Background Individuals with psychotic disorders experience widespread treatment failures and risk early death. Sweden’s largest department specializing in psychotic disorders sought to improve patients’ health by developing a point-of-care dashboard to support joint planning and co-production of care. The dashboard was tested for 18 months and included more than 400 patients at two outpatient clinics. Methods This study evaluates the dashboard by addressing two questions: Can differences in health-related outcome measures be attributed to the use of the dashboard? How did the case managers experience the accessibility, use, and usefulness of the dashboard for co-producing care with individuals with psychotic disorders? This mixed-method case study used both Patient-Reported Outcome Measures (PROM) and data from a focus group interview with case managers. Data collection and analysis were framed by the Clinical Adoption Meta Model (CAMM) phases: i) accessibility, ii) system use, iii) behavior, and iv) clinical outcomes. The PROM used was the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0), which assesses functional impairment and disability. Patients at clinics using the dashboard were matched with patients at clinics not using the dashboard. PROM data were compared using non-parametric statistics due to skewness in distribution. The focus group included five case managers who had experience using the dashboard with patients. Results Compared to patients from clinics that did not use the dashboard, patients from clinics that did use the dashboard improved significantly overall ( p = 0.045) and in the domain self-care ( p = 0.041). Focus group participants reported that the dashboard supported data feedback-informed care and a proactive stance related to changes in patients’ health. The dashboard helped users identify critical changes and enabled joint planning and evaluation. Conclusion Dashboard use was related to better patient health (WHODAS scores) when compared with matched patients from clinics that did not use the dashboard. In addition, case managers had a positive experience using the dashboard. Dashboard use might have lowered the risk for missing critical changes in patients’ health while increasing the ability to proactively address needs. Future studies should investigate how to enhance patient co-production through use of supportive technologies.

Background: Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care. Objective: This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders' experiences with using NASSS-CAT, and practical implications. Methods: We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness. Results: Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described. Conclusions: This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general.

BackgroundThe resource group method provides a structure to facilitate patients' empowerment and recovery processes, and to systematically engage significant others in treatment and care. A patient chooses members of a resource group (RG) that will work together on fulfilling patients' recovery plan. By adopting shared decision-making processes and stimulating collaboration of different support systems, a broad and continuous support of patients' chosen goals and wishes is preserved and problem solving and communication skills of the RG members are addressed.ObjectiveThe objectives of this study are (1) to establish the effectiveness of the RG method in increasing empowerment in patients with severe mental illnesses (SMI) in the Netherlands; (2) to investigate the cost-effectiveness and cost utility of the RG method; and (3) to qualitatively explore its dynamics and processes.Methods/designThis multisite randomized controlled trial will compare the effects of the RG-method integrated in Flexible Assertive Community Treatment (FACT) (90 patients) with those of standard FACT (90 patients). Baseline assessments and 9-month and 18-month follow-up assessments will be conducted in face-to-face home visits. The primary outcome measure, empowerment, will be assessed using the Netherlands Empowerment List (NEL). The secondary outcomes will be quality of life (MANSA); personal, community and clinical recovery (I.ROC); general, social and community functioning (WHODAS 2.0); general psychopathological signs and symptoms (BSI-18); and societal costs (TiC-P). An economic evaluation of the cost-effectiveness and cost utility of the RG method will also be conducted. A qualitative multiple case-study will be added to collect patients', RG members' and professionals' perspectives by in-depth interviews, observations and focus groups.DiscussionThis trial will be the first to study the effects of the RG method on empowerment in patients with SMI. By combining clinical-effectiveness data with an economic evaluation and in-depth qualitative information from primary stakeholders, it will provide a detailed overview of the RG method as a mean of improving care for patients with SMI.Trial registration The study has been registered in the Dutch Trial Register, identifier: NTR6737, September 2017.

A Learning Health System (LHS) promotes the patient being at the very center of his or her care. Patient coproduction of care in an LHS is enabled by a focus on improving outcomes through the use o...

BACKGROUND Healthcare is argued to grow increasingly complex, characterized by being unpredictable, dynamic, and more than its constituents. There are multiple challenges in enabling healthcare for people with chronic and severe illnesses like schizophrenia, e.g., care being compounded by poor adherence among both patients and health professionals to evidence-based treatment guidelines. New technologies hold promise in enabling decision support and feedback, but adoption, scale-up, and spread of new technologies in general often fail due to complexity. A dashboard to support patient coproduction at the point of care for people with schizophrenia was developed locally in the west of Sweden. Scale-up and spread proved difficult. Knowledge of complex systems has been used to create the non-adoption, abandonment, and challenges to scale-up, spread, and sustainability (NASSS) framework and a complexity assessment tool (NASSS-CAT) supporting the use of principles or rules, in facilitating the development of technology-enabled support functions in complex contexts. We use the framework and tool to assess complexity as well as to look into the usability and usefulness of the tool in the dashboard deployment initiative to inform digitalization of schizophrenia care. OBJECTIVE The (NASSS) framework and a complexity assessment tool (NASSS-CAT) were used to address two questions: 1) How can development and deployment of digital dashboard for schizophrenia care be informed by an assessment of complexity? 2) What are stakeholders’ experiences of the usability and usefulness of NASSS-CAT in the dashboard project? METHODS This is a naturalistic case study of the dashboard deployment initiative. Complexity assessment was used to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We performed a thematic content analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on the tool’s usefulness. RESULTS Application of the NASSS framework revealed different kinds of complexity across multiple domains, including the condition, the technology, the value proposition, organizational tasks and pathways, and the wider system. These complexities consisted of interdependencies and uncertainties of which some had to be actively managed as the project unfolded – a process that was time-consuming and required resources. Resolving problems was often achievable but sometimes generated further problems elsewhere in the system. The NASSS-CAT tool was perceived by stakeholders as useful in getting perspective and new insights, covering areas that otherwise might have been neglected. CONCLUSIONS This case study shows how stakeholders can identify and plan to address complexities in the introduction of a technological solution to support coproduction. This suggests that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general.

In this study, we investigated the performance of thin (0.5 μm) CIGS solar cells with focus on (1) the amount of alkali (NaF and KF) supplied to the CIGS layer, and (2) the Ga/(Ga+In) (GGI) evaporation profile during growth of the CIGS film. The best solar cell performance was achieved with a NaF precursor layer and a KF post-deposited layer of substantially higher doses per unit mass of CIGS compared to what is optimal for our standard 2 μm thick CIGS layer. The cells had a much weaker resulting GGI gradient in the film compared to the one obtained for standard CIGS, despite a similar deposition recipe. The best 0.5 μm solar cell achieved as a result of these optimization efforts had an efficiency of 13.8 % (without antireflection coating).

The significant gain in efficiency by a KF post deposition treatment (PDT) on small cells, observed by several groups, can be scaled to full size modules. This is shown here by a significant gain for full size modules with KF PDT and a module reaching 17.2% (aperture area efficiency, externally confirmed). Another important topic is reducing the cell-to-module losses. Two different methods are presented and compared, a metal grid on top of the TCO and an improved TCO (ZnO:B). A sub-module (300×275 mm2) reaching 17.6% efficiency and a mini-module (50×50 mm 2) reaching 18.7% efficiency is presented and confirms the reduction of cell-to-module losses.

The implementation of evidence-based treatment methods for patients with severe mental illness must be deeply rooted in clinical case management and an ACT service delivery model, where the patient user can be involved in shared-decision making in the cycle of "assess-plan-act-follow up-feedback". In order to prepare and empower the client for the new role as a participating decision maker in the management of his/her own illness, various psychoeducational strategies are employed. The original 'family unit in the community' of the Integrated Mental Health Care program (IC) was developed step-by-step through practice-based evidence and clinical expertise to include significant others as resource persons in a so called Resource Group, and therefore the program was subsequently named as "Resource group ACT" (RACT). The service delivery by community mental health teams involving the patient by way of resource groups as well as the psychoeducational treatment conditions involving both individual patients and family groups may contribute to the understanding of how RACT added clinical effectiveness in functioning and satisfaction.

OBJECTIVE The aim of the study was to evaluate the durability of efficacy of the Integrated Care (IC) program in a Swedish context. The IC program is a person-centered flexible assertive community treatment approach delivered through a novel mechanism: a resource group clinical microsystem for each patient. METHODS All patients with schizophrenia in a Gothenburg urban-sector catchment area were randomly assigned to either the IC or the Rational Rehabilitation (RR) programs. Sixty-six patients were interviewed and assessed by independent interviewers before treatment, after treatment (24 months), and at follow-up (five years). Analysis was by intention to treat. RESULTS At the five-year follow-up, significant improvements were noted in social functioning and consumer satisfaction in the IC group (N=35) compared with the RR group (N=31). No patients were lost to services in either program. CONCLUSIONS The major finding was the durability of efficacy of the IC program.

Excellent planned services and planned care are attainable today in microsystems that provide understanding of what really matters to a patient and family and have the capacity to provide services to meet each and every patient's needs embedded in adequate larger systems. The hybrid Assertive Community Treatment (ACT) model, the Resource group ACT (RACT), is such a clinical interactive microsystem for implementing treatment and psychosocial rehabilitation: A person-centered approach to recovery and health promotion for severe mental illness and disabilities.

The Clinical Strategies Implementation scale (CSI) was originally designed to be used by external reviewers in order to measure the extent to which evidence-based strategies had been implemented in the treatment of persons with schizophrenia spectrum disorders according to Resource-group Assertive Community Treatment (RACT). The present investigation had two aims: 1) to conduct a revision of CSI and to examine the revised instrument (CSI-R) in terms of interrater reliability (Study I); 2) to compare assessments of CSI-R made by experienced assessors with assessments made by students in case management (Study II) in order to determine whether the instrument has validity even when more inexperienced persons are using it. In Study I six raters, who took part in 12 to 15 cases from three outpatient community mental health teams, participated. Results indicated that internal consistency of the CSI-R was strong (alpha = 0.89) as well as correlations between individual raters’ (r between 0.80-0.98). In Study II 91 newly trained RACT praxis trainees participated. Each of them followed one case for eighteen months, i.e., the client which they had been assigned during training (n = 91). The five external auditors in the education program then independently assessed the 91 cases with the CSI-R. Results showed significant correlations between experts and trainees (rho = 0.68, p

Light-induced metastabilities of Cu(In,Ga)Se2 (CIGS)-based thin film solar cells have been extensively researched for many years. It is commonly observed that junction capacitance and p-doping level in CIGS absorbers increase considerably after light soaking (LS). In this work, we focus on the LS behaviors of cells with different minority carrier lifetimes (τn). Experiments show that high efficiency cells with long τn lose open circuit voltage (Voc) and fill factor (FF) upon LS, whereas low efficiency cells with short τn lose less or even gain Voc and FF. The sodium content measured with glow discharge optical emission spectroscopy (GD-OES) increases in the region close to the CdS/CIGS interface with LS and may contribute to the observed LS behaviors. The change in electrical parameters is explained with simulations, which relate the Voc and FF changes to a reduced recombination rate in the space charge region due to the light-induced doping increase. The simulations also suggest that cells with higher n-doping in the CdS are less sensitive to changes in interface recombination rate and doping of CIGS, which agrees with the hypothesis that the CdS buffer deposition is important for the LS behavior.

This chapter offers for clinicians, supervisors, and supervisees an opportunity to review the level of competence in clinical practice. The cognitive behaviour therapy (CBT) model is a structured model that can be applied with idiosyncratic flexibility. The CBT skills are divided into eight categories: assessment; interviewing; structuring; change directed interventions; overcoming resistance; evaluation; self-reflection; intervention planning. A pass for the assessment component is defined as: competent use of existing assessment tools and monitoring forms, designing idiosyncratic ones for specific situations, combined with the ability to translate historical and assessment data in a cognitive behavioural framework leading to a case formulation. For a client entering therapy with a complaint of depression, the therapist should use tools to measure frequency, intensity, and duration of the depressive symptoms. Competence …