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Weaver SJ, Breslau ES, Russell LE, Zhang A, Sharma R, Bass EB, Marsteller JA, Snyder C. Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation. J Natl Cancer Inst 2024; 116:800-811. [PMID: 38419574 DOI: 10.1093/jnci/djae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Context can influence cancer-related outcomes. For example, health-care organization characteristics, including ownership, leadership, and culture, can affect care access, communication, and patient outcomes. Health-care organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming health-care organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-level, organization-level, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in health care delivery-and their dynamics is an important yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. The field lacks conceptual grounding, however, to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.
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Affiliation(s)
- Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Erica S Breslau
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lauren E Russell
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allen Zhang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ritu Sharma
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marsteller
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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JaKa MM, Beran MS, Andersen JA, Whitebird RR, Bergdall AR, Kindt JM, Dehmer SP, Winger M, Solberg LI. The Role of Care Coordination: A Qualitative Study of Care Coordinator Perceptions. J Nurs Care Qual 2024; 39:44-50. [PMID: 37163721 DOI: 10.1097/ncq.0000000000000719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Care coordination is important for patients with complex needs; yet, little is known about the factors impacting implementation from the care coordinator perspective. PURPOSE To understand how care coordination implementation differs across clinics and what care coordinators perceive as barriers and facilitators of effective coordination. METHODS Nineteen care coordinators from primary care clinics in Minnesota participated in interviews about their perceptions of care coordination. A team of analysts coded interviews using inductive thematic analysis. RESULTS Four major themes emerged: variety in care coordination implementation; importance of social needs; necessity for leader buy-in; and importance of communication skills. CONCLUSIONS Described differences in care coordination implementation were often logistical, but the implications of these differences were foundational to care coordinator perceived effectiveness.
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Affiliation(s)
- Meghan M JaKa
- Center for Evaluation and Survey Research, HealthPartners Institute (Dr JaKa and Ms Andersen), HealthPartners Institute (Drs Beran, Dehmer, and Solberg and Mss Bergdall and Winger), Bloomington, Minnesota; Morrison Family College of Health, University of St Thomas, St Paul, Minnesota (Dr Whitebird); and Minnesota Department of Health, St Paul (Ms Kindt)
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Khatri RB, Wolka E, Nigatu F, Zewdie A, Erku D, Endalamaw A, Assefa Y. People-centred primary health care: a scoping review. BMC PRIMARY CARE 2023; 24:236. [PMID: 37946115 PMCID: PMC10633931 DOI: 10.1186/s12875-023-02194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Integrated people-centred health services (IPCHS) are vital for ensuring comprehensive care towards achieving universal health coverage (UHC). The World Health Organisation (WHO) envisions IPCHS in delivery and access to health services. This scoping review aimed to synthesize available evidence on people-centred primary health care (PHC) and primary care. METHODS We conducted a scoping review of published literature on people-centred PHC. We searched eight databases (PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science, and Google Scholar) using search terms related to people-centred and integrated PHC/primary care services. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to select studies. We analyzed data and generated themes using Gale's framework thematic analysis method. Themes were explained under five components of the WHO IPCHS framework. RESULTS A total of fifty-two studies were included in the review; most were from high-income countries (HICs), primarily focusing on patient-centred primary care. Themes under each component of the framework included: engaging and empowering people and communities (engagement of community, empowerment and empathy); strengthening governance and accountability (organizational leadership, and mutual accountability); reorienting the model of care (residential care, care for multimorbidity, participatory care); coordinating services within and across sectors (partnership with stakeholders and sectors, and coordination of care); creating an enabling environment and funding support (flexible management for change; and enabling environment). CONCLUSIONS Several people-centred PHC and primary care approaches are implemented in HICs but have little priority in low-income countries. Potential strategies for people-centred PHC could be engaging end users in delivering integrated care, ensuring accountability, and implementing a residential model of care in coordination with communities. Flexible management options could create an enabling environment for strengthening health systems to deliver people-centred PHC services.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia.
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Eskinder Wolka
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Southport, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Aklilu Endalamaw
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
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Reichman M, Briskin EA, Duarte BA, Vranceanu AM, Grunberg VA. Integrating Psychosocial Care into Orthopedic Settings: A Qualitative Study of Provider Perspectives. Int J Integr Care 2023; 23:15. [PMID: 38074513 PMCID: PMC10705025 DOI: 10.5334/ijic.7579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 10/12/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction Approximately 50% of persons with orthopedic injuries experience psychosocial distress (e.g., depression, anxiety), which can predict chronic pain and disability. Offering psychosocial services in orthopedic settings can promote patient recovery. This study explores health care professionals' perceptions of and recommendations regarding integrated psychosocial care for orthopedic settings. Methods We conducted 18 semi-structured focus groups with 79 orthopedic health care professionals (e.g., surgeons, residents, nurses) across three Level I Trauma Centers. This secondary data analysis used the evidence-based Rainbow Model of Integrated Care framework to structure hybrid inductive-deductive qualitative data analysis. Results Orthopedic health care professionals identified potential benefits to psychosocial service integration across all dimensions of integration (i.e., clinical, professional, organizational, system, functional, and normative). These benefits included increased patient satisfaction with care, decreased burden on medical providers to manage patient distress, and decreased healthcare utilization costs. They also identified barriers (e.g., fast-paced clinic flow, mental health stigma) and offered recommendations to address barriers across dimensions of integration. Conclusion Integrated psychosocial care for orthopedic trauma patients has the potential to improve patient recovery and long-term physical and mental health outcomes. This work identifies strategies to inform the development and implementation of initiatives to integrate psychosocial services within orthopedic settings.
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Affiliation(s)
- Mira Reichman
- University of Washington, Department of Psychology, Seattle, WA, USA
| | - Ellie A. Briskin
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brooke A. Duarte
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Suffolk University, Department of Psychology, Boston, Massachusetts, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Victoria A. Grunberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Newborn Medicine, MassGeneral for Children, Boston, Massachusetts, USA
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Hynes DM, Govier DJ, Niederhausen M, Tuepker A, Laliberte AZ, McCready H, Hickok A, Rowneki M, Waller D, Cordasco KM, Singer SJ, McDonald KM, Slatore CG, Thomas KC, Maciejewski M, Battaglia C, Perla L. Understanding care coordination for Veterans with complex care needs: protocol of a multiple-methods study to build evidence for an effectiveness and implementation study. FRONTIERS IN HEALTH SERVICES 2023; 3:1211577. [PMID: 37654810 PMCID: PMC10465329 DOI: 10.3389/frhs.2023.1211577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023]
Abstract
Background For patients with complex health and social needs, care coordination is crucial for improving their access to care, clinical outcomes, care experiences, and controlling their healthcare costs. However, evidence is inconsistent regarding the core elements of care coordination interventions, and lack of standardized processes for assessing patients' needs has made it challenging for providers to optimize care coordination based on patient needs and preferences. Further, ensuring providers have reliable and timely means of communicating about care plans, patients' full spectrum of needs, and transitions in care is important for overcoming potential care fragmentation. In the Veterans Health Administration (VA), several initiatives are underway to implement care coordination processes and services. In this paper, we describe our study underway in the VA aimed at building evidence for designing and implementing care coordination practices that enhance care integration and improve health and care outcomes for Veterans with complex care needs. Methods In a prospective observational multiple methods study, for Aim 1 we will use existing data to identify Veterans with complex care needs who have and have not received care coordination services. We will examine the relationship between receipt of care coordination services and their health outcomes. In Aim 2, we will adapt the Patient Perceptions of Integrated Veteran Care questionnaire to survey a sample of Veterans about their experiences regarding coordination, integration, and the extent to which their care needs are being met. For Aim 3, we will interview providers and care teams about their perceptions of the innovation attributes of current care coordination needs assessment tools and processes, including their improvement over other approaches (relative advantage), fit with current practices (compatibility and innovation fit), complexity, and ability to visualize how the steps proceed to impact the right care at the right time (observability). The provider interviews will inform design and deployment of a widescale provider survey. Discussion Taken together, our study will inform development of an enhanced care coordination intervention that seeks to improve care and outcomes for Veterans with complex care needs.
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Affiliation(s)
- Denise M. Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Diana J. Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Public Health, Oregon Health & Science University & Portland State University, Portland, OR, United States
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Public Health, Oregon Health & Science University & Portland State University, Portland, OR, United States
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Avery Z. Laliberte
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Holly McCready
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Mazhgan Rowneki
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Dylan Waller
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Kristina M. Cordasco
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, United States
| | - Sara J. Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Kathryn M. McDonald
- Center for Diagnostic Excellence, Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Nursing, Baltimore, MD, United States
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, United States
- Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, United States
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences & Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, United States
| | - Catherine Battaglia
- Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, United States
- Department of Health Systems, Management & Policy, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa Perla
- Rehabilitation Services, Veterans Affairs Central Office, Washington, DC, United States
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Khatri R, Endalamaw A, Erku D, Wolka E, Nigatu F, Zewdie A, Assefa Y. Continuity and care coordination of primary health care: a scoping review. BMC Health Serv Res 2023; 23:750. [PMID: 37443006 DOI: 10.1186/s12913-023-09718-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Healthcare coordination and continuity of care conceptualize all care providers and organizations involved in health care to ensure the right care at the right time. However, systematic evidence synthesis is lacking in the care coordination of health services. This scoping review synthesizes evidence on different levels of care coordination of primary health care (PHC) and primary care. METHODS We conducted a scoping review of published evidence on healthcare coordination. PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science and Google Scholar were searched until 30 November 2022 for studies that describe care coordination/continuity of care in PHC and primary care. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to select studies. We analysed data using a thematic analysis approach and explained themes adopting a multilevel (individual, organizational, and system) analytical framework. RESULTS A total of 56 studies were included in the review. Most studies were from upper-middle-income or high-income countries, primarily focusing on continuity/care coordination in primary care. Ten themes were identified in care coordination in PHC/primary care. Four themes under care coordination at the individual level were the continuity of services, linkage at different stages of health conditions (from health promotion to rehabilitation), health care from a life-course (conception to elderly), and care coordination of health services at places (family to hospitals). Five themes under organizational level care coordination included interprofessional, multidisciplinary services, community collaboration, integrated care, and information in care coordination. Finally, a theme under system-level care coordination was related to service management involving multisectoral coordination within and beyond health systems. CONCLUSIONS Continuity and coordination of care involve healthcare provisions from family to health facility throughout the life-course to provide a range of services. Several issues could influence multilevel care coordination, including at the individual (services or users), organizational (providers), and system (departments and sectors) levels. Health systems should focus on care coordination, ensuring types of care per the healthcare needs at different stages of health conditions by a multidisciplinary team. Coordinating multiple technical and supporting stakeholders and sectors within and beyond health sector is also vital for the continuity of care especially in resource-limited health systems and settings.
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Affiliation(s)
- Resham Khatri
- School of Public Health, the University of Queensland, Brisbane, Australia.
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Aklilu Endalamaw
- School of Public Health, the University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Mount Gravatt, Australia
- Menzies Health Institute Queensland, Griffith University, Mount Gravatt, Australia
| | - Eskinder Wolka
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
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Vargas I, Mogollón-Pérez AS, Eguiguren P, Samico I, Bertolotto F, López-Vázquez J, Amarilla DI, De Paepe P, Vázquez ML. Lessons learnt from the process of designing care coordination interventions through participatory action research in public healthcare networks of six Latin American countries. Health Res Policy Syst 2023; 21:39. [PMID: 37264416 DOI: 10.1186/s12961-023-00985-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The participation of health professionals in designing interventions is considered vital to effective implementation, yet in areas such as clinical coordination is rarely promoted and evaluated. This study, part of Equity-LA II, aims to analyse the design process of interventions to improve clinical coordination, taking a participatory-action-research (PAR) approach, in healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. This participatory process was planned in four phases, led by a local steering committee (LSC): (1) dissemination of problem analysis results and creation of professionals' platform, (2) selection of problems and intervention (3) intervention design and planning (4) adjustments after evaluation of first implementation stage. METHODS A descriptive qualitative study based on documentary analysis, using a topic guide, was conducted in each intervention network. Documents produced regarding the intervention design process were selected. Thematic content analysis was conducted, generating mixed categories taken from the topic guide and identified from data. Main categories were LSC characteristics, type of design process (phases, participants' roles, methods) and associated difficulties, coordination problems and interventions selected. RESULTS LSCs of similar composition (managers, professionals and researchers) were established, with increasing membership in Chile and high turnover in Argentina, Colombia and Mexico. Following results dissemination and selection of problems and interventions (more participatory in Chile and Colombia: 200-479 participants), the interventions were designed and planned, resulting in three different types of processes: (1) short initial design with adjustments after first implementation stage, in Colombia, Brazil and Mexico; (2) longer, more participatory process, with multiple cycles of action/reflection and pilot tests, in Chile; (3) open-ended design for ongoing adaptation, in Argentina and Uruguay. Professionals' time and the political cycle were the main barriers to participation. The clinical coordination problem selected was limited communication between primary and secondary care doctors. To address it, through discussions guided by context and feasibility criteria, interventions based on mutual feedback were selected. CONCLUSIONS As expected in a flexible PAR process, its rollout differed across countries in participation and PAR cycles. Results show that PAR can help to design interventions adapted to context and offers lessons that can be applied in other contexts.
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Affiliation(s)
- Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo 21, 08022, Barcelona, Spain.
| | - Amparo-Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, 11001, Bogotá, Colombia
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Avenida Independencia, 939, Santiago de Chile, Chile
| | - Isabella Samico
- Instituto de Medicina Integral Prof. Fernando Figueira-IMIP, Rua Dos Coelhos No. 300, Boa Vista, 50070-550, Recife, Brasil
| | - Fernando Bertolotto
- Facultad de Enfermería, Universidad de la República, Avenida 18 de Julio 124, 11200, Montevideo, Uruguay
| | - Julieta López-Vázquez
- Instituto de Salud Pública, Universidad Veracruzana, Avenida Dr. Luis Castelazo Ayala S/N. Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México
| | - Delia-Inés Amarilla
- Centro de Estudios Interdisciplinarios, Universidad Nacional de Rosario, Rosario, Argentina
| | - Pierre De Paepe
- Public Sector Care Unit, Department of Public Health, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo 21, 08022, Barcelona, Spain
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Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Möckli N, Espinosa JA, Simon M, Meyer-Massetti C, Zúñiga F. Clarifying the muddy concept of home healthcare coordination: A comprehensive theoretical framework. Heliyon 2023; 9:e14243. [PMID: 36967915 PMCID: PMC10031358 DOI: 10.1016/j.heliyon.2023.e14243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Effective healthcare coordination is vital when such care is provided as a collaborative effort by many individuals and their task activities are interdependent. Coordination is necessary to ensure that care not only meets the needs of patients, but also avoids negative consequences for them due to omitted, inefficient, unnecessary, or even incorrect treatments. It also helps conserve resources. This has contributed to a rapid increase in articles on this subject. Still, while care coordination topics are gaining the attention of researchers, there are a number of issues experienced, including the delineation of limitations, inconsistent definitions, and problems with measurement. Therefore, the aim of this article is to refine the concept of homecare coordination and provide a comprehensive theoretical framework, illustrated with examples from practice. Focusing on this goal, we have reviewed the extant literature on the subject to develop a theoretical homecare coordination framework. The first intermediary goal was to integrate relevant concepts across multiple theories and frameworks into a unified synthesis. We do so in two parts: (1) analysis of extant coordination frameworks and theories; and (2) the presentation of our newly developed theoretical framework for homecare coordination. The new framework differentiates clearly between coordination as a process-i.e., what people do to coordinate and coordination as an outcome-i.e., the state of coordination. Applying this distinction to both, measurement and interpretation of results helps avoid misleading conclusions. As a research outcome, our framework builds upon the extant coordination literature, considers the complex relationships among the various coordination-related factors and, while focusing on homecare, is applicable to various healthcare settings in general. A nuanced differentiation and explanation of the elements involved enable a more consistent operationalization of the coordination concept. Additionally, as they explicitly address the healthcare system's micro, meso, and macro levels, they can be applied across diverse healthcare settings to investigate homecare coordination.
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Narea P, Hernández B, Cisterna J, Cárdenas A, Amo-Ochoa P, Zamora F, Delgado GE, Llanos J, Brito I. The Methylene Spacer Matters: The Structural and Luminescent Effects of Positional Isomerism of n-Methylpyridyltriazole Carboxylate Semi-Rigid Ligands in the Structure of Zn(II) Based Coordination Polymers. Polymers (Basel) 2023; 15:polym15040888. [PMID: 36850172 PMCID: PMC9961080 DOI: 10.3390/polym15040888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
Two Zn(II) coordination polymers (CPs) based on n-methylpyridyltriazole carboxylate semi-rigid organic ligands (n-MPTC), with n = 3 (L1) and 4 (L2), have been prepared at the water n-butanol interphase by reacting Zn(NO3)2·4H2O with NaL1 and NaL2. This allows us to systematically investigate the influence of the isomeric positional effect on their structures. The organic ligands were obtained by saponification from their respective ester precursors ethyl-5-methyl-1-(pyridin-3-ylmethyl)-1H-1,2,3-triazole-4-carboxylate (P1) and ethyl-5-methyl-1-(pyridin-4-ylmethyl)-1H-1,2,3-triazole-4-carboxylate (P2), resulting in their corresponding sodium salt forms, 3-MPTC, and 4-MPTC. The structure of the Zn(II) CPs determined by single-crystal X-ray diffraction reveals that both CPs have 2D supramolecular hydrogen bond networks. The 2D supramolecular network of [Zn(L1)]n (1) is built up by hydrogen bond interactions between oxygen and hydrogen atoms between neighboring n-methylpyridyltriazole molecules, whereas in [Zn(L2)·4H2O]n (2) the water molecules link 1D polymeric chains forming a 2D supramolecular aggregate. The structures of 1 and 2 clearly show that the isomeric effect in the semi-rigid ligands plays a vital role in constructing the Zn(II) coordination polymers, helped by the presence of the methylene spacer group, in the final structural conformation. The structures of 1 and 2 significantly affect their luminescent properties. Thus, while 2 shows strong emission at room temperature centered at 367 nm, the emission of 1 is quenched substantially.
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Affiliation(s)
- Pilar Narea
- Departamento de Química, Facultad de Ciencias Básicas, Universidad de Antofagasta, Casilla 170, Antofagasta 1240000, Chile
| | - Benjamín Hernández
- Departamento de Química, Facultad de Ciencias Básicas, Universidad de Antofagasta, Casilla 170, Antofagasta 1240000, Chile
| | - Jonathan Cisterna
- Departamento de Química, Facultad de Ciencias, Universidad de Católica del Norte, Sede Casa Central, Av. Angamos 0610, Antofagasta 1240000, Chile
| | - Alejandro Cárdenas
- Departamento de Física, Facultad de Ciencias Básicas, Universidad de Antofagasta, Casilla 170, Antofagasta 1240000, Chile
| | - Pilar Amo-Ochoa
- Departamento de Química Inorgánica, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Institute for Advanced Research Chemistry (IAdChem), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Félix Zamora
- Departamento de Química Inorgánica, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Institute for Advanced Research Chemistry (IAdChem), Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Condensed Matter Physics Center (IFIMAC), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Gerzon E. Delgado
- Departamento de Química, Facultad de Ciencias Básicas, Universidad de Antofagasta, Casilla 170, Antofagasta 1240000, Chile
- Laboratorio de Cristalografía, Departamento de Química, Facultad de Ciencias, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Jaime Llanos
- Departamento de Química, Facultad de Ciencias, Universidad de Católica del Norte, Sede Casa Central, Av. Angamos 0610, Antofagasta 1240000, Chile
| | - Iván Brito
- Departamento de Química, Facultad de Ciencias Básicas, Universidad de Antofagasta, Casilla 170, Antofagasta 1240000, Chile
- Correspondence: ; Tel.: +56-55-2637814
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Skjærpe JN, Joa I, Willumsen E, Hegelstad WTV, Iakovleva TA, Storm M. Perspectives on Coordinating Health Services for Individuals with Serious Mental Illness - A Qualitative Study. J Multidiscip Healthc 2022; 15:2735-2750. [PMID: 36483581 PMCID: PMC9724573 DOI: 10.2147/jmdh.s384072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/27/2022] [Indexed: 10/28/2023] Open
Abstract
PURPOSE Individuals with serious mental illness (SMI) might require coordinated health services to meet their healthcare needs. The overall aim of this study was to describe the perspectives of professionals (registered nurses, medical doctors, social educators, and social workers) on care coordination and measures to ensure proper and coordinated follow-up of the healthcare needs of individuals with SMI. More specifically, we investigated which measures are taken by employees in municipal health and care services to prevent the deterioration of health conditions and which measures are taken in cases where deterioration occurs despite preventive efforts. METHOD The study comprised individual qualitative interviews with professionals employed in municipal health and care services in two Norwegian municipalities. The interview material was analyzed using systematic text condensation. RESULTS Three categories and seven subcategories were created in the data analysis: 1) Maintain a stable and meaningful home life, including ensuring proper housing and access to services and assistance in receiving healthcare; 2) Measures to prevent deterioration of the health condition, including close monitoring of symptoms, emergency psychiatric care plans and emergency room calls and visits; and 3) Inpatient care to stabilize acute and severe symptoms, including municipal inpatient care, returning home after inpatient care and a need for shared responsibility for treatment and care. CONCLUSION Professionals employed in municipal health and care services coordinate health services to ensure proper and coordinated follow-up of the healthcare needs of individuals with SMI by ensuring housing services and access to the required healthcare. Measures taken when deterioration occurs include monitoring symptoms, use of emergency psychiatric care plans, emergency room contacts, or inpatient care.
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Affiliation(s)
- Jorunn Nærland Skjærpe
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Inge Joa
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
| | - Elisabeth Willumsen
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Wenche ten Velden Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Department of Social Studies, Faculty of Social Science, University of Stavanger, Stavanger, Norway
| | | | - Marianne Storm
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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Khanna A, Fix GM, Anderson E, Bolton RE, Bokhour BG, Foster M, Smith JG, Vimalananda VG. Towards a framework for patient-centred care coordination: a scoping review protocol. BMJ Open 2022; 12:e066808. [PMID: 36456025 PMCID: PMC9716881 DOI: 10.1136/bmjopen-2022-066808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Patient-centred care and care coordination are each key priority areas for delivering high quality healthcare. However, the intersection between these two concepts is poorly characterised. We theorise that greater advancements in healthcare quality could be realised when care is organised in a way that aligns with patients' preferences, needs and values across every level of the healthcare system. There is currently no published review that describes the intersection of patient-centred care and care coordination. We will undertake a scoping review that will be foundational to the development of a conceptual framework for patient-centred care coordination that integrates and synthesises the overlap between these two concepts and describe how it manifests across levels of the healthcare system. METHODS AND ANALYSIS A multidisciplinary team of reviewers will conduct a scoping review of published and grey literature to identify and synthesise key concepts at the intersection of patient-centred care and care coordination, following Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidance for scoping reviews. Databases we will use in our search include PubMed, CINAHL, Embase, Social Sciences Abstracts, Nursing and Allied Health Premium, Health and Medical Collection, and PsycINFO. Articles will be included that are English-language; published during or after 2001; describe a theory, conceptual model, theoretical framework or definition that addresses both patient-centred care and care coordination. Articles will be excluded if they do not address the intersection of patient-centred care and care coordination; discuss a patient-centred medical home without discussion on patient-centred care concepts; or discuss a paediatric, inpatient or palliative care setting. A data extraction template will facilitate qualitative thematic analysis and findings will be synthesised into a conceptual framework. ETHICS AND DISSEMINATION This work does not require ethics approval. A preliminary framework will be presented to a group of patient stakeholders for refinement before dissemination through a peer-reviewed journal and conference presentations.
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Affiliation(s)
- Aishwarya Khanna
- VA Bedford Healthcare System Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Gemmae M Fix
- VA Center for Healthcare Organization & Implementation Research Bedford Campus, Bedford, Massachusetts, USA
- Department of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ekaterina Anderson
- VA Bedford Healthcare System Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Rendelle E Bolton
- VA Bedford Healthcare System Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
- Brandeis University Heller School for Social Policy and Management, Waltham, Massachusetts, USA
| | - Barbara G Bokhour
- VA Center for Healthcare Organization & Implementation Research Bedford Campus, Bedford, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Marva Foster
- Department of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Center for Healthcare Organization and Implementation Research Boston Campus, Boston, Massachusetts, USA
| | - Jason G Smith
- VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Varsha G Vimalananda
- VA Center for Healthcare Organization & Implementation Research Bedford Campus, Bedford, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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Abuga J, Mwangi L, Ndolo J, Kariuki S, Newton C. Healthcare utilization by children with neurological impairments and disabilities in rural Kenya: a retrospective cohort study combined with secondary analysis of audit data. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18405.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: There is a paucity of data on healthcare utilization by children with neurological impairments (NI) in sub-Saharan Africa. We determined the rate, risk factors, causes, and outcomes of hospital admission and utilization patterns for rehabilitative care among children with NI in a defined rural area in Kenya. Methods: We designed two sub-studies to address the primary objectives. Firstly, we retrospectively observed 251 children aged 6–9 years with NI and 2162 age-matched controls to determine the rate, causes and outcomes of hospitalization in a local referral hospital. The two cohorts were identified from an epidemiological survey conducted in 2015 in a defined geographical area. Secondly, we reviewed hospital records to characterize utilization patterns for rehabilitative care. Results: Thirty-four in-patient admissions occurred in 8503 person-years of observation (PYO), yielding a crude rate of 400 admissions per 100 000 PYO (95% confidence interval (Cl): 286–560). The risk of admission was similar between cases and controls (rate ratio=0.70, 95%CI: 0.10–2.30, p = 0.31). The presence of electricity in the household was associated with reduced odds of admission (odds ratio=0.32, 95% Cl: 0.10–0.90, p < 0.01). Seizures and malaria were the main causes of admission. We confirmed six (0.3%) deaths during the follow-up period. Over 93% of outpatient paediatric visits for rehabilitative care were related to cerebral palsy and intellectual developmental delay. Health education (87%), rehabilitative exercises (79%) and assistive technology (64%) were the most common interventions. Conclusions: Surprisingly, the risk of hospitalization was not different between children with NI and those without, possibly because those with severe NI who died before this follow-up were under seclusion and restraint in the community. Evidence-based and tailored rehabilitative interventions are urgently required based on the existing secondary data.
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Understanding the invisible workforce: lessons for general practice from a survey of receptionists. BMC PRIMARY CARE 2022; 23:230. [PMID: 36085008 PMCID: PMC9462614 DOI: 10.1186/s12875-022-01842-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/30/2022] [Indexed: 12/02/2022]
Abstract
Introduction The significance of the role of receptionists during the recent shift to remote triage has been widely recognised and they will have a significant role to play in UK general practice as it continues to cope with a huge increase in demand exacerbated by the COVID-19 pandemic. To maximise their contribution, it is important the social and occupational characteristics of the modern receptionist are understood, alongside their attitudes towards the role and their perceptions of the support and training they receive . Methods We used convenience and cross-sectional sampling to survey the demographic characteristics of receptionists and various aspects of their role and responsibilities. This included the training received, specific tasks performed, job satisfaction, the importance of the role, and their interaction with clinical and non-clinical colleagues. We also captured data on the characteristics of their practice including the number of GPs and location. Results A total of 70 participants completed the survey (16 postal and 54 online responses) of whom the majority were white (97.2%), female (98.6%), and aged 40 and over (56.7%). The majority of the training focussed on customer service (72.9%), telephone (64.3%), and medical administration skills (58.6%). Just over a quarter had received training in basic triage (25.7%). A standard multiple regression model revealed that the strongest predictor of satisfaction was support from practice GPs (β = .65, p <.001) there were also significant positive correlations between satisfaction and appreciation from GPs, r(68) = .609, p < .001. Conclusion This study has provided a much-needed update on the demographics, duties, and job satisfaction of GP receptionists. The need for diversification of the workforce to reflect the range of primary care patients warrants consideration in light of continuing variation in access along lines of gender andethnicity. Training continues to focus on administrative duties not on the clinically relevant aspects of their role such as triage.
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15
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Braut H, Øygarden O, Storm M, Mikkelsen A. General practitioners' perceptions of distributed leadership in providing integrated care for elderly chronic multi-morbid patients: a qualitative study. BMC Health Serv Res 2022; 22:1085. [PMID: 36002824 PMCID: PMC9404619 DOI: 10.1186/s12913-022-08460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background Distributed Leadership (DL) has been suggested as being helpful when different health care professionals and patients need to work together across professional and organizational boundaries to provide integrated care (IC). This study explores whether General Practitioners (GPs) adopt leadership actions that transcend organizational boundaries to provide IC for patients and discusses whether the GPs’ leadership actions in collaboration with patients and health care professionals contribute to DL. Methods We interviewed GPs (n = 20) of elderly multimorbid patients in a municipality in Norway. A qualitative interpretive case design and Gioia methodology was applied to the collection and analysis of data from semi-structured interviews. Results GPs are involved in three processes when contributing to IC for elderly multimorbidity patients; the process of creating an integrated patient experience, the workflow process and the process of maneuvering organizational structures and medical culture. GPs take part in processes comparable to configurations of DL described in the literature. Patient micro-context and health care macro-context are related to observed configurations of DL. Conclusion Initiating or moving between different configurations of DL in IC requires awareness of patient context and the health care macro-context, of ways of working, capacity of digital tools and use of health care personnel. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08460-x.
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Affiliation(s)
- Harald Braut
- University of Stavanger Business School, Stavanger, Norway.
| | | | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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Fjellså HMH, Husebø AML, Storm M. eHealth in Care Coordination for Older Adults Living at Home: A Scoping Review (Preprint). J Med Internet Res 2022; 24:e39584. [DOI: 10.2196/39584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
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Litchfield I, Kingston B, Narga D, Turner A. The move towards integrated care: Lessons learnt from managing patients with multiple morbidities in the UK. Health Policy 2022; 126:777-785. [DOI: 10.1016/j.healthpol.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
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McCarthy M, Mak S, Kaufmann CN, Lum HD, Fung CH. Care coordination needs for deprescribing benzodiazepines and benzodiazepine receptor agonists. Res Social Adm Pharm 2022; 18:2691-2694. [PMID: 34229951 PMCID: PMC8720104 DOI: 10.1016/j.sapharm.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 02/02/2023]
Abstract
Deprescribing of medications such as benzodiazepines and benzodiazepine receptor agonists (z-drugs) can be a complex process that varies across practices, specialties, and health care systems. Care coordination among healthcare providers, patients, families, and other healthcare system components is critical to achieving high levels of deprescribing and person-centered care. We present a framework for promoting care coordination in the context of benzodiazepine/z-drug deprescribing. Future efforts are needed to study the impact of better care coordination on benzodiazepines/z-drug discontinuation and other outcomes that are important to stakeholders.
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Affiliation(s)
- Michaela McCarthy
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), VA Eastern Colorado Health Care System, Denver, CO,College of Nursing, University of Colorado, Aurora, CO
| | - Selene Mak
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Christopher N. Kaufmann
- Division of Epidemiology and Data Science in Gerontology, Department of Aging and Geriatric Research, University of Florida, Gainesville, FL
| | - Hillary D. Lum
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Health Care System, Aurora, CO,Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Constance H. Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Albertson EM, Chuang E, O'Masta B, Miake-Lye I, Haley LA, Pourat N. Systematic Review of Care Coordination Interventions Linking Health and Social Services for High-Utilizing Patient Populations. Popul Health Manag 2022; 25:73-85. [PMID: 34134511 PMCID: PMC8861924 DOI: 10.1089/pop.2021.0057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Recognizing that social factors influence patient health outcomes and utilization, health systems have developed interventions to address patients' social needs. Care coordination across the health care and social service sectors is a distinct and important strategy to address social determinants of health, but limited information exists about how care coordination operates in this context. To address this gap, the authors conducted a systematic review of peer-reviewed publications that document the coordination of health care and social services in the United States. After a structured elimination process, 25 publications of 19 programs were synthesized to identify patterns in care coordination implementation. Results indicate that patient needs assessment, in-person patient contact, and standardized care coordination protocols are common across programs that bridge health care and social services. Publications discussing these programs often provide limited detail on other key elements of care coordination, especially the nature of referrals and care coordinator caseload. Additional research is needed to document critical elements of program implementation and to evaluate program impacts.
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Affiliation(s)
- Elaine Michelle Albertson
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA.,University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA.,Address correspondence to: Elaine Michelle Albertson, MPH, Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, 650 Charles Young Drive S, Los Angeles, CA 90095, USA
| | - Emmeline Chuang
- University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA.,University of California Berkeley School of Social Welfare, Berkeley, California, USA
| | - Brenna O'Masta
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA
| | - Isomi Miake-Lye
- University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Leigh Ann Haley
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA
| | - Nadereh Pourat
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA.,University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA
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Maguire AM, Keyser J, Brown K, Kivlahan D, Romaniuk M, Gardner IR, Dwyer M. Veteran families with complex needs: a qualitative study of the veterans' support system. BMC Health Serv Res 2022; 22:74. [PMID: 35031051 PMCID: PMC8760758 DOI: 10.1186/s12913-021-07368-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Families with complex needs face significant challenges accessing and navigating health and social services. For veteran families, these challenges are exacerbated by interactions between military and civilian systems of care, and the density of the veterans’ non-profit sector. This qualitative study was designed to gather rich, detailed information on complex needs in veteran families; and explore service providers’ and families’ experiences of accessing and navigating the veterans’ support system. Methods The study comprised participant background questionnaires (n = 34), focus groups with frontline service providers (n = 18), and one-on-one interviews with veteran families (n = 16) in Australia. The semi-structured focus groups and interviews were designed to gather rich, detailed information on four study topics: (i) health and wellbeing needs in veteran families; (ii) service-access barriers and facilitators; (iii) unmet needs and gaps in service provision; and (iv) practical solutions for improving service delivery. The study recruited participants who could best address the focus on veteran families with complex needs. The questionnaire data was used to describe relevant characteristics of the participant sample. The focus groups and interviews were audio-recorded, transcribed, and a reflexive thematic analysis was conducted to identify patterns of shared meaning in the qualitative data. Results Both service providers and families found the veterans’ support system difficult to access and navigate. System fragmentation was perceived to impede care coordination, and delay access to holistic care for veteran families with complex needs. The medico-legal aspects of compensation and rehabilitation processes were perceived to harm veteran identity, and undermine health and wellbeing outcomes. Recovery-oriented practice was viewed as a way to promote veteran independence and self-management. Participants expressed a strong preference for family-centred care that was informed by an understanding of military lifestyle and culture. Conclusion The health and wellbeing needs of veteran families intensify during the transition from full-time military service to civilian environments, and service- or reintegration-related difficulties may emerge (or persist) for a significant period of time thereafter. Veteran families with complex needs are unduly burdened by care coordination demands. There is a pressing need for high-quality implementation studies that evaluate initiatives for integrating fragmented systems of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07368-2.
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Affiliation(s)
- Angela M Maguire
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Julieann Keyser
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia
| | - Kelly Brown
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Daniel Kivlahan
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Madeline Romaniuk
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia.,Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Ian R Gardner
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia
| | - Miriam Dwyer
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Development of an evidence-based reference framework for care coordination with a focus on the micro level of integrated care: A mixed method design study combining scoping review of reviews and nominal group technique. Health Policy 2022; 126:245-261. [DOI: 10.1016/j.healthpol.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
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Fraze TK, Beidler LB, Fichtenberg C, Brewster AL, Gottlieb LM. Resource Brokering: Efforts to Assist Patients With Housing, Transportation, and Economic Needs in Primary Care Settings. Ann Fam Med 2021; 19:507-514. [PMID: 34750125 PMCID: PMC8575510 DOI: 10.1370/afm.2739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/14/2021] [Accepted: 04/13/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Clinicians and policy makers are exploring the role of primary care in improving patients' social conditions, yet little research examines strategies used in clinical settings to assist patients with social needs. METHODS Study used semistructured interviews with leaders and frontline staff at 29 diverse health care organizations with active programs used to address patients' social needs. Interviews focused on how organizations develop and implement case management-style programs to assist patients with social needs including staffing, assistance intensity, and use of referrals to community-based organizations (CBOs). RESULTS Organizations used case management programs to assist patients with social needs through referrals to CBOs and regular follow-up with patients. About one-half incorporated care for social needs into established case management programs and the remaining described standalone programs developed specifically to address social needs independent of clinical needs. Referrals were the foundation for assistance and included preprinted resource lists, patient-tailored lists, and warm handoffs to the CBOs. While all organizations referred patients to CBOs, some also provided more intense services such as assistance completing patients' applications for services or conducting home visits. Organizations described 4 operational challenges in addressing patients' social needs: (1) effectively engaging CBOs; (2) obtaining buy-in from clinical staff; (3) considering patients' perspectives; and (4) ensuring program sustainability. CONCLUSION As the US health care sector faces pressure to improve quality while managing costs, many health care organizations will likely develop or rely on case management approaches to address patients' social conditions. Health care organizations may require support to address the key operational challenges.Visual abstract.
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Affiliation(s)
- Taressa K Fraze
- Department of Family and Community Medicine, University of California, San Francisco, California
| | - Laura B Beidler
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Caroline Fichtenberg
- Department of Family and Community Medicine, Social Interventions Research & Evaluation Network, University of California, San Francisco, California
| | - Amanda L Brewster
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, California
| | - Laura M Gottlieb
- Department of Family and Community Medicine, Social Interventions Research & Evaluation Network, University of California, San Francisco, California
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23
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Ehab J, Powers B, Kim R, Haider M, Utuama O, Chin A, Denbo J, Kis B, Frakes J, Jeong D, Lauwers G, Vadaparampil S, Fleming JB, Anaya DA. Integrating a Disease-Focused Tumor Board as a Delivery-of-Care Model to Expedite Treatment Initiation for Patients With Liver Malignancies. Ann Surg Oncol 2021; 29:2371-2380. [PMID: 34671878 DOI: 10.1245/s10434-021-10909-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with hepatobiliary malignancies are especially vulnerable to treatment delays. This study sought to evaluate the impact of implementing a new delivery-of-care model centered around a hepatobiliary multidisciplinary tumor board (HB-MTB) and integrated with an optimized patient workflow process to expedite treatment initiation. METHODS A hybrid type 2 study (effectiveness-implementation) was performed. Implementation measures were examined prospectively using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) approach during 5 years after the HB-MTB program deployment (2015-2020). The primary outcome was effectiveness, measured as time to treatment initiation (TTI) using a before and after design (1 year each). The patients were grouped into before (BP) and after (AP) categories based on date of HB-MTB program implementation. Multivariable Cox and linear regression analyses were performed to examine and compare time to treatment initiation between groups. RESULTS The HB-MTB program enrolled 2457 patients (reach). The RE-AIM measures were favorable and improved over time (P < 0.01 for all). The median TTI was lower for the AP group than for the BP group (17 vs 24 days; P < 0.01). In the multivariable Cox and linear regressions, treatment in the AP group was associated with a faster TTI (hazard ratio, 1.75; 95 % confidence interval, 1.31-2.35; p < 0.01), and a mean of 13 days faster treatment initiation than the BP group (P < 0.01). CONCLUSIONS Implementation of an HB-MTB program integrated with an optimized patient workflow was successful and led to faster treatment initiation. This delivery-of-care model can serve as a blueprint to expedite treatment of patients with cancer.
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Affiliation(s)
- Jasmina Ehab
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Benjamin Powers
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Richard Kim
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Mintallah Haider
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Ovie Utuama
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Alicia Chin
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Jason Denbo
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Bela Kis
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jessica Frakes
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel Jeong
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gregory Lauwers
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jason B Fleming
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA. .,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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Penney LS, Bharath PS, Miake-Lye I, Leng M, Olmos-Ochoa TT, Finley EP, Chawla N, Barnard JM, Ganz DA. Toolkit and distance coaching strategies: a mixed methods evaluation of a trial to implement care coordination quality improvement projects in primary care. BMC Health Serv Res 2021; 21:817. [PMID: 34391443 PMCID: PMC8364700 DOI: 10.1186/s12913-021-06850-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background Care coordination tools and toolkits can be challenging to implement. Practice facilitation, an active but expensive strategy, may facilitate toolkit implementation. We evaluated the comparative effectiveness of distance coaching, a form of practice facilitation, for improving the implementation of care coordination quality improvement (QI) projects. Methods We conducted a mixed methods evaluation of the Coordination Toolkit and Coaching (CTAC) initiative. Twelve matched US Veterans Health Administration primary care clinics were randomized to receive coaching and an online care coordination toolkit (“coached”; n = 6) or access to the toolkit only (“non-coached”; n = 6). We did interviews at six, 12, and 18 months. For coached sites, we‘ly collected site visit fieldnotes, prospective coach logs, retrospective coach team debriefs, and project reports. We employed matrix analysis using constructs from the Consolidated Framework for Implementation Research and a taxonomy of outcomes. We assessed each site’s project(s) using an adapted Complexity Assessment Tool for Systematic Reviews. Results Eleven sites implemented a local CTAC project. Eight sites (5 coached, 3 non-coached) used at least one tool from the toolkit. Coached sites implemented significantly more complex projects than non-coached sites (11.5 vs 7.5, 95% confidence interval 1.75–6.25, p < 0.001); engaged in more formal implementation processes (planning, engaging, reflecting and evaluating); and generally had larger, more multidisciplinary QI teams. Regardless of coaching status, sites focused on internal organizational improvement and low-intensity educational projects rather than the full suite of care coordination tools. At 12 months, half the coached and non-coached sites had clinic-wide project implementation; the remaining coached sites had implemented most of their project(s), while the remaining non-coached sites had either not implemented anything or conducted limited pilots. At 18 months, coached sites reported ongoing effort to monitor, adapt, and spread their CTAC projects, while non-coached sites did not report much continuing work. Coached sites accrued benefits like improved clinic relationships and team QI skill building that non-coached sites did not describe. Conclusions Coaching had a positive influence on QI skills of (and relationships among) coached sites’ team members, and the scope and rigor of projects. However, a 12-month project period was potentially too short to ensure full project implementation or to address cross-setting or patient-partnered initiatives. Trial registration NCT03063294. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06850-1.
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Affiliation(s)
- Lauren S Penney
- Elizabeth Dole Center of Excellence for Veteran & Caregiver Research, South Texas Veterans Health Care System, San Antonio, TX, USA. .,Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.
| | - Purnima S Bharath
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA.,Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Isomi Miake-Lye
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA.,Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mei Leng
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Tanya T Olmos-Ochoa
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Erin P Finley
- Elizabeth Dole Center of Excellence for Veteran & Caregiver Research, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.,HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Neetu Chawla
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Jenny M Barnard
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - David A Ganz
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA.,David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, California, USA
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25
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Caldas BDN, Portela MC, Singer SJ, Aveling EL. How Can Implementation of a Large-Scale Patient Safety Program Strengthen Hospital Safety Culture? Lessons From a Qualitative Study of National Patient Safety Program Implementation in Two Public Hospitals in Brazil. Med Care Res Rev 2021; 79:562-575. [PMID: 34253081 DOI: 10.1177/10775587211028068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Large-scale (e.g., national) programs could strengthen safety culture, which is foundational to patient safety, yet we know little about how to optimize this potential. In 2013, Brazil's Ministry of Health launched the National Patient Safety Program, involving hospital-level safety teams and targeted safety protocols. We conducted in-depth qualitative case studies of National Patient Safety Program implementation in two hospitals, with different readiness, to understand how program implementation affected enabling, enacting, and elaborating processes that produce and sustain safety culture. For both hospitals, external mandates were insufficient for enabling hospital-level action. Internal enabling failures (e.g., little safety-relevant senior leadership) hindered enactment (e.g., safety teams unable to institute plans). Limited enactment and weak elaboration processes (e.g., bureaucratic monitoring) failed to institutionalize protocol use and undermined safety culture. Optimizing the safety culture impact of large-scale programs requires effective multi-level enabling and capitalizing on the productive potential of interacting national- and local-level influences.
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Affiliation(s)
- Bárbara do Nascimento Caldas
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.,National Institute of Cardiology, Rio de Janeiro, RJ, Brazil
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Siqueira M, Coube M, Millett C, Rocha R, Hone T. The impacts of health systems financing fragmentation in low- and middle-income countries: a systematic review protocol. Syst Rev 2021; 10:164. [PMID: 34078460 PMCID: PMC8170990 DOI: 10.1186/s13643-021-01714-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/19/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Health systems are often fragmented in low- and middle-income countries (LMICs). This can increase inefficiencies and restrict progress towards universal health coverage. The objective of the systematic review described in this protocol will be to evaluate and synthesize the evidence concerning the impacts of health systems financing fragmentation in LMICs. METHODS Literature searches will be conducted in multiple electronic databases, from their inception onwards, including MEDLINE, EMBASE, LILACS, CINAHL, Scopus, ScienceDirect, Scielo, Cochrane Library, EconLit, and JSTOR. Gray literature will be also targeted through searching OpenSIGLE, Google Scholar, and institutional websites (e.g., HMIC, The World Bank, WHO, PAHO, OECD). The search strings will include keywords related to LMICs, health system financing fragmentation, and health system goals. Experimental, quasi-experimental, and observational studies conducted in LMICs and examining health financing fragmentation across any relevant metric (e.g., the presence of different health funders/insurers, risk pooling mechanisms, eligibility categories, benefits packages, premiums) will be included. Studies will be eligible if they compare financing fragmentation in alternative settings or at least two-time points. The primary outcomes will be health system-related goals such as health outcomes (e.g., mortality, morbidity, patient-reported outcome measures) and indicators of access, services utilization, equity, and financial risk protection. Additional outcomes will include intermediate health system objectives (e.g., indicators of efficiency and quality). Two reviewers will independently screen all citations, abstract data, and full-text articles. Potential conflicts will be resolved through discussion and, when necessary, resolved by a third reviewer. The methodological quality (or risk of bias) of selected studies will be appraised using established checklists. Data extraction categories will include the studies' objective and design, the fragmentation measurement and domains, and health outcomes linked to the fragmentation. A narrative synthesis will be used to describe the results and characteristics of all included studies and to explore relationships and findings both within and between the studies. DISCUSSION Evidence on the impacts of health system fragmentation in LMICs is key for identifying evidence gaps and priority areas for intervention. This knowledge will be valuable to health system policymakers aiming to strengthen health systems in LMICs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020201467.
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Affiliation(s)
- Marina Siqueira
- Institute for Health Policy Studies, IEPS, Itapeva St 286, Conjunto 81-84, Bela Vista, São Paulo, SP, 01332-000, Brazil.
| | - Maíra Coube
- Institute for Health Policy Studies, IEPS, Itapeva St 286, Conjunto 81-84, Bela Vista, São Paulo, SP, 01332-000, Brazil
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
| | - Rudi Rocha
- Institute for Health Policy Studies, IEPS, Itapeva St 286, Conjunto 81-84, Bela Vista, São Paulo, SP, 01332-000, Brazil
| | - Thomas Hone
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
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27
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Garvin LA, Pugatch M, Gurewich D, Pendergast JN, Miller CJ. Interorganizational Care Coordination of Rural Veterans by Veterans Affairs and Community Care Programs: A Systematic Review. Med Care 2021; 59:S259-S269. [PMID: 33976075 PMCID: PMC8132902 DOI: 10.1097/mlr.0000000000001542] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the unique context of rural Veterans' health care needs, expansion of US Department of Veterans Affairs and Community Care programs under the MISSION Act, and the uncertainties of coronavirus disease 2019 (COVID-19), it is critical to understand what may support effective interorganizational care coordination for increased access to high-quality care. OBJECTIVES We conducted a systematic review to examine the interorganizational care coordination initiatives that Veterans Affairs (VA) and community partners have pursued in caring for rural Veterans, including challenges and opportunities, organizational domains shaping care coordination, and among these, initiatives that improve or impede health care outcomes. RESEARCH DESIGN We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search 2 electronic databases (PubMed and Embase) for peer-reviewed articles published between January 2009 and May 2020. Building on prior research, we conducted a systematic review. RESULTS Sixteen articles met our criteria. Each captured a unique health care focus while examining common challenges. Four organizational domains emerged: policy and administration, culture, mechanisms, and relational practices. Exemplars highlight how initiatives improve or impede rural health care delivery. CONCLUSIONS This is the first systematic review, to our knowledge, examining interorganizational care coordination of rural Veterans by VA and Community Care programs. Results provide exemplars of interorganizational care coordination domains and program effectiveness. It suggests that partners' efforts to align their coordination domains can improve health care, with rurality serving as a critical contextual factor. Findings are important for policies, practices, and research of VA and Community Care partners committed to improving access and health care for rural Veterans.
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Affiliation(s)
- Lynn A. Garvin
- United States Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Marianne Pugatch
- United States Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Deborah Gurewich
- United States Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Department of Medicine, Boston University School of Medicine
| | - Jacquelyn N. Pendergast
- United States Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
| | - Christopher J. Miller
- United States Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Department of Psychiatry, Harvard Medical School, Boston, MA
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deJong NA, Vu MB, Cui J, Dole M, Moulton DE, Kappelman MD. A Multiple Case Study of Coordinated Care for Children with IBD through Caregiver Interviews. INTERNATIONAL JOURNAL OF CARE COORDINATION 2021; 23:156-164. [PMID: 33884199 DOI: 10.1177/2053434520979957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Effective care coordination is critical to manage unpredictable complications of conditions such as pediatric inflammatory bowel disease (IBD) that have a relapsing and remitting course. Our objective was to explore perspectives of care coordination following emergency department (ED) visits by children with IBD, because these may indicate deficient care coordination. Methods Using a multiple case study approach, we sought perspectives through semi-structured interviews of caregivers (parents, primary care providers, and gastroenterologists) for children with IBD who had a recent ED visit in either of two large pediatric referral centers in the southeastern US. We used criterion sampling to identify eligible participants through a medical record report of ED visits, and iterative sampling concurrent with analysis until no new themes were identified. Interviews were transcribed verbatim, and transcripts were coded using directed content analysis to identify emergent themes. Results From twenty-six interviews, three major themes emerged: perceptions of appropriate expertise, desire for integration of information and services, and making assumptions instead of engaging. Participants describe distinct roles for primary care and gastroenterology providers and recognize communication and information barriers to better coordination. Some parents and gastroenterologists perceive challenges to engaging primary care providers. Common recommendations include explicit guidance from gastroenterologists to primary care providers and methods for direct communication. Discussion Stakeholders describe common barriers and facilitators for effective care coordination, but some express beliefs about provider roles that could hinder improvement efforts. Tools to support asynchronous communication and shared planning may improve coordination and care quality for complications of IBD.
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Affiliation(s)
- Neal A deJong
- University of North Carolina School of Medicine, Department of Pediatrics; Division of General Pediatrics and Adolescent Medicine; 231 MacNider Hall, CB# 7225; 301B S. Columbia St., Chapel Hill, NC 27599
| | - Maihan B Vu
- University of North Carolina, Center for Health Promotion and Disease Prevention; Qualitative Research Unit, Department #4985, 1700 Martin Luther King Jr. Boulevard, CB# 7426, Chapel Hill, NC 27599
| | - Jiawei Cui
- University of North Carolina at Chapel Hill; School of Medicine, CB# 7000, 4068 Bondurant Hall, Chapel Hill, NC 27599
| | - Michael Dole
- Vanderbilt University; Department of Pediatrics; Division of Gastroenterology, Hepatology, and Nutrition, 2200 Children's Way, Nashville, TN 37232
| | - Dedrick E Moulton
- Vanderbilt University; Department of Pediatrics; Division of Gastroenterology, Hepatology, and Nutrition, 2200 Children's Way, Nashville, TN 37232
| | - Michael D Kappelman
- University of North Carolina School of Medicine, Department of Pediatrics; Division of Pediatric Gastroenterology; 101 Manning Drive, Chapel Hill, NC 27514
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The comprehensive framework for integrated healthcare implementation: a realist evaluation of positive parenting in rural primary care in the US. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-06-2020-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study aimed to develop a comprehensive framework that encompasses contextual determinants of integrated care implementation. The initial framework was developed based on literature and was refined based on contexts and mechanisms that facilitated or interfered with integrating a pilot parenting intervention, Behavior Checker (BC), into the routine service delivery in a rural primary care clinic in the USA.Design/methodology/approachThis study was a single organizational case study informed by the realist evaluation methodology. Data collection methods included key informant interviews, healthcare staff surveys, a focus group and direct observation of meetings. Data analysis focused on identifying the context-mechanism-outcome (CMO) frameworks, a heuristic used in a realist evaluation to map pathways of the interactions between program inputs and contextual conditions leading to intended and/or unintended outcomes.FindingsThe identified CMOs and antecedent contexts identified informed the process of revising the initial Comprehensive Framework for Integrated Healthcare Development and Implementation (CF-IHDI). The revised CF-IHDI contained six parent domains of outer setting, basic structures, people and value, intervention characteristics, organizational capabilities for change and key processes.Research limitations/implicationsThe CMOs and core characteristics of contextual conditions that activated facilitating mechanisms can inform future studies examining healthcare integration efforts.Practical implicationsThe CF-IHDI can guide primary care clinics in identifying factors and strategies to consider when integrating parenting or other psychosocial interventions into primary care routine service delivery.Originality/valueThe CF-IHDI developed in this study contributes to the knowledge of contexts and mechanisms that facilitate and interfere with integrated care implementation.
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Loewenbrück KF, Stein DB, Amelung VE, Bitterlich R, Brumme M, Falkenburger B, Fehre A, Feige T, Frank A, Gißke C, Helmert C, Kerkemeyer L, Knapp A, Lang C, Leuner A, Lummer C, Minkman MMN, Müller G, van Munster M, Schlieter H, Themann P, Zonneveld N, Wolz M. Parkinson Network Eastern Saxony (PANOS): Reaching Consensus for a Regional Intersectoral Integrated Care Concept for Patients with Parkinson's Disease in the Region of Eastern Saxony, Germany. J Clin Med 2020; 9:E2906. [PMID: 32911841 PMCID: PMC7563971 DOI: 10.3390/jcm9092906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
As integrated care is recognized as crucial to meet the challenges of chronic conditions such as Parkinson's disease (PD), integrated care networks have emerged internationally and throughout Germany. One of these networks is the Parkinson Network Eastern Saxony (PANOS). PANOS aims to deliver timely and equal care to PD patients with a collaborative intersectoral structured care pathway. Additional components encompass personalized case management, an electronic health record, and communicative and educative measures. To reach an intersectoral consensus of the future collaboration in PANOS, a structured consensus process was conducted in three sequential workshops. Community-based physicians, PD specialists, therapists, scientists and representatives of regulatory authorities and statutory health insurances were asked to rate core pathway-elements and supporting technological, personal and communicative measures. For the majority of core elements/planned measures, a consensus was reached, defined as an agreement by >75% of participants. Additionally, six representatives from all partners involved in the network-design independently assessed PANOS based on the Development Model for Integrated Care (DMIC), a validated model addressing the comprehensiveness and maturity of integrated care concepts. The results show that PANOS is currently in an early maturation state but has the potential to comprehensively represent the DMIC if all planned activities are implemented successfully. Despite the favorable high level of consensus regarding the PANOS concept and despite its potential to become a balanced integrated care concept according to the DMIC, its full implementation remains a considerable challenge.
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Affiliation(s)
- Kai F. Loewenbrück
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
- Clinical Trial Unit, German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307 Dresden, Germany
| | - Doron B. Stein
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Volker E. Amelung
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Robert Bitterlich
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
| | - Martin Brumme
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Björn Falkenburger
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
- Clinical Trial Unit, German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307 Dresden, Germany
| | - Annekathrin Fehre
- Department of Neurology, Elblandklinikum Meißen, 01662 Meißen, Germany; (A.F.); (A.L.); (M.W.)
| | - Tim Feige
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
| | - Anika Frank
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
- Clinical Trial Unit, German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307 Dresden, Germany
| | - Carola Gißke
- Chair of Business Informatics, esp. Systems Development, Faculty of Business and Economics, Technical University of Dresden, 01062 Dresden, Germany; (C.G.); (H.S.)
| | - Claudia Helmert
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Linda Kerkemeyer
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Andreas Knapp
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Caroline Lang
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Annegret Leuner
- Department of Neurology, Elblandklinikum Meißen, 01662 Meißen, Germany; (A.F.); (A.L.); (M.W.)
| | - Carina Lummer
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Mirella M. N. Minkman
- Vilans, National Centre of Expertise in Long Term Care, 3527 GV Utrecht, The Netherlands; (M.M.N.M.); (N.Z.)
- Tilburg University/TIAS School for Business and Society, 5037 AB Tilburg, The Netherlands
| | - Gabriele Müller
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Marlena van Munster
- Department of Neurology, University Hospital Marburg, 35043 Marburg, Germany;
| | - Hannes Schlieter
- Chair of Business Informatics, esp. Systems Development, Faculty of Business and Economics, Technical University of Dresden, 01062 Dresden, Germany; (C.G.); (H.S.)
| | - Peter Themann
- Department of Neurology, Klinik am Tharandter Wald Hetzdorf, Herzogswalder Straße 1, 09633 Halsbrücke, Germany;
| | - Nick Zonneveld
- Vilans, National Centre of Expertise in Long Term Care, 3527 GV Utrecht, The Netherlands; (M.M.N.M.); (N.Z.)
- Tilburg University/TIAS School for Business and Society, 5037 AB Tilburg, The Netherlands
| | - Martin Wolz
- Department of Neurology, Elblandklinikum Meißen, 01662 Meißen, Germany; (A.F.); (A.L.); (M.W.)
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31
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Building a Parkinson-Network-Experiences from Germany. J Clin Med 2020; 9:jcm9092743. [PMID: 32854328 PMCID: PMC7563415 DOI: 10.3390/jcm9092743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022] Open
Abstract
Parkinson’s disease is a complex neurodegenerative disease that can be best treated with a multi-disciplinary care approach. Building care networks has been shown as a useful tool to facilitate the integration of care services and improve outcomes for patients and care providers. However, experiences and practices relating to building a network are very limited in the field of Parkinson’s disease. This paper portrays existing Parkinson networks in Germany. With the help of a standardized template, description of networks and their building-blocks, so-called modules, were collected from all over Germany. Modules were rated in terms of their expected benefit and the required effort when implementing them, with the help of an expert survey. The rating showed that some modules were perceived as more important than others, but all modules were recognized as beneficial for patients and care providers. Overall, the German experience shows that building a Parkinson network facilitates the integration of care and provides a benefit to all stakeholders involved.
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32
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Schlosser J, Kollisch D, Johnson D, Perkins T, Olson A. VA-Community Dual Care: Veteran and Clinician Perspectives. J Community Health 2020; 45:795-802. [PMID: 32112237 PMCID: PMC7319870 DOI: 10.1007/s10900-020-00795-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Many veterans receive care in both community settings and the VA. Recent legislation has increased veteran access to community providers, raising concerns about safety and coordination. This project aimed to understand the benefits and challenges of dual care from the perceptions of both the Veterans their clinicians. We conducted surveys and focus groups of veterans who use both VA and community care in VT and NH. We also conducted a web-based survey and a focus group involving primary care clinicians from both settings. The main measures included (1) reasons that veterans seek care in both settings; (2) problems faced by veterans and clinicians; (3) association of health status and ease of managing care with sites of primary care; and (4) association of veteran rurality with dual care experiences. The primary reasons veterans reported for using both VA and community care were (1) for convenience, (2) to access needed services, and (3) to get a second opinion. Veterans reported that community and VA providers were informed about the others' care more than half the time. Veterans in isolated rural towns reported better overall health and ease of managing their care. VA and community primary care clinicians reported encountering systems problems with dual-care including communicating medication changes, sharing lab and imaging results, communicating with specialists, sharing discharge summaries and managing medication renewals. Both Veterans and their primary clinicians report substantial system issues in coordinating care between the VA and the community, raising the potential for significant patient safety and Veteran satisfaction concerns.
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Affiliation(s)
- James Schlosser
- VA New England Healthcare System, the Manchester VA Medical Center, Manchester, USA.
- , Concord, USA.
| | - Donald Kollisch
- VA New England Healthcare System, the White River Junction VA Medical Center, White River Junction, USA
- Geisel School of Medicine At Dartmouth, Hanover, USA
| | | | - Troi Perkins
- Nicholas School of the Environment, Duke University, Durham, USA
| | - Ardis Olson
- Geisel School of Medicine At Dartmouth, Hanover, USA
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33
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Misra V, Sedig K, Dixon DR, Sibbald SL. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e165-e170. [PMID: 32532734 PMCID: PMC7292506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Vaidehi Misra
- Analyste de données pour le London InterCommunity Health Centre en Ontario.
| | - Kimia Sedig
- Assistante de recherche à l'Hôpital général de North York en Ontario
| | - David R Dixon
- Membre du corps professoral de clinique à la Faculté de médecine et de chirurgie dentaire Schulich de l'Université Western à London
| | - Shannon L Sibbald
- Professeure adjointe à l'École des études de la santé de l'Université Western
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34
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Misra V, Sedig K, Dixon DR, Sibbald SL. Prioritizing coordination of primary health care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:399-403. [PMID: 32532718 PMCID: PMC7292521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Vaidehi Misra
- Data analyst for the London InterCommunity Health Centre in Ontario.
| | - Kimia Sedig
- Research assistant at the North York General Hospital in Ontario
| | - David R Dixon
- Member of the clinical faculty in the Schulich School of Medicine and Dentistry at Western University in London
| | - Shannon L Sibbald
- Assistant Professor in the School of Health Studies at Western University
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35
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Amsters D, Kendall M, Kuipers P. Rehabilitation for participation in life after spinal cord injury - clinician responses to a preliminary conceptual framework. Disabil Rehabil 2020; 43:2593-2601. [PMID: 32037903 DOI: 10.1080/09638288.2019.1706647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To explore face validity of a preliminary conceptual framework for rehabilitation (the HEAR Framework), which is grounded in the narratives of people with spinal cord injury. METHODS Using a quantitative online survey, experienced spinal cord injury rehabilitation practitioners were asked to compare the overall Framework, and its three components and nine elements, against usual practice. Participants rated the helpfulness and ease of implementation of each component. Perceived training needs, to support the implementation of the Framework were also explored. Respondents were given the opportunity to provide qualitative feedback about the Framework. RESULTS Thirty-four participants completed the survey. Median rating of congruence of the Framework with usual practice was 6 (out of 10). The Help component of the Framework was rated as more like usual practice than the Encourage and Accept components. Median rating of the potential helpfulness to practice, of all the elements of the Framework was 5 (out of 5). Participants rated the elements within the Help component of the Framework as easiest to implement. Teaching assertiveness, promoting flexible thinking and fostering responsive communication were the highest rated training topics related to implementation of the Framework. CONCLUSIONS Face validity testing suggests the preliminary HEAR Framework is promising as a basis for spinal cord injury rehabilitation theory. Broad-based testing is required to progress the promise of the Framework.IMPLICATIONS FOR REHABILITATIONSpinal cord injury rehabilitation lacks conceptual frameworks to guide practice.This validity study suggests moderate alignment between the preliminary HEAR Framework and usual practice (based on the perceptions of professionals in a spinal cord injury service).The Framework may be useful to individual rehabilitation practitioners as a basis for clinical reflection.The Framework may be useful as a practice development tool for teams of rehabilitation practitioners.
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Affiliation(s)
- Delena Amsters
- Spinal Outreach Team, Queensland Spinal Cord Injuries Service, Princess Alexandra Hospital, Brisbane, Australia.,The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Melissa Kendall
- Transitional Rehabilitation Program, Queensland Spinal Cord Injuries Service, Princess Alexandra Hospital, Brisbane, Australia.,The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Pim Kuipers
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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36
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Capturing the Role of Context in Complex System Change: An Application of the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to an Integrated Care Organisation in the UK. Int J Integr Care 2020; 20:4. [PMID: 32089656 PMCID: PMC7019199 DOI: 10.5334/ijic.5196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: If integrated care approaches are to be properly adapted to local contexts, a better understanding is required of key determinants of implementation and how these might be appropriately supported. Purpose: This study applied the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to investigate factors influencing the implementation and outcomes of a complex integrated care change programme in Torbay and South Devon (TSD) and, more specifically, in one of five sub-localities, Coastal. Methods: A case study method using embedded ‘Researchers in Residence’ to conduct action-based participatory research and deploying mixed qualitative methods. Results: The relative importance of some domains differ between the English and Canadian studies. In this case study, physical features (structural and geographic) were found to be very pertinent to the relative success of the Coastal Locality, as were empowered clinical leadership, with readiness for change being expressed through processes and cultures that were risk-enabling, strengths-based, person-/outcome-focused. Conclusions: The CCIC Framework provided a useful tool capturing key elements of complex system change with key domains being transferable across settings, while also finding local variation in the UK. This would encourage its wider application so that further comparisons can be made of the ways in which different contextual and implementation properties impact upon delivery and outcomes.
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37
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Cordasco KM, Hynes DM, Mattocks KM, Bastian LA, Bosworth HB, Atkins D. Improving Care Coordination for Veterans Within VA and Across Healthcare Systems. J Gen Intern Med 2019; 34:1-3. [PMID: 31098970 PMCID: PMC6542920 DOI: 10.1007/s11606-019-04999-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kristina M Cordasco
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA. .,Division of General Internal Medicine, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Department of Medicine, University of California Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, CA, USA.
| | - Denise M Hynes
- Center to Improve Veteran Involvement in Care, Portland VA Health Care System, Portland, OR, USA.,College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Kristin M Mattocks
- VA Central Western Massachusetts, Leeds, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities and Education Center, VA Connecticut, West Haven, CT, USA.,Division of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, USA.,Departments of Population Health Sciences, Medicine, Psychiatry, and School of Nursing, Duke University, Durham, NC, USA
| | - David Atkins
- VA Health Services Research and Development Services, Office of Research and Development, Washington, DC, USA
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38
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Cordasco KM, Frayne SM, Kansagara D, Zulman DM, Asch SM, Burke RE, Post EP, Fihn SD, Klobucar T, Meyer LJ, Kirsh SR, Atkins D. Coordinating Care Across VA Providers and Settings: Policy and Research Recommendations from VA's State of the Art Conference. J Gen Intern Med 2019; 34:11-17. [PMID: 31098966 PMCID: PMC6542870 DOI: 10.1007/s11606-019-04970-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Delivering well-coordinated care is essential for optimizing clinical outcomes, enhancing patient care experiences, minimizing costs, and increasing provider satisfaction. The Veterans Health Administration (VA) has built a strong foundation for internally coordinating care. However, VA faces mounting internal care coordination challenges due to growth in the number of Veterans using VA care, high complexity in Veterans' care needs, the breadth and depth of VA services, and increasing use of virtual care. VA's Health Services Research and Development service with the Office of Research and Development held a conference assessing the state-of-the-art (SOTA) on care coordination. One workgroup within the SOTA focused on coordination between VA providers for high-need Veterans, including (1) Veterans with multiple chronic conditions; (2) Veterans with high-intensity, focused, specialty care needs; (3) Veterans experiencing care transitions; (4) Veterans with severe mental illness; (5) and Veterans with homelessness and/or substance use disorders. We report on this workgroup's recommendations for policy and organizational initiatives and identify questions for further research. Recommendations from a separate workgroup on coordinating VA and non-VA care are contained in a companion paper. Leaders from research, clinical services, and VA policy will need to partner closely as they develop, implement, assess, and spread effective practices if VA is to fully realize its potential for delivering highly coordinated care to every Veteran.
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Affiliation(s)
- Kristina M Cordasco
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Department of Medicine, University of California Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, CA, USA.
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Women's Health Section, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Devan Kansagara
- VA Portland Healthcare System, Portland, OR, USA.,Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Donna M Zulman
- Women's Health Section, VA Palo Alto Health Care System, Palo Alto, CA, USA.,VA Portland Healthcare System, Portland, OR, USA
| | - Steven M Asch
- Women's Health Section, VA Palo Alto Health Care System, Palo Alto, CA, USA.,VA Portland Healthcare System, Portland, OR, USA
| | - Robert E Burke
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward P Post
- VA Center for Clinical Management Research, Ann Arbor, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephan D Fihn
- VA Office of Clinical System Development and Evaluation, Seattle, WA, USA.,VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services and Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Laurence J Meyer
- VA Office of Specialty Care Services, Washington, DC, USA.,VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Susan R Kirsh
- Office of Veterans Access to Care, Washington, DC, USA.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David Atkins
- VA Office of Research and Development, Health Services Research and Development, Washington, DC, USA
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39
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McDonald KM, Singer SJ, Gorin SS, Haggstrom DA, Hynes DM, Charns MP, Yano EM, Lucatorto MA, Zulman DM, Ong MK, Axon RN, Vogel D, Upton M. Incorporating Theory into Practice: Reconceptualizing Exemplary Care Coordination Initiatives from the US Veterans Health Delivery System. J Gen Intern Med 2019; 34:24-29. [PMID: 31098965 PMCID: PMC6542860 DOI: 10.1007/s11606-019-04969-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This perspective paper seeks to lay out an efficient approach for health care providers, researchers, and other stakeholders involved in interventions aimed at improving care coordination to partner in locating and using applicable care coordination theory. The objective is to learn from relevant theory-based literature about fit between intervention options and coordination needs, thereby bringing insights from theory to enhance intervention design, implementation, and troubleshooting. To take this idea from an abstract notion to tangible application, our workgroup on models and measures from the Veterans Health Administration (VA) State of the Art (SOTA) conference on care coordination first summarizes our distillation of care coordination theoretical frameworks (models) into three common conceptual domains-context of an intervention, locus in which an intervention is applied, and specific design features of the intervention. Then we apply these three conceptual domains to four cases of care coordination interventions ("use cases") chosen to represent various scopes and stages of interventions to improve care coordination for veterans. Taken together, these examples make theory more accessible and practical by demonstrating how it can be applied to specific cases. Drawing from theory offers one method to anticipate which intervention options match a particular coordination situation.
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Affiliation(s)
- Kathryn M McDonald
- Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.
| | - Sara J Singer
- Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Stanford University Graduate School of Business, Stanford, CA, USA
| | - Sherri Sheinfeld Gorin
- New York Physicians against Cancer (NYPAC), New York, NY, USA
- The University of Michigan Medical School, Ann Arbor, MI, USA
| | - David A Haggstrom
- Indianapolis VA Medical Center, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Denise M Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Martin P Charns
- VA HSR&D Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | | | - Donna M Zulman
- Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- VA Palo Alto, Palo Alto, CA, USA
| | - Michael K Ong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Neal Axon
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
| | - Donna Vogel
- VA Office of Nursing Services, Washington, DC, USA
| | - Mark Upton
- VHA Office of Community Care, Denver, CO, USA
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