomy) is a common treatment for diseases caused by gallstones, with 1.2 million surgeries in the US each year, each costing USD 10,000. Gallbladder disease has a significant impact on the logistics and economics of healthcare. We discuss the two most common presentations of gallbladder disease (biliary colic and cholecystitis) and their pathophysiology, risk factors, signs and symptoms. We discuss the factors that affect clinical care, including diagnosis, treatment outcomes, surgical risk factors, quality of life and cost-efficacy. We highlight the importance of standardised guidelines and objective scoring systems in improving quality, consistency and compatibility across healthcare providers and in improving patient outcomes, collaborative opportunities and the cost-effectiveness of treatment. Guidelines and scoring only exist in select areas of the care pathway. Opportunities exist elsewhere in the care pathway.

Aim: To estimate and examine hospitalisation costs of Type 1 and Type 2 diabetes in an Irish public hospital.Methods: A retrospective audit of hospital inpatient admissions over a 5‐year period was undertaken, and a wide range of admission‐related data were collected for a sample of 7,548 admissions. Hospitalisations were costed using the diagnosis‐related group methodology. A series of descriptive, univariate and multivariate regression analyses were undertaken.Results: The mean hospitalisation cost for Type 1 diabetes was €4,027 and for Type 2 diabetes was €5,026 per admission. Sex, admission type and length of stay were significantly associated with hospitalisation costs for admissions with a primary diagnosis of Type 1 diabetes. Age, admission type, diagnosis status, complications status, discharge destination, length of stay and year were significantly associated with hospitalisation costs for admissions with a primary diagnosis of Type 2 diabetes. Length of stay was associated with higher mean costs, with each additional day increasing Type 1 diabetes costs by €260 (p = 0.001) and Type 2 diabetes by €216 (p < 0.001). Unscheduled admissions were associated with significantly lower costs than elective admissions; €1,578 (p = 0.035) lower for Type 1 diabetes and €2,108 (p < 0.001) lower for Type 2 diabetes.Conclusions: This study presents estimates of the costs of diabetes care in the Irish public hospital system and identifies the factors which influence costs for Type 1 and Type 2 diabetes. These findings may be of interest to patients, the public, researchers and those with influence over diabetes policy and practice in Ireland and internationally.

Background: Digital technologies are increasingly being implemented in health care to improve the quality and efficiency of care for patients. However, the rapid adoption of health technologies over the last 5 years has failed to adequately consider patient and clinician needs, which results in ineffective implementation. There is also a lack of consideration for the differences between patient and clinician needs, resulting in overgeneralized approaches to the implementation and use of digital health technologies. Objective: This study aimed to explore barriers and facilitators of the implementation of digital technologies in the diagnosis of heart disease for both patients and clinicians, and to provide recommendations to increase the acceptability of novel health technologies. Methods: We recruited 32 participants from across the United Kingdom, including 23 (72%) individuals with lived experience of heart disease and 9 (28%) clinicians involved in diagnosing heart disease. Participants with experience of living with heart disease took part in semistructured focused groups, while clinicians contributed to one-to-one semistructured interviews. Inductive thematic analysis using a phenomenological approach was conducted to analyze the resulting qualitative data and to identify themes. Results were discussed with a cardiovascular patient advisory group to enhance the rigor of our interpretation of the data. Results: Emerging themes were separated into facilitators and barriers and categorized into resource-, technology-, and user-related themes. Resource-related barriers and facilitators related to concerns around increased clinician workload, the high cost of digital technologies, and systemic limitations within health care systems such as outdated equipment and limited support. Technology-related barriers and facilitators included themes related to reliability, accuracy, safety parameters, data security, ease of use, and personalization, all of which can impact engagement and trust with digital technologies. Finally, the most prominent themes were the user-related barriers and facilitators, which encompassed user attitudes, individual-level variation in preferences and capabilities, and impact on quality of health care experiences. This theme captured a wide variety of perspectives among the sample and revealed how patient and clinician attitudes and personal experiences substantially impact engagement with digital health technologies across the cardiovascular care pathway. Conclusions: Our findings highlight the importance of considering both patient and clinician needs and preferences when investigating the barriers and facilitators to effective implementation of digital health technologies. Facilitators to technology adoption include the need for cost-effective, accurate, reliable, and easy-to-use systems as well as adequate setup support and personalization to meet individual needs. Positive user attitudes, perceived improvement in care quality, and increased involvement in the care process also enhance engagement. While both clinicians and patients acknowledge the potential benefits of digital technologies, effective implementation hinges on addressing these barriers and leveraging facilitators to ensure that the technologies are perceived as useful, safe, and supportive of health care outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-072952

Background: Generalized anxiety disorder (GAD) is common among university students due to academic pressure and financial uncertainty, among other challenges. Despite the need, the receipt of available psychological services is often low. Objective: This study investigates the feasibility of a digital unguided cognitive behavioral therapy (CBT)–based mobile app, Cerina, and examines the likely effects of this intervention in reducing GAD symptoms compared to the waitlist control group. Methods: Eligible students (n=158) with mild to moderate GAD symptoms were self-assessed through web-based questionnaires and were randomly allocated to the intervention group (n=79) or to the waitlist control group (n=79) following their informed consent. The intervention group had direct access to Cerina and followed CBT-based interactive sessions for 6 weeks. The waitlist control group participants had access to optional on-campus well-being services, and they were given access to Cerina 6 weeks after their randomization. Participants completed assessments on anxiety, depression, worry, and usability at three time points. Additionally, upon completing the intervention, they were invited to a web-based interview to understand the implementation of the intervention in more depth. Results: On average, 13% (10/79) intervention group participants dropped out, 61% (36/69) completed the core clinical content (2 sessions), and 12% (7/69) completed the desired number of sessions (6 or 7 sessions). Analyses of the completers (2 or more sessions) revealed significant group differences in GAD (mean 8.4, SD 3.7; t42=–2.25; P=.03; d=–0.7) and worry symptoms (mean 42.3, SD 10.8; t42=–2.50; P=.02; d=–0.8), as well as functional impairment (mean 16.7, SD 2.44; t42=–2.12; P=.04; d=–0.6) in favor of the intervention group at posttest with medium to large effect sizes. The intention-to-treat analyses confirmed significant group differences in GAD (mean 8.47, SD 2.7; t156=–2.23; P=.03; d=–0.4), and there were marginally nonsignificant group differences in worry symptoms (mean 41.5, SD 8.40; t156=–1.94; P=.05; d=–0.3) in favor of the intervention group at posttest with medium effect sizes. These results suggest that the intervention had a meaningful impact on reducing GAD symptoms and a modest impact on reducing worry symptoms among participants. Conclusions: The Cerina app showed promising results in reducing GAD symptoms among students. This result supports findings from other randomized controlled trials showing that digital CBT-based interventions are effective and feasible for a wide range of age groups and populations experiencing GAD symptoms. The low number of participants completing the recommended number of sessions suggests a usability issue. To address this, the intervention could be refined through an iterative design process informed by user feedback, and the long-term impact of specific engagement features in improving usability and retention could be assessed through extended evaluations. Trial Registration: ClinicalTrials.gov NCT06146530; https://clinicaltrials.gov/study/NCT06146530 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-083554

BACKGROUND Generalized anxiety disorder (GAD) is common among university students due to academic pressure and financial uncertainty, among other challenges. Despite the need, the receipt of available psychological services is often low. OBJECTIVE This study investigates the feasibility of a digital unguided cognitive behavioral therapy (CBT)–based mobile app, Cerina, and examines the likely effects of this intervention in reducing GAD symptoms compared to the waitlist control group. METHODS Eligible students (n=158) with mild to moderate GAD symptoms were self-assessed through web-based questionnaires and were randomly allocated to the intervention group (n=79) or to the waitlist control group (n=79) following their informed consent. The intervention group had direct access to Cerina and followed CBT-based interactive sessions for 6 weeks. The waitlist control group participants had access to optional on-campus well-being services, and they were given access to Cerina 6 weeks after their randomization. Participants completed assessments on anxiety, depression, worry, and usability at three time points. Additionally, upon completing the intervention, they were invited to a web-based interview to understand the implementation of the intervention in more depth. RESULTS On average, 13% (10/79) intervention group participants dropped out, 61% (36/69) completed the core clinical content (2 sessions), and 12% (7/69) completed the desired number of sessions (6 or 7 sessions). Analyses of the completers (2 or more sessions) revealed significant group differences in GAD (mean 8.4, SD 3.7; t42=–2.25; P=.03; d=–0.7) and worry symptoms (mean 42.3, SD 10.8; t42=–2.50; P=.02; d=–0.8), as well as functional impairment (mean 16.7, SD 2.44; t42=–2.12; P=.04; d=–0.6) in favor of the intervention group at posttest with medium to large effect sizes. The intention-to-treat analyses confirmed significant group differences in GAD (mean 8.47, SD 2.7; t156=–2.23; P=.03; d=–0.4), and there were marginally nonsignificant group differences in worry symptoms (mean 41.5, SD 8.40; t156=–1.94; P=.05; d=–0.3) in favor of the intervention group at posttest with medium effect sizes. These results suggest that the intervention had a meaningful impact on reducing GAD symptoms and a modest impact on reducing worry symptoms among participants. CONCLUSIONS The Cerina app showed promising results in reducing GAD symptoms among students. This result supports findings from other randomized controlled trials showing that digital CBT-based interventions are effective and feasible for a wide range of age groups and populations experiencing GAD symptoms. The low number of participants completing the recommended number of sessions suggests a usability issue. To address this, the intervention could be refined through an iterative design process informed by user feedback, and the long-term impact of specific engagement features in improving usability and retention could be assessed through extended evaluations. CLINICALTRIAL ClinicalTrials.gov NCT06146530; https://clinicaltrials.gov/study/NCT06146530 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2023-083554