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Cicli di apprendimento

Panoramica

Ciascun istituto partner lavora su un tema specifico che sarà al centro di Policy Briefs e Stakeholder Dialogues. I temi vengono selezionati tramite un processo di priorizzazione, tenendo conto della loro rilevanza scientifica e politica. Le discipline coinvolte spaziano dalla medicina all’economia, dalla comunicazione al diritto, dalla salute pubblica alla teologia, mettendo in evidenza l’interdisciplinarità delle Health Sciences e della ricerca sui sistemi sanitari.

Sintesi delle evidenze (Policy Brief)

Una condizione indispensabile per affrontare i problemi inizialmente identificati e garantire l’apprendimento ciclico del sistema sanitario è esaminare le evidenze relative alle possibili opzioni di soluzione. Per questo lo Swiss Learning Health System (SLHS) prevede due distinti strumenti di sintesi delle evidenze: a) Policy Brief, che funge da base per il successivo Stakeholder Dialogue, e b) Rapid Response Synthesis.

Policy Brief

Una volta identificato il tema di uno Stakeholder Dialogue, il passo successivo è la preparazione di un Policy Brief. Si tratta di un documento che descrive il problema dettagliatamente, considerando tutti i fattori contestuali rilevanti. Il Policy Brief presenta inoltre diverse possibili soluzioni basate sulle evidenze e spiega, per ciascuna di esse, gli aspetti principali, compresi i benefici e costi previsti e i fattori che possono ostacolare o facilitare l’implementazione. Il Policy Brief viene distribuito preventivamente ai partecipanti allo Stakeholder Dialogue.

Rapid Response Synthesis

Il panorama sanitario svizzero è soggetto a continui cambiamenti: un’impasse nella fornitura di merci o servizi può verificarsi in modo relativamente improvviso. Lo strumento della Rapid Response Synthesis permette di rispondere in modo rapido ed efficace ai problemi momentanei del sistema sanitario, identificando e sintetizzando gli interventi più adeguati tramite l’analisi delle evidenze disponibili e delle possibili soluzioni. Ogni Rapid Response Synthesis comprende una guida all’implementazione, che affronta gli aspetti rilevanti per l’implementazione nel caso specifico e contiene suggerimenti per il monitoraggio e la valutazione.

Stakeholder Dialogue

Lo Stakeholder Dialogue è un processo di comunicazione strutturato, che mira a sostenere e incoraggiare gli stakeholder nell’esame di un determinato problema e nell’implementazione di soluzioni basate sulle evidenze. Sulla base di un Policy Brief, un gruppo di 6–20 stakeholder affronta in modo cooperativo un determinato problema, con l’obiettivo di pervenire ad un consenso e di definire gli interventi più adeguati. 

Gli incontri sono condotti da un moderatore che guida la discussione, incoraggia i partecipanti a confrontarsi sull’argomento e aiuta a superare i conflitti in caso di diversità di opinioni.

In generale, al termine dello Stakeholder Dialogue si decide prima di tutto se esiste o meno un consenso sugli interventi da attuare. Se non c’è consenso, si passa a decidere se i) convocare un secondo Stakeholder Dialogue per raggiungere un accordo oppure ii) proseguire nella ricerca scientifica, nel caso in cui manchino evidenze sufficienti per trovare un accordo sulla soluzione da adottare. Se si verifica il caso i), l’SLHS coinvolge gli stakeholder in un processo di mediazione strutturato al fine di superare le loro diversità di opinioni. Nel caso ii), invece, l’SLHS informa i ricercatori dei partner accademici in modo da adeguare l’agenda di ricerca alle esigenze emerse.

Lo Stakeholder Dialogue è un meccanismo molto promettente, che consente di informare i responsabili delle politiche sanitarie sulle possibili soluzioni basate sulle evidenze di un determinato problema. E questo a tutti i livelli, dalle scelte politiche fino alla fornitura di servizi, dal finanziamento fino alla raccolta di informazioni. Inoltre, lo Stakeholder Dialogue supporta l’identificazione dei temi di ricerca più in linea con le attuali esigenze del sistema sanitario e promuove quindi una cultura basata sulla condivisione delle responsabilità.

L’elenco degli Stakeholder Dialogues condotti nell’ambito dell’SLHS è disponibile alla voce Temi.

Temi

Ciascun istituto partner lavora su un tema specifico, che sfocerà in Policy Briefs e Stakeholder Dialogues. I temi vengono selezionati tramite un processo di priorizzazione, tenendo conto della loro rilevanza scientifica e politica.

Detecting psychosocial stress

Stress due to physical or emotional problems (psychosocial stress) causes various medical, social, and economic consequences in patients with somatic complaints. Therefore, early detection and treatment of psychosocial stress in hospital patients is important. Data on the prevalence of psychosocial stress in acute hospitals is unclear due to the low probability of detection and treatment. To improve detection and treatment of psychosocial stress, this policy brief recommends (1.) increasing knowledge and awareness of psychosocial stress among hospital staff and patients, (2.) promoting interprofessional collaboration in acute care hospitals, as well as (3.) facilitating access to support services for psychosocial stress in acute care hospitals. 

Stakeholder(s): Representatives from research and practice 
SLHS Lead: Swiss Centre for International Health, Swiss TPH 
Policy Brief: Download PDF (Currently only available in German)
Key Messages: Download PDF (Currently only available in German)
Stakeholder dialogue summary: Download PDF (Currently only available in German) 

Methods for identifying socially isolated and lonely older adults in Switzerland

Social isolation and loneliness amongst older adults are one of the most pressing public health issues in our ageing society. A big obstacle to effectively addressing this issue is how to identify individuals who are experiencing or most at risk of social isolation and loneliness. This policy brief outlines current strategies used to facilitate the outreach to people most in need: i) enlist personnel in the community in the identification process, ii) build strong databases and use existing data to create heat maps, and iii) launch awareness campaigns to raise awareness and reduce stigma.

 Stakeholder(s):

Representatives from local and regional authorities, senior organizations, NGOs and educational institutions.

 SLHS lead: Department of Health Sciences and Medicine, University of Lucerne
 Policy brief: Download PDF (Currently only available in English)
 Key Messages: Download PDF (Currently only available in English)
 Summary of stakeholder dialogue: Download PDF (Currently only available in English)

  

                              


Rapid Response Reviews

In March 2020, the Swiss Learning Health System invited its partners to think and work on ways current research efforts in Switzerland and outside of the country can be supported and strengthened to address the international COVID-19 emergency. Thereupon, three Rapid Response Reviews on the following topics have been written:

Rapid Review Response 1:                                                                     Sectorial and managerial response of non-profit assistance and homecare services of public interest in Ticino facing the SARS-CoV-2 pandemic outbreak: a case study (Download PDF)
Stakeholder dialogue summary: The future of homecare and "proximity integrated healthcare networks" (Download PDF) (Currently only available in English) 
Rapid Review Response 2:    Strategic and organizational response of Ticino's hospital system facing the COVID-19 emergency: three case studies (Download PDF)
Rapid Review Response 3:                                                      Sectorial and managerial response of nursing homes in Ticino facing the SARS-CoV-2 pandemic outbreak: a case study (Download PDF)

Evidence use in health policymaking

Policymakers have to consider various factors and information types when making decisions about policies, health service management and delivery. Apart from research and data, stakeholder interests, public opinion, ideology, values, and emotions may essentially influence how policymakers think and decide. To increase the relevance of research in policymaking within Swiss health authorities, this policy brief discusses recommendations for effective interventions to build capacity for evidence-use and the implementation thereof.

Stakeholder(s): Representatives from public administration, observatories and registries, NGOs and education 
SLHS Lead: Swiss Centre of International Health, Swiss TPH
Policy Brief: Download PDF
Key Messages: Download PDF 
Stakeholder dialogue summary:        Download PDF 

 


Measuring over- and underuse in family medicine

In order to reduce overuse and underuse in the healthcare system, it is necessary to define appropriate care according to current knowledge and to measure it. However, measurement is hampered by inadequate political and structural frameworks, limited availability of electronic data and poor data quality. To improve the measurement of over- and underuse in Swiss family medicine, this policy brief recommends i) the development of a comprehensive digital strategy, ii) the strengthening of a data-based quality culture and iii) the support of bottom-up initiatives.

Stakeholder(s): Representatives from the practice, health insurances, physicians' network organisations, and education 
SLHS Lead: Institute for Familiy Medicine, University of Zurich 
Policy Brief: Download PDF (Currently only available in German)
Key Messages: Download PDF (Currently only available in German)
Stakeholder dialogue summary:        Download PDF (Currently only available in German)

PREMs in cancer care

Improving care and the experiences of care by providing high-quality care responding to people’s needs (i.e. patient-centered care), are important as it translates into more positive experiences of care, which in turn can translate into treatments working better and better health. Patient-centered care is especially important in cancer care, as cancer has a particular emotional, social and financial burden on patients and their families, in addition to the health burden. While information about the effectiveness of cancer care is available in Switzerland, reports from patients about cancer care are missing. To increase the patient-centeredness in cancer care, this policy brief recommends i) developing a position statement on the importance and value of patients’ experiences of cancer care and ii) collecting patients’ experiences of cancer care at the national level, by implementing a national survey or by integrating data collection in cantonal cancer registries.

Stakeholder(s): Representatives from cancer care, quality assessment, patients and physicians organizations, and education
SLHS Lead: Département Epidémiologie et Systèmes de Santé, Unisanté
Policy Brief:    Download PDF 
Lay Policy Brief: Download PDF (currently only available in French)
Key Messages: Download PDF 
Stakeholder dialogue summary:                               Download PDF 

Discrimination in case of impotence

The Code of Law of the Roman Catholic Church contains an impediment to the marriage of impotence. It says that someone can only get married if the person can engage in sexual intercourse. To forbid marriage due to this reason poses discrimination for the people concerned because entering marriage is a fundamental and human right that cannot be exercised. This learning cycle meets the challenge to examine and eliminate the discrimination of people with a disability posed by the law of the Roman Catholic Church, by presenting information on i) the signing of the convention on the Rights of Persons with Disabilities by the Holy See with the consequence of a legislative adjustment, ii) the revision and discussion of the natural justice of the impediment to the marriage of impotence and iii) the discussion of the implementation/third-party effect of the fundamental rights.

Stakeholder(s): Canon law experts, lawyers, social workers
SLHS Lead: Center for Comparative Constitutional Law and Religion (ZRV), University of Lucerne
Policy Brief I: Download PDF (Currently only available in German)
Policy Brief II: Will follow soon 
Key Messages: Download PDF (Currently only available in German)
Summary of stakeholder dialogue(s): Download PDF (Currently only available in German)
Abstract: Download PDF (Currently only available in English)

Advanced practice nurses in general practice

For reasons such as non-standardized final competencies for Advanced Practice Nurses (APN) or the lack of role definitions, APNs are not sufficiently employed in general practitioners' (GP) practices in Switzerland. APNs are already taking over GPs' activities on their own responsibility, however these are performed in a "grey area" and are associated with many uncertainties. The aim is to leave this "grey area" and to promote the implementation of new care models with APNs in Swiss GP practices. To this end, this policy brief recommends (1.) clarifying and expanding the roles of APNs in primary care, as well as (2.) clarifying the training and legal framework for the employment of APNs (available only in german)

Stakeholder(s): Representatives from practice, education, health insurances and policy
SLHS Lead: Dipartimento economia aziendale, sanità e sociale, SUPSI and Institut für Hausarztmedizin & Community Care Luzern
Policy Brief: Download PDF (Currently only available in German)
Key Messages Download PDF (Currently only available in German)
Stakeholder dialogue summary: Download PDF (Currently only available in German)

Strengthening Social Participation of Socially Disadvantaged Older Adults in Switzerland

Social isolation and loneliness in the elderly have a number of negative health consequences and are particularly harsh for the socially disadvantaged. Strengthening social participation of socially disadvantaged older people can contribute to reducing social isolation and loneliness and the associated health inequalities in this group. This learning cycle approaches the challenge of increasing social participation among the socially disadvantaged elderly by providing evidence-based insights on i) improved methods of outreach, ii) the inclusion of target groups in the planning and implementation of programs, and iii) improved program evaluation considering socially disadvantaged groups.

 Stakeholder(s):
Health Promotion Switzerland, Program Leaders
 SLHS lead: Department of Health Sciences and Medicine, University of Lucerne
 Policy brief: Download PDF
 Key Messages: Download PDF
 Summary of stakeholder dialogue: Download PDF (Currently only available in German)

Hospital Pastoral Care and Privacy

Greater awareness for the right for data protection leads to conflicts in the collaboration between hospitals and hospital pastors. This Policy Brief examines how the involvement of pastoral care in hospitals in the canton of Zurich can be better regulated in terms of legal requirements for patient data protection. In order to change the current situation, it is recommended (1.) to take the Palliative Care Concept as a model, (2.) to change the cantonal and federal legislation and (3.) to use the digital patient file to improve the holistic approach to treatment. 

Stakeholder(s):      

Representatives from practice, education, and legislation

SLHS lead:

Center for Comparative Constitutional Law and Religion, University of Lucerne
Policy brief:               

Download PDF (Currently only available in German)

Key Messages:             

Download PDF (Currently only available in German)

Stakeholder dialogue summary:          

Download PDF (Currently only available in German)

Additional Information:                                                                                                                        

Download PDF (Currently only available in German)
Handout:                    

This handout was developed in the context of the policy brief and stakeholder dialogue. It provides information on the right for hospital pastoral care and the access to patient data for the canton of Zurich. It is meant to serve as a basis for discussions and analysis in the hospital setting. (Currently only available in German)


International clinical guidelines for knee osteoarthritis management in Switzerland

International clinical guidelines for the conservative management of knee osteoarthritis (OA) recommend exercise, education, and weight control as first-line treatment for all people with knee OA. However, findings from various health care settings have identified an underuse of exercise and education. A recent survey among medical specialists in Switzerland identified an evidence-performance gap, implying that the strong evidence in favour of exercise is not being transferred into clinical practice. This policy brief describes the challenges facing the improvement of conservative disease management by presenting recommendations regarding i) tanslation of guideline recommendations into a specific exercise and education programme ii) facilitation of the systematic application of exercise through standardised treatment pathways and iii) promotion of the benefits of exercise in the long-term management of chronic diseases.

Stakeholder(s):

Representatives from research and practice

SLHS Lead: Institute of Physiotherapy, ZHAW (Zurich University of Applied Sciences)
Policy Brief: Download PDF
Key Messages: Download PDF
Stakeholder dialogue summary:

Download PDF (Currently only available in German)


Design principles of a central metadata repository as a key element of an integrated health information system

The Swiss Health System is a complex system with different groups of actors for which data is collected and analyzed using various methods, leading to a large heterogeneity and dispersion of available data. The specificities of a Swiss Health System favor a hybrid infrastructure to manage the heterogeneity and dispersion of Swiss health-related data. This policy brief shows the importance of a metadata management infrastructure to identify and describe health data resources and highlights several essential key elements for the design of a metadata repository and also raises important practical questions.

Stakeholder(s):

Representatives from the IT sector, policy, and health research

SLHS Lead: Information management institute, University of Neuchatel
Policy Brief: Download PDF
Key Messages: Download PDF
Stakeholder dialogue summary:

Download PDF

Ricerca delle evidenze

La ricerca e la sintesi delle evidenze da esporre in Policy Briefs o Rapid Response Syntheses è l’aspetto centrale del lavoro dello Swiss Learning Health System (SLHS). Un buon punto di partenza per la ricerca delle evidenze rilevanti è selezionare le pubblicazioni che riassumono e valutano i risultati di diversi studi: per esempio revisioni sistematiche, direttive basate sulle evidenze o analisi critiche (CAT, Critical Appraised Topics).

Cochrane Switzerland

Cochrane Switzerland

Cochrane offre revisioni sistematiche della ricerca primaria sui temi della salute e delle politiche sanitarie; gli standard qualitativi delle Cochrane Reviews sono ritenuti tra i più alti in assoluto del settore a livello internazionale. Sono disponibili analisi degli effetti di interventi di prevenzione, trattamento e riabilitazione, ma anche valutazioni dell’affidabilità di test diagnostici per determinate condizioni o gruppi di pazienti. Le Cochrane Reviews sono sottoposte a peer-review; sono inoltre dinamiche, vengono cioè aggiornate regolarmente in modo da comprendere anche i nuovi studi. In Svizzera, le Cochrane Reviews sono accessibili gratuitamente.


PubMed (MEDLINE)

PubMed (MEDLINE)

PubMed è un motore di ricerca gratuito che attinge principalmente al database MEDLINE, che contiene articoli e sommari di articoli relativi alle Life Sciences e a temi biomedici. Per cercare in modo mirato le revisioni sistematiche, è sufficiente limitare l’ambito di ricerca a "Systematic Reviews” o utilizzare il relativo search string.


Epistemonikos

Epistemonikos

Epistemonikos è un database multilingue per la ricerca delle evidenze; raccoglie revisioni sistematiche, panoramiche generali, studi primari e sommari strutturati. Viene costantemente aggiornato.


TRIP Medical Database

TRIP Medical Database

Si tratta di un motore di ricerca che permette di trovare e utilizzare in modo rapido e semplice evidenze di elevata qualità a supporto delle attività di cura e assistenza medica. TRIP consente inoltre agli operatori medici di cercare anche altri tipi di contenuti, quali immagini, video, foglietti illustrativi, materiali didattici e informazioni di attualità.


McMaster Health Forum

McMaster Health Forum

Questa piattaforma con sede in Canada mette a disposizione evidenze scientifiche ripartite in tre categorie tematiche:

  1. evidenze predisposte per rispondere alle esigenze dei dirigenti dei sistemi sanitari;
  2. evidenze scientifiche pre-valutate e sintetizzate sul tema del rafforzamento dei sistemi sanitari (Health Systems Evidence) e dei servizi sociali (Social Systems Evidence);
  3. informazioni di elevata qualità sull’invecchiamento ottimale, dedicate agli anziani, a chi li assiste e agli operatori del settore (McMaster Optimal Aging Portal).

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Swiss Learning Health System
University of Lucerne
Department of Health Sciences and Medicine
Frohburgstrasse 3
6002 Lucerne
Switzerland
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