Pēdējās desmitgadēs Latvijas slimnīcas tāpat kā veselības aprūpe kopumā pārdzīvo būtiskas pārmaiņ... more Pēdējās desmitgadēs Latvijas slimnīcas tāpat kā veselības aprūpe kopumā pārdzīvo būtiskas pārmaiņas. Attīstoties tehnoloģijām un mainoties demogrāfiskajai situācijai, slimnīcu skaits un gultu skaits tajās samazinās, savukārt prasības ārstēsanas kvalitātei, intensitātei un izmaksu efektivitātei pieaug. Tas rada nepieciesamību būtiski mainīt slimnīcu līdzsinējo vadīsanas sistēmu, pārejot uz procesu un klientu orientētu vadības un darba organizācijas sistēmu. Promocijas darba mērķis ir izpētīt slimnīcas kā sarežģītas, atvērtas, mainīgā vidē darbojosās sistēmas attīstības prieksnoteikumus un izstrādāt metodoloģiju slimnīcas pārejai uz procesu orientētu vadīsanas sistēmu. Promocijas darba struktūra ir pakārtota promocijas darba uzdevumu risināsanai. Promocijas darbs sastāv no cetrām nodaļām, secinājumiem un priekslikumiem. Promocijas darba pamatteksts ir izklāstīts uz 167 lappusēm, labākai darba izpratnei ir izveidotas 26 tabulas un 39 attēli, kā arī darbam ir pievienoti 5 pielikumi. Lit...
Background and Objectives: The aim of the study was to analyze the prevalence of cardiovascular r... more Background and Objectives: The aim of the study was to analyze the prevalence of cardiovascular risk factors (RFs) in Latvia from the population-based cross-sectional study performed in 2019–2020 and to compare the results with a similar study done in 2009–2010. Materials and Methods: The target sample of 6000 individuals representing a cross-section of Latvia’s inhabitants (aged 25–74) was formed using stratified two-stage cluster sampling. The survey had two components: (1) an interview using a pre-specified questionnaire and (2) physical examination (height, weight, arterial pressure) and collection of venous blood samples to measure levels of fasting glucose (Glu), total cholesterol (TC), high and low-density lipoprotein cholesterol (HDL-C/LDL-C), and triglycerides (Tg). In total, 4070 individuals were interviewed (32% non-response), from which 2218 (55%) individuals underwent physical examination and collection of blood samples. Results: The most frequently observed RFs were hi...
Legal Science: Functions, Significance and Future in Legal Systems II
The article analyses legal background for using data concerning health (including administrative ... more The article analyses legal background for using data concerning health (including administrative health data) for research purposes in Latvia in the context of the General Data Protection Regulation (GDPR) 2. Latvia is used as an example to reflect on how the GDPR interacts with the national legal framework regulating scientific research. The article argues that there are several gaps in regulation requiring systematic amendments, considering both the GDPR and the practical needs of Latvian researchers.
Visual notations based on customized entity relationship and basic UML class diagram paradigm of ... more Visual notations based on customized entity relationship and basic UML class diagram paradigm of classes, associations and attributes are successfully used in data modeling and data querying alike, both in relational database and in semantic/conceptual model setting. We propose a number of constructs for extending the basic diagrammatic framework in the setting of visual specification of SPARQL select queries for enabling visual specification of hierarchic data instance and aggregated queries. Our proposal includes: (i) a visual notation for subqueries, (ii) separate lists of aggregated and grouping attributes in aggregated queries, (iii) query control nodes (unit and union) not corresponding to data instances, and (iv) integration with textual SPARQL fragments. We report on an initial user study validating the understandability of the subquery notion by users without specific IT training, as well as announce implementation of the proposed notation constructs in a web-based diagramm...
Studies in health technology and informatics, 2020
The paper presents analysis of the legal and ethical issues surrounding establishment of the Latv... more The paper presents analysis of the legal and ethical issues surrounding establishment of the Latvian Healthcare Monitoring Datalink. The paper covers three interconnected issues in the context of the use of administrative health data for research purposes - anonymization of data, concept of 'public interest' and involvement of research ethics committees. The analysis has been put into broader context of interaction between General Data Protection Regulation (GDPR), national legislative measures and practical needs of researchers. Neither GDPR, nor Latvian legal framework regulate the particularities on the use of potentially identifiable health data in research. Also, the practical use of 'public interest' as a basis for lawful processing of personal data concerning health for research purposes is not clear. More extended involvement of research ethics committees might serve as useful tool for determination the 'public interest' and for the evaluation of prop...
Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding sour... more Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EUROPEAN SOCIAL FUND MINISTRY OF HEALTH, LATVIA Background. An increasing prevalence (PREV.) of noncomunicable diseases is a major public health concern in Latvia. Regular nationwide epidemiological studies present an opportunity to estimate the dinamics of PREV of health risk factors (RF) and thus assist in planning resources and improving prevention strategies at national level. Objective. The aim was to analyze the PREV of cardiovascular RF identified in a epidemiological study in 2019-2020. To assess changes in RF prevalence, the results were compared to data from a similar study in 2009-2010. Methods. 4070 inhabitants (age 25-74) of Latvia enrolled. The statistical sample (6000 pers.) was random selected from the Housing Register, Central Statistical Bureau (1’209’756 INDV). The survey included an interview, physical examination (body mass index (BMI), arterial pressure...
Background According to statistics of Organisation for Economic Cooperation and Development (OECD... more Background According to statistics of Organisation for Economic Cooperation and Development (OECD) Latvia has one of the highest 30-day mortality for acute myocardial infarction (AMI). The output data used in the calculation of this indicator was analysed at a hospital level to explain the causes of it. Methods Linked to Causes of death registry administrative reimbursement system data from 2014 to 2017 were analysed. Defined exclusion criteria were applied and 11675 emergency AMI admissions were indexed. As evaluation of the inter-hospital differences in non-ST elevation myocardial infarction (NSTEMI) revealed significant inconsistency in statistical classification of non-ST elevation acute cardiac events, the 30-day mortality and the factors influencing it, was exclusively analysed for 9168 ST elevation myocardial infarction (STEMI) cases. The outcomes of different reperfusion scenarios were analysed for five groups of hospitals of size, location, the availability of percutaneous ...
International Journal of Healthcare Management, 2016
Hospitals face increasing pressure to reduce costs, improve efficiency, and guarantee a quality o... more Hospitals face increasing pressure to reduce costs, improve efficiency, and guarantee a quality of services. This is perhaps the main reason why hospital process orientation (HPO)a view on a hospital being a group of processes organized around patients with similar needs is a growing field of interest among hospital managers and researchers. The theoretical research of the content of hospital activities was performed in order to determine the main distinct characteristics in hospital organization that determine the specifics for a process-oriented knowledge system. A conceptual proposal of a technological tool was elaborated taking into account the limited control of hospital management over clinical process dominated by the doctor's decision-making and self-regulating activities.
Communications in Computer and Information Science, 2016
The ad-hoc querying process is slow and error prone due to inability of business experts of acces... more The ad-hoc querying process is slow and error prone due to inability of business experts of accessing data directly without involving IT experts. The problem lies in complexity of means used to query data. We propose a new natural language-and semistar ontology-based ad-hoc querying approach which lowers the steep learning curve required to be able to query data. The proposed approach would significantly shorten the time needed to master the ad-hoc querying and to gain the direct access to data by business experts, thus facilitating the decision making process in enterprises, government institutions and other organizations.
Nowadays large databases of clinical process data exist in hospitals. However, these data are rar... more Nowadays large databases of clinical process data exist in hospitals. However, these data are rarely used in full scope. In order to perform queries on hospital processes, one must either choose from the predefined queries or develop queries using MS Excel-type software system, which is not always a trivial task. In this paper we propose a new query language for analyzing clinical processes that is easily perceptible also by non-IT professionals. We develop this language based on a process modeling language which is also described in this paper. Prototypes of both languages have already been verified using real examples from hospitals.
We propose a new modeling language (as a profile of UML Class diagrams) that captures all the use... more We propose a new modeling language (as a profile of UML Class diagrams) that captures all the useful features from various UML diagrams and can be used in modeling of the hospitals. Based on the modeling language, we have developed an easy-to-perceive graphical query language, which allows the physicians to retrieve directly from the various hospital databases information they need to better understand the flow of clinical processes.
Objectives: To assess the self-perceived need and preferred format for educational intervention a... more Objectives: To assess the self-perceived need and preferred format for educational intervention among Latvian medical students in fostering the increasing demanding of management-related competences for healthcare professionals. Methods: A cross sectional study design was used to assess student-perceived deficiencies and the need for knowledge and skills in 10 different domains of activity. All medical students from one of the two major Latvian universities were invited to participate in this survey. The knowledge gap between perceived deficiency and actual need for training in specific domains was calculated. Possible correlations between a total gap of knowledge and selected demographic parameters were identified. Results: The response rate to this web-based questionnaire was 101/458 (22%). The most evident gaps were reported in the domains of Management of Legal Issues in Health Care (47%), followed by the domains of National Healthcare System (37%) and Management of Safety and Quality (37%). The knowledge gap was wider among students with a higher degree of perceived competition their chosen speciality (R=0.25, p=0.011) and with a preference to work in private clinic (R=0.26, p=0.009), but it narrowed with advanced degree of studies (R=-0.27, p=0.006). Conclusions: This pilot study demonstrates that medical students recognise the necessity for additional training in management. It also highlights those domains of managerial skills and knowledge in which the students have observed the most notable existing deficiencies. These gaps and resultant issues should be addressed in the development studies programmes.
Studies in Health Technology and Informatics, 2021
Medication adherence is a significant problem in public health. Prescription-level pharmacy datab... more Medication adherence is a significant problem in public health. Prescription-level pharmacy databases have great potential for monitoring actual drug adherence patterns at the healthcare system level. Many research papers have reported adherence estimates in different settings and populations. However, comparison between studies is not always straightforward due to different approaches taken when computing adherence. A crucial component to accurately estimate adherence is the availability of days’ supply information for each dispensing event. Reasonable assumptions regarding medication dosage have to be made, when this information is not available. In this study, we evaluate adherence and persistence to medication in patients after myocardial infarction and show that corresponding estimates differ significantly, when using different dosage assumptions, namely, when using defined daily dose or tablet per day dosage regimens. Moreover, we demonstrate that observed differences between ...
Management of processes instead of functions has growing importance into the health care. Transit... more Management of processes instead of functions has growing importance into the health care. Transition to hospital process orientation (HPO) changes the way physicians and other health professionals have used to practice before. Study was performed to explore factors affecting introduction of HPO in Latvian hospitals responding to significant external pressures during the years of economic crisis to detect the best practices used for process management implementation in clinical setting. To reach the research goal dissimilarities between current performance and management of hospitals were explored. As changes in hospital reimbursement system demand improved efficiency, hospital's performance was measured by decrease in avoidable hospitalisations, and increase in usage of more cost effective alternatives to a full hospitalisation. A regression analysis was performed to evaluate correlations of hospitalisation rates in Latvian hospitals to various outpatient health services utilisation indicators. This was done to exclude influence of external factors on hospital performance and to prove the positive impact of HPO initiatives on hospitalisation rate. Afterward the performance of all regional hospitals was compared and the two most distinct hospitals were selected for further in depth analysis. Operational data of the selected hospitals and a set of structured interviews outlined the differences between both hospital's managerial practices and factors affecting the introduction of process oriented initiatives. The theoretical research together with comparative analysis of approaches used in both hospitals served as a basis for elaboration of recommendations towards development of HPO and facilitation of the development of self-management competence of health professionals.
Academic Journal of Research in Economics and Management
Founded in 2001 as Acta Universitatis Latviensis, series «Economics. Business Administration» Vol... more Founded in 2001 as Acta Universitatis Latviensis, series «Economics. Business Administration» Volume 2 Rīga 2013
Pēdējās desmitgadēs Latvijas slimnīcas tāpat kā veselības aprūpe kopumā pārdzīvo būtiskas pārmaiņ... more Pēdējās desmitgadēs Latvijas slimnīcas tāpat kā veselības aprūpe kopumā pārdzīvo būtiskas pārmaiņas. Attīstoties tehnoloģijām un mainoties demogrāfiskajai situācijai, slimnīcu skaits un gultu skaits tajās samazinās, savukārt prasības ārstēsanas kvalitātei, intensitātei un izmaksu efektivitātei pieaug. Tas rada nepieciesamību būtiski mainīt slimnīcu līdzsinējo vadīsanas sistēmu, pārejot uz procesu un klientu orientētu vadības un darba organizācijas sistēmu. Promocijas darba mērķis ir izpētīt slimnīcas kā sarežģītas, atvērtas, mainīgā vidē darbojosās sistēmas attīstības prieksnoteikumus un izstrādāt metodoloģiju slimnīcas pārejai uz procesu orientētu vadīsanas sistēmu. Promocijas darba struktūra ir pakārtota promocijas darba uzdevumu risināsanai. Promocijas darbs sastāv no cetrām nodaļām, secinājumiem un priekslikumiem. Promocijas darba pamatteksts ir izklāstīts uz 167 lappusēm, labākai darba izpratnei ir izveidotas 26 tabulas un 39 attēli, kā arī darbam ir pievienoti 5 pielikumi. Lit...
Background and Objectives: The aim of the study was to analyze the prevalence of cardiovascular r... more Background and Objectives: The aim of the study was to analyze the prevalence of cardiovascular risk factors (RFs) in Latvia from the population-based cross-sectional study performed in 2019–2020 and to compare the results with a similar study done in 2009–2010. Materials and Methods: The target sample of 6000 individuals representing a cross-section of Latvia’s inhabitants (aged 25–74) was formed using stratified two-stage cluster sampling. The survey had two components: (1) an interview using a pre-specified questionnaire and (2) physical examination (height, weight, arterial pressure) and collection of venous blood samples to measure levels of fasting glucose (Glu), total cholesterol (TC), high and low-density lipoprotein cholesterol (HDL-C/LDL-C), and triglycerides (Tg). In total, 4070 individuals were interviewed (32% non-response), from which 2218 (55%) individuals underwent physical examination and collection of blood samples. Results: The most frequently observed RFs were hi...
Legal Science: Functions, Significance and Future in Legal Systems II
The article analyses legal background for using data concerning health (including administrative ... more The article analyses legal background for using data concerning health (including administrative health data) for research purposes in Latvia in the context of the General Data Protection Regulation (GDPR) 2. Latvia is used as an example to reflect on how the GDPR interacts with the national legal framework regulating scientific research. The article argues that there are several gaps in regulation requiring systematic amendments, considering both the GDPR and the practical needs of Latvian researchers.
Visual notations based on customized entity relationship and basic UML class diagram paradigm of ... more Visual notations based on customized entity relationship and basic UML class diagram paradigm of classes, associations and attributes are successfully used in data modeling and data querying alike, both in relational database and in semantic/conceptual model setting. We propose a number of constructs for extending the basic diagrammatic framework in the setting of visual specification of SPARQL select queries for enabling visual specification of hierarchic data instance and aggregated queries. Our proposal includes: (i) a visual notation for subqueries, (ii) separate lists of aggregated and grouping attributes in aggregated queries, (iii) query control nodes (unit and union) not corresponding to data instances, and (iv) integration with textual SPARQL fragments. We report on an initial user study validating the understandability of the subquery notion by users without specific IT training, as well as announce implementation of the proposed notation constructs in a web-based diagramm...
Studies in health technology and informatics, 2020
The paper presents analysis of the legal and ethical issues surrounding establishment of the Latv... more The paper presents analysis of the legal and ethical issues surrounding establishment of the Latvian Healthcare Monitoring Datalink. The paper covers three interconnected issues in the context of the use of administrative health data for research purposes - anonymization of data, concept of 'public interest' and involvement of research ethics committees. The analysis has been put into broader context of interaction between General Data Protection Regulation (GDPR), national legislative measures and practical needs of researchers. Neither GDPR, nor Latvian legal framework regulate the particularities on the use of potentially identifiable health data in research. Also, the practical use of 'public interest' as a basis for lawful processing of personal data concerning health for research purposes is not clear. More extended involvement of research ethics committees might serve as useful tool for determination the 'public interest' and for the evaluation of prop...
Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding sour... more Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EUROPEAN SOCIAL FUND MINISTRY OF HEALTH, LATVIA Background. An increasing prevalence (PREV.) of noncomunicable diseases is a major public health concern in Latvia. Regular nationwide epidemiological studies present an opportunity to estimate the dinamics of PREV of health risk factors (RF) and thus assist in planning resources and improving prevention strategies at national level. Objective. The aim was to analyze the PREV of cardiovascular RF identified in a epidemiological study in 2019-2020. To assess changes in RF prevalence, the results were compared to data from a similar study in 2009-2010. Methods. 4070 inhabitants (age 25-74) of Latvia enrolled. The statistical sample (6000 pers.) was random selected from the Housing Register, Central Statistical Bureau (1’209’756 INDV). The survey included an interview, physical examination (body mass index (BMI), arterial pressure...
Background According to statistics of Organisation for Economic Cooperation and Development (OECD... more Background According to statistics of Organisation for Economic Cooperation and Development (OECD) Latvia has one of the highest 30-day mortality for acute myocardial infarction (AMI). The output data used in the calculation of this indicator was analysed at a hospital level to explain the causes of it. Methods Linked to Causes of death registry administrative reimbursement system data from 2014 to 2017 were analysed. Defined exclusion criteria were applied and 11675 emergency AMI admissions were indexed. As evaluation of the inter-hospital differences in non-ST elevation myocardial infarction (NSTEMI) revealed significant inconsistency in statistical classification of non-ST elevation acute cardiac events, the 30-day mortality and the factors influencing it, was exclusively analysed for 9168 ST elevation myocardial infarction (STEMI) cases. The outcomes of different reperfusion scenarios were analysed for five groups of hospitals of size, location, the availability of percutaneous ...
International Journal of Healthcare Management, 2016
Hospitals face increasing pressure to reduce costs, improve efficiency, and guarantee a quality o... more Hospitals face increasing pressure to reduce costs, improve efficiency, and guarantee a quality of services. This is perhaps the main reason why hospital process orientation (HPO)a view on a hospital being a group of processes organized around patients with similar needs is a growing field of interest among hospital managers and researchers. The theoretical research of the content of hospital activities was performed in order to determine the main distinct characteristics in hospital organization that determine the specifics for a process-oriented knowledge system. A conceptual proposal of a technological tool was elaborated taking into account the limited control of hospital management over clinical process dominated by the doctor's decision-making and self-regulating activities.
Communications in Computer and Information Science, 2016
The ad-hoc querying process is slow and error prone due to inability of business experts of acces... more The ad-hoc querying process is slow and error prone due to inability of business experts of accessing data directly without involving IT experts. The problem lies in complexity of means used to query data. We propose a new natural language-and semistar ontology-based ad-hoc querying approach which lowers the steep learning curve required to be able to query data. The proposed approach would significantly shorten the time needed to master the ad-hoc querying and to gain the direct access to data by business experts, thus facilitating the decision making process in enterprises, government institutions and other organizations.
Nowadays large databases of clinical process data exist in hospitals. However, these data are rar... more Nowadays large databases of clinical process data exist in hospitals. However, these data are rarely used in full scope. In order to perform queries on hospital processes, one must either choose from the predefined queries or develop queries using MS Excel-type software system, which is not always a trivial task. In this paper we propose a new query language for analyzing clinical processes that is easily perceptible also by non-IT professionals. We develop this language based on a process modeling language which is also described in this paper. Prototypes of both languages have already been verified using real examples from hospitals.
We propose a new modeling language (as a profile of UML Class diagrams) that captures all the use... more We propose a new modeling language (as a profile of UML Class diagrams) that captures all the useful features from various UML diagrams and can be used in modeling of the hospitals. Based on the modeling language, we have developed an easy-to-perceive graphical query language, which allows the physicians to retrieve directly from the various hospital databases information they need to better understand the flow of clinical processes.
Objectives: To assess the self-perceived need and preferred format for educational intervention a... more Objectives: To assess the self-perceived need and preferred format for educational intervention among Latvian medical students in fostering the increasing demanding of management-related competences for healthcare professionals. Methods: A cross sectional study design was used to assess student-perceived deficiencies and the need for knowledge and skills in 10 different domains of activity. All medical students from one of the two major Latvian universities were invited to participate in this survey. The knowledge gap between perceived deficiency and actual need for training in specific domains was calculated. Possible correlations between a total gap of knowledge and selected demographic parameters were identified. Results: The response rate to this web-based questionnaire was 101/458 (22%). The most evident gaps were reported in the domains of Management of Legal Issues in Health Care (47%), followed by the domains of National Healthcare System (37%) and Management of Safety and Quality (37%). The knowledge gap was wider among students with a higher degree of perceived competition their chosen speciality (R=0.25, p=0.011) and with a preference to work in private clinic (R=0.26, p=0.009), but it narrowed with advanced degree of studies (R=-0.27, p=0.006). Conclusions: This pilot study demonstrates that medical students recognise the necessity for additional training in management. It also highlights those domains of managerial skills and knowledge in which the students have observed the most notable existing deficiencies. These gaps and resultant issues should be addressed in the development studies programmes.
Studies in Health Technology and Informatics, 2021
Medication adherence is a significant problem in public health. Prescription-level pharmacy datab... more Medication adherence is a significant problem in public health. Prescription-level pharmacy databases have great potential for monitoring actual drug adherence patterns at the healthcare system level. Many research papers have reported adherence estimates in different settings and populations. However, comparison between studies is not always straightforward due to different approaches taken when computing adherence. A crucial component to accurately estimate adherence is the availability of days’ supply information for each dispensing event. Reasonable assumptions regarding medication dosage have to be made, when this information is not available. In this study, we evaluate adherence and persistence to medication in patients after myocardial infarction and show that corresponding estimates differ significantly, when using different dosage assumptions, namely, when using defined daily dose or tablet per day dosage regimens. Moreover, we demonstrate that observed differences between ...
Management of processes instead of functions has growing importance into the health care. Transit... more Management of processes instead of functions has growing importance into the health care. Transition to hospital process orientation (HPO) changes the way physicians and other health professionals have used to practice before. Study was performed to explore factors affecting introduction of HPO in Latvian hospitals responding to significant external pressures during the years of economic crisis to detect the best practices used for process management implementation in clinical setting. To reach the research goal dissimilarities between current performance and management of hospitals were explored. As changes in hospital reimbursement system demand improved efficiency, hospital's performance was measured by decrease in avoidable hospitalisations, and increase in usage of more cost effective alternatives to a full hospitalisation. A regression analysis was performed to evaluate correlations of hospitalisation rates in Latvian hospitals to various outpatient health services utilisation indicators. This was done to exclude influence of external factors on hospital performance and to prove the positive impact of HPO initiatives on hospitalisation rate. Afterward the performance of all regional hospitals was compared and the two most distinct hospitals were selected for further in depth analysis. Operational data of the selected hospitals and a set of structured interviews outlined the differences between both hospital's managerial practices and factors affecting the introduction of process oriented initiatives. The theoretical research together with comparative analysis of approaches used in both hospitals served as a basis for elaboration of recommendations towards development of HPO and facilitation of the development of self-management competence of health professionals.
Academic Journal of Research in Economics and Management
Founded in 2001 as Acta Universitatis Latviensis, series «Economics. Business Administration» Vol... more Founded in 2001 as Acta Universitatis Latviensis, series «Economics. Business Administration» Volume 2 Rīga 2013
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