Cycles d’apprentissage

Vue d’ensemble

Chaque établissement partenaire travaille sur un thème particulier qui conduira à des policy briefs et à des dialogues entre parties prenantes. Ces thèmes ont été choisis en fixant des priorités en fonction de la pertinence scientifique et politique.

Synthèse des preuves (policy brief)

Avant toute délibération de fond et tout cycle d’apprentissage du système de santé, il faut que l’examen des preuves décrive des options possibles pour cibler les problématiques identifiées au départ. Le Swiss Learning Health System (SLHS) fournit deux outils de synthèse des preuves: a) les policy briefs, qui servent de base aux dialogues entre parties prenantes, et b) les synthèses des réactions rapides.

Policy Brief

Quand un enjeu a été identifié pour un dialogue entre parties prenantes, l’étape suivante est d’élaborer un policy brief. Un policy brief est un document qui décrit le problème et son enjeu en expliquant les facteurs contextuels déterminants. Il présente un certain nombre de solutions bien fondées au problème, et, pour chaque solution possible, explique les aspects pertinents, y compris les coûts et bénéfices attendus, et les obstacles ou ouvertures pour l’implémentation. Le policy brief est ensuite distribué aux participants au dialogue, avant la délibération.

Synthèse des réactions rapides

Le paysage du système de santé suisse change continuellement, et il peut y avoir des pénuries spontanées de services ou de fournitures. Les synthèses de réactions rapides sont des moyens de répondre vite et intelligemment aux problèmes qui se manifestent dans le système de santé. Elles identifient et synthétisent la meilleure ligne d’action en examinant les preuves actuelles et les solutions possibles. La synthèse des réactions rapides comprend un guide d’implémentation, avec des considérations d’implémentation, un suivi et une évaluation spécifiques à l’enjeu.

Dialogue entre parties prenantes

Stakeholder dialogues are structured communication processes that aim at supporting and engaging stakeholders to implement evidence-based solutions to a particular issue at hand. Based on a policy brief, a group of 6-20 stakeholders work collaboratively toward a common understanding of the problem and the best course of action. 

Les dialogues entre parties prenantes sont des processus de communication visant à soutenir les parties prenantes et à les inciter à implémenter des solutions fondées lorsqu’un problème particulier se pose. Sur la base d’un policy brief, un groupe de 6 à 20 parties prenantes collabore pour une compréhension commune du problème et de la meilleure ligne d’action. 

Les dialogues sont guidés par un animateur qui supervise les délibérations, incite les participants à confronter leurs avis et modère la confrontation de leurs différences d’opinion.

On clôt généralement le dialogue en décidant, en premier lieu, si une ligne d’action fait l’objet d’un accord ou non. En second lieu, s’il n’y a pas d’accord, on décide i) s’il est nécessaire de reconvoquer un dialogue pour avancer vers un accord, ou ii) si, étant donné un éventuel manque de preuves, il y a lieu de chercher davantage pour convenir de la meilleure solution possible. Si le résultat est i), le SLHS invite les parties prenantes à une négociation structurée pour résoudre les différences d’opinions. Si le résultat des ii), le SLHS contribue au programme de recherche des partenaires académiques en vue de traiter les questions en suspens.

Les dialogues entre parties prenantes sont des mécanismes prometteurs pour éclairer les politiciens au sujet d’actions factuelles pour identifier des problèmes, à tous les niveaux de la santé, y compris politique, prestation de services, ou collecte d’informations sur le financement et la santé. En outre, ce sont des mécanismes qui aident à identifier des thèmes de recherche répondant aux besoins actuels du système de santé et créent ainsi une culture de la responsabilité partagée.

On trouvera sous Thèmes une liste de dialogues entre parties prenantes menés par le SLHS.

Thèmes

Chaque établissement partenaire travaille sur un thème particulier qui conduira à des policy briefs et à des dialogues entre parties prenantes. Ces thèmes ont été choisis en fixant des priorités en fonction de la pertinence scientifique et politique.

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

Trouver des preuves

Trouver et synthétiser des preuves, que ce soit pour les policy briefs ou pour les synthèses de réactions rapides, est essentiel dans le travail du Swiss Learning Health System (SLHS). De bons points de départ pour rechercher des preuves pertinentes sont des ressources filtrées qui résument et évaluent les preuves apportées par différentes études; il peut s’agit de revues systématiques, de directives basées sur des preuves ou de critiques portant sur des cas concrets.

Cochrane Switzerland

Cochrane Switzerland

Les revues Cochrane sont des revues systématiques de recherche préliminaire dans les soins et la politique de la santé, internationalement reconnues comme la norme la plus élevée dans les ressources de santé fondées sur des preuves. Elles étudient les effets d’interventions sur la prévention, le traitement et la réadaptation. Elles évaluent également l’exactitude d’un test diagnostique pour une condition donnée dans un groupe de patients et un cadre particulier. Les revues Cochrane sont revues par des pairs et sont dynamiques, étant régulièrement adaptées pour intégrer des recherches récentes. En Suisse, les revues Cochrane sont accessibles gratuitement.


PubMed (MEDLINE)

PubMed (MEDLINE)

PubMed est un moteur de recherche gratuit qui accède en premier lieu à la base de données MEDLINE, contenant des références et des extraits sur les sciences de la vie et des thèmes biomédicaux.

Trouvez des revues systématiques dans PubMed en restreignant votre recherche de publication à des « Systematic Reviews » ou en l’intégrant dans votre chaîne de recherche.


Epistemonikos

Epistemonikos

Epistemonikos est une base de données multilingue de preuves qui établit des liens avec des revues systématiques, des récapitulatifs de revues, des études préliminaires et des résumés structurés. Elle est mise à jour continuellement.


Base de données TRIP

Base de données TRIP

Trip est un moteur de recherche clinique conçu pour permettre aux utilisateurs de trouver et d’utiliser, vite et facilement, des preuves issues de recherches de qualité pour étayer leur pratique et/ou leurs soins. En plus des preuves issues de la recherche, TRIP permet aux cliniciens des recherches dans d’autres types de contenus: images, vidéos, prospectus d’informations pour patients, cours, actualités, etc.


Forum de santé McMaster

Forum de santé McMaster

Le forum de santé canadien McMaster fournit des preuves issues de recherches sur des enjeux urgents, principalement de trois manières:

  1. produits-preuves, préparés en réponse à des requêtes soumises par des dirigeants de systèmes de santé;
  2. sources de preuves pré-évaluées, synthétisées, issues de la recherche, sur les manières de consolider les systèmes de santé (Health Systems Evidence) et les systèmes sociaux (Social Systems Evidence); et
  3. source d’informations de haute qualité sur un vieillissement optimal, pour seniors, soignants et professionnels (McMaster Optimal Aging Portal).

Swiss Learning Health System
University of Lucerne
Department of Health Sciences and Medicine
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