El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / In this paper, we propose a mobile solution to optimize the medical referral process for pediatric patients with presumptive cancer diagnosis. This proposal allows the automation of the process through the identification of the main gaps that are covered by the following functionalities: (1) Registration and interaction of the actors in the process, (2) Support for timely diagnosis with first-hand information, (3) Creation of request tickets and personalized medical appointments, and (4) Creation of reports on the response time and compliance with the process. The proposal is described in three sections: (1) The automation of the medical referral process, (2) The functionalities of the mobile solution, and (3) the designed technology architecture. The validation of the proposal was carried out in a social health insurance in Lima-Peru, with data and information of the process obtained by the institution. The measurement was made through the mobile solution which allowed obtaining the response times of the process with the main actors such as the pediatric doctor, an oncology specialist and a pediatric patient's guardian. The results showed that the time of the referral process is optimized between an interval of [95%-97.5%], which mainly generates a social benefit to the community by assuring a timely treatment of the pediatric cancer patient, based on diagnosis and early care.

Patterns of representation of African Americans in K-12 special education programs vary across the United States. A school district in Arizona has a 13% African American population, yet the African American special education representation is 17%. The purpose of this grounded theory study was to generate an understanding of the processes related to special education referral and assignment of African American elementary students as perceived by 7 teachers and 6 parents in the school district. Inductive analysis including open, axial, and selective coding led to the categorization of three themes: complexity in the referral process, inadequate teacher-parent communication and lack of shared knowledge, and inadequate teacher training. A key finding was parents' dependency on teachers for placing children in special education without the requisite knowledge to ask questions or make critical choices for their children. Parents' powerlessness and lack of knowledge may contribute to the overrepresentation of African American children in special education programs in the district. Findings may be used to educate parents and train teachers in the processes of referral and assignment of students to special education programs.

Early intervention services are important in obtaining better outcomes for infants with a developmental delay or a condition that may result in a delay. In Florida, a primary resource for providing these services is the Early Steps Program. This study analyzed the Early Steps referral process to identify barriers to prompt access. The guiding hypothesis was if differences exist in key outcomes of the referral process, then these differences may reveal where improvements can be made. Improving access to early intervention should produce better outcomes and reduce the costs of services required later by addressing developmental concerns earlier. The dataset included records for 10,688 infants referred to the Hillsborough County Early Steps Program between 2006 and 2009. Two measures (age at referral and time to IFSP) represented points within the referral process where delays could be quantified. Age at referral is a measure of how long it takes for a delay to be identified and the infant referred for evaluation. The time from the referral to the date an IFSP is created provides a measure of the delay in beginning services. Delays in obtaining a referral were associated with being referred by a family member, the referral code Developmental Delay At Risk and barrier codes Child/Family Issues and No Show/Unsuccessful Contact. Delays in completing the IFSP were related to being younger at referral, being referred by one of the sources that made less frequent referrals to Early Steps, an eligibility determination related to behavior concerns, maternal education that stopped at grade 8 or below and being Black.

The purpose of this study was to explore what makes the interorganizational referral process effective and efficient from the perspectives of acute care referral senders and post acute care referral receivers. The referral process was conceptualized as the classic communication model involving a sender, receiver, information, a communication channel and contextual factors such as formalization and relationships. The hypotheses proposed that the relationships between each of the variables information usefulness, communication channel richness, and degree of formalization affected each of perceived referral process effectiveness and efficiency through the variable ‘relational coordination’. Key informants who either sent referrals from acute care settings or who received them in post acute care inpatient settings were asked to discuss each variable. These results were combined with those of a literature review to develop questionnaires containing a scale with acceptable Chronbach alpha for each. Surveys were disseminated through networks and associations involved in acute and post acute stroke and hip fracture care and in discharge planning and Long Term Care. Useable responses included 114 surveys from referral senders and 171 from referral recipients. Baron and Kenny’s four step test for mediation was used to test the hypotheses. For senders, each of channel richness (adjR2 = 10% p= 0.001), information usefulness (adjR2 = 16% p= 0.000), and formalization (adjR2 = 10% p= 0.000) were significantly related to perceived effectiveness. For channel richness, the relationship with perceived effectiveness was partially mediated by relational coordination (adjR2 = 19% p= 0.001). This was also the case for the relationship between information usefulness and perceived effectiveness (adjR2 = 0.20; p=000). For receivers, channel richness is related to perceived effectiveness through relational coordination (adjR2 = 12% p= 0.003). This was also the case for information usefulness (adjR2 = 13% p= 0.000). In neither group were any of the variables significantly related to efficiency. We may conclude that in the referral process, channel richness and information usefulness are related to perceived effectiveness for both senders and receivers. These may provide an important return on investment if chosen as an areas for referral process improvement, if accompanied by concurrent investments in relational coordination.

The purpose of this study was to explore what makes the interorganizational referral process effective and efficient from the perspectives of acute care referral senders and post acute care referral receivers. The referral process was conceptualized as the classic communication model involving a sender, receiver, information, a communication channel and contextual factors such as formalization and relationships. The hypotheses proposed that the relationships between each of the variables information usefulness, communication channel richness, and degree of formalization affected each of perceived referral process effectiveness and efficiency through the variable ‘relational coordination’. Key informants who either sent referrals from acute care settings or who received them in post acute care inpatient settings were asked to discuss each variable. These results were combined with those of a literature review to develop questionnaires containing a scale with acceptable Chronbach alpha for each. Surveys were disseminated through networks and associations involved in acute and post acute stroke and hip fracture care and in discharge planning and Long Term Care. Useable responses included 114 surveys from referral senders and 171 from referral recipients. Baron and Kenny’s four step test for mediation was used to test the hypotheses. For senders, each of channel richness (adjR2 = 10% p= 0.001), information usefulness (adjR2 = 16% p= 0.000), and formalization (adjR2 = 10% p= 0.000) were significantly related to perceived effectiveness. For channel richness, the relationship with perceived effectiveness was partially mediated by relational coordination (adjR2 = 19% p= 0.001). This was also the case for the relationship between information usefulness and perceived effectiveness (adjR2 = 0.20; p=000). For receivers, channel richness is related to perceived effectiveness through relational coordination (adjR2 = 12% p= 0.003). This was also the case for information usefulness (adjR2 = 13% p= 0.000). In neither group were any of the variables significantly related to efficiency. We may conclude that in the referral process, channel richness and information usefulness are related to perceived effectiveness for both senders and receivers. These may provide an important return on investment if chosen as an areas for referral process improvement, if accompanied by concurrent investments in relational coordination.

Business processes that are maintained in, and through, digital information chains are a widespread phenomenon in society. In these chains, several actors are active both in the production and transfer of information, where each actor is dependent on another actor's effective transmission to be able to perform his job. To explore this phenomenon, this study investigates an electronic referral process of the regional Health Care system in Sweden, that allows for the transfer of rights, duties and obligations between health care providers. In this process, effective information transfer is necessary to achieve high levels of patient safety and to prevent delays in care delivery. This study intends to unveil the technological and communicative challenges of information transfer faced by doctors who are involved in that process. The study draws upon primary data collected from nine interviews conducted with secondary care doctors working at the Uppsala University Hospital. The results were analyzed primarily using communication theories of representation and through a constructionist perspective of knowledge. The results show that most challenges are communicative, most of which, as well as the technological challenges identified, relate to mediation and sharing of meaning. Challenges also tend to be more or less prominent depending on the actors involved, and the nature of what is being transferred. In order to deal with the challenges, the referral process is circumvented and the methods of circumventing prove to be as institutionalized as the referral process itself. / Verksamhetsprocesser som upprätthålls i och genom digitala informationskedjor är ett utbrett fenomen. I dessa kedjor är flertalet aktörer aktiva i både produktionen och överföringen av information, där varje aktör är beroende av en annan aktörs överföring för att kunna utföra sitt arbete. I avsikt att närma sig detta fenomen, är syftet med studien att förstå vilka utmaningar som kan uppstå i en sådan verksamhetsprocess genom att undersöka det digitala remissförfarandet inom sjukvården. Remissförfarandet är en central process genom vilken patientvård samordnas via remisser och remissvar. För att uppnå hög patientsäkerhet, är processen beroende av effektiv informationsöverföring. Frågeställningen som studien ämnar besvara, är “Vilka informationsteknologiska och kommunikativa utmaningar kring informationsöverföring i remissförfarandet upplevs inom specialistsjukvården?”. För att besvara denna fråga har nio intervjuer med specialistläkare på Akademiska sjukhuset i Uppsala utförts. Intervjudatan har i huvudsak analyserats utifrån ett kommunikationsvetenskapligt angreppssätt som kombinerar ett konstruktivistiskt kunskapsperspektiv och representationsteori. Resultaten visar på att majoriteten av utmaningar är kommunikativa, varav de flesta, liksom de informationsteknologiska utmaningar som identifierats, relaterar till förmedling och delande av mening. Utmaningar tenderar också bli mer eller mindre framträdande beroende på vilka aktörer som deltar i informationskedjan samt karaktären på det som överförs. För att hantera utmaningarna kringgås remissförfarandet, där sätten att kringgå visar sig vara lika institutionaliserat som remissförfarandet självt.

There is minimal research into families where a person who is receiving palliative care has dependent children. In particular, there is a lack of information about the work that palliative care social workers undertake with such families. This study examines the role of the palliative care social worker in safeguarding and promoting the welfare of children of adults receiving specialist palliative care. This is a qualitative study involving the collection of information from a total of 57 palliative care social workers in three ways: focus groups, survey and semi-structured interviews. The analysis demonstrates that palliative care social workers understand the term 'safeguarding children' to mean more than child protection alone. The analysis also focuses on the process of referral, institutional barriers, supports for their work with children, and inter-agency collaboration. An equally important aspect of the analysis, and one generally neglected in psycho-social studies, relates to the socio-economic context of the palliative care social workers' work, including the effects of the immigration status of families on children. In the main, concerns about the present and future care of children come to the attention of palliative care social workers via members of the multidisciplinary team in which they are based. The numbers are reported to be relatively small in contrast to the total number of referrals received. The extent to which support to children is provided varies considerably; some palliative care agencies do not encourage palliative care social workers to work directly with children prior to bereavement and others restrict direct work with children post-bereavement. The main emphasis for all workers, however, is on support to the parents to help them understand their children's needs during the terminal phase of the illness. The well-being of children at this time of emotional stress is included in the palliative care social workers' definition of 'safeguarding children'. In addition, the wide-ranging examination of the palliative care social workers' involvement with the families illustrates the extent of the dedication involved in an under-resourced and little understood area of their work. Whilst palliative care social workers reported receiving basic training on child protection within their agency, with some themselves providing this training, further training on safeguarding children is not always available or known about. The amount and type of professional supervision and support is also varied, particularly in relation to child-care matters; not all have access to supervision from another social work professional. There are a small number of examples given in the study where children are considered to be at risk in some way. Children cared for by lone parents are recognised as being especially vulnerable, particularly if future care plans are not in place before the death of the parent. Also identified as vulnerable are children of parents whose immigration status is in question as their future location may be in doubt, placing children and the surviving parent under additional stress. One of the major difficulties for palliative care social workers is securing support services from local authority children's services. Whilst there are examples of collaboration and co-operation, the findings in this study echo those of others which examine the relationship between adult and children's services. In this study, palliative care social workers speak of frustration and disappointment in the responses they receive, and they are concerned that the needs of children of dying parents are not understood. This study contributes to the debate about the focus of children in care services for adults and how staff may be supported in their task of safeguarding and promoting the welfare of children. This study also adds to the limited existing knowledge about palliative care social work practice.