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Ljungholm L, Edin-Liljegren A, Ekstedt M, Klinga C. What is needed for continuity of care and how can we achieve it? - Perceptions among multiprofessionals on the chronic care trajectory. BMC Health Serv Res 2022; 22:686. [PMID: 35606787 PMCID: PMC9125858 DOI: 10.1186/s12913-022-08023-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background Continuity of care (CoC) implies delivery of services in a coherent, logical and timely fashion. Continuity is conceptualized as multidimensional, encompassing three specific domains – relational, management and informational continuity – with emphasis placed on their interrelations, i.e., how they affect and are affected by each other. This study sought to investigate professionals’ perceptions of the prerequisites of CoC within and between organizations and how CoC can be realized for people with complex care needs. Methods This study had a qualitative design using individual, paired and focus group interviews with a purposeful sample of professionals involved in the chain of care for patients with chronic conditions across healthcare and social care services from three different geographical areas in Sweden, covering both urban and rural areas. Transcripts from interviews with 34 informants were analysed using conventional content analysis. Results CoC was found to be dependent on professional and cross-disciplinary cooperation at the micro, meso and macro system levels. Continuity is dependent on long-term and person-centred relationships (micro level), dynamic stability in organizational structures (meso level) and joint responsibility for cohesive care and enabling of uniform solutions for knowledge and information exchange (macro level). Conclusions Achieving CoC that creates coherent and long-term person-centred care requires knowledge- and information-sharing that transcends disciplinary and organizational boundaries. Collaborative accountability is needed both horizontally and vertically across micro, meso and macro system levels, rather than a focus on personal responsibility and relationships at the micro level. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08023-0.
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Affiliation(s)
- Linda Ljungholm
- Department of Health and Caring Sciences, Linnaeus University, Pedalstråket 13, S-39182, Kalmar, Sweden.
| | - Anette Edin-Liljegren
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,The Centre for Rural Medicine, Research and Development Unit, Region Västerbotten, Storuman, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Pedalstråket 13, S-39182, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Klinga
- Department of Health and Caring Sciences, Linnaeus University, Pedalstråket 13, S-39182, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Research and Development Unit for Elderly Persons (FOU Nu) Region Stockholm, Stockholm, Sweden
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Abstract
Ethical issues related to electronic health records (EHRs) confront health personnel. Electronic health records create conflict among several ethical principals. Electronic health records may represent beneficence because they are alleged to increase access to health care, improve the quality of care and health, and decrease costs. Research, however, has not consistently demonstrated access for disadvantaged persons, the accuracy of EHRs, their positive effects on productivity, nor decreased costs. Should beneficence be universally acknowledged, conflicts exist with other ethical principles. Autonomy is jeopardized when patients' health data are shared or linked without the patients' knowledge. Fidelity is breached by the exposure of thousands of patients' health data through mistakes or theft. Lack of confidence in the security of health data may induce patients to conceal sensitive information. As a consequence, their treatment may be compromised. Justice is breached when persons, because of their socioeconomic class or age, do not have equal access to health information resources and public health services. Health personnel, leaders, and policy makers should discuss the ethical implications of EHRs before the occurrence of conflicts among the ethical principles. Recommendations to guide health personnel, leaders, and policy makers are provided.
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Graham JE, Prvu Bettger J, Middleton A, Spratt H, Sharma G, Ottenbacher KJ. Effects of Acute-Postacute Continuity on Community Discharge and 30-Day Rehospitalization Following Inpatient Rehabilitation. Health Serv Res 2017; 52:1631-1646. [PMID: 28580725 PMCID: PMC5583304 DOI: 10.1111/1475-6773.12678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine the effects of facility-level acute-postacute continuity on probability of community discharge and 30-day rehospitalization following inpatient rehabilitation. DATA SOURCES We used national Medicare enrollment, claims, and assessment data to study 541,097 patients discharged from 1,156 inpatient rehabilitation facilities (IRFs) in 2010-2011. STUDY DESIGN We calculated facility-level continuity as the percentages of an IRF's patients admitted from each contributing acute care hospital. Patients were categorized into three groups: low continuity (<26 percent from same hospital that discharged the patient), medium continuity (26-75 percent from same hospital), or high continuity (>75 percent from same hospital). The multivariable models included an interaction term to examine the potential moderating effects of facility type (freestanding facility vs. hospital-based rehabilitation unit) on the relationships between facility-level continuity and our two outcomes: community discharge and 30-day rehospitalization. PRINCIPAL FINDINGS Medicare beneficiaries in hospital-based rehabilitation units were more likely to be referred from a high-contributing hospital compared to those in freestanding facilities. However, the association between higher acute-postacute continuity and desirable outcomes is significantly better in freestanding rehabilitation facilities than in hospital-based units. CONCLUSIONS Improving continuity is a key premise of health care reform. We found that both observed referral patterns and continuity-related benefits differed markedly by facility type. These findings provide a starting point for health systems establishing or strengthening acute-postacute relationships to improve patient outcomes in this new era of shared accountability and public quality reporting programs.
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Affiliation(s)
- James E. Graham
- Division of Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonTX
| | | | - Addie Middleton
- Division of Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonTX
| | - Heidi Spratt
- Office of BiostatisticsDepartment of Preventive Medicine & Community HealthUniversity of Texas Medical BranchGalvestonTX
| | - Gulshan Sharma
- Division of Pulmonary Critical Care and Sleep MedicineUniversity of Texas Medical BranchGalvestonTX
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Slomic M, Soberg HL, Sveen U, Christiansen B. Transitions of patients with traumatic brain injury and multiple trauma between specialized and municipal rehabilitation services—Professionals’ perspectives. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1320849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Mirela Slomic
- Faculty of Health Sciences, Oslo and Akershus University College, Postboks 4 St. Olavs plass, Oslo, Norway
| | - Helene L. Soberg
- Faculty of Health Sciences, Oslo and Akershus University College, Postboks 4 St. Olavs plass, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Unni Sveen
- Faculty of Health Sciences, Oslo and Akershus University College, Postboks 4 St. Olavs plass, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Bjørg Christiansen
- Faculty of Health Sciences, Oslo and Akershus University College, Postboks 4 St. Olavs plass, Oslo, Norway
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La Rocca A, Hoholm T. Coordination between primary and secondary care: the role of electronic messages and economic incentives. BMC Health Serv Res 2017; 17:149. [PMID: 28212653 PMCID: PMC5316199 DOI: 10.1186/s12913-017-2096-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 02/11/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In Norway, a government reform has recently been introduced to enhance coordination between primary and secondary care. This paper examines the effects of two newly introduced measures to improve the coordination: an ICT-based communication tool/standard and an economic incentive scheme. METHOD This qualitative study is based primarily on 27 open-ended interviews. We interviewed nine employees at a hospital (the focal actor), 17 employees from seven different municipalities, and a representative of a Regional Health Authority. RESULTS ICT-based communication is perceived to facilitate information exchange between primary and secondary care, thus positively affecting coordination. However, the economic incentive scheme appears to have the opposite effect by creating tensions between the two organizations and accentuating power asymmetry in favor of secondary care. CONCLUSIONS The inter-organizational nature of coordination in health care makes it crucial for policymakers and management of care organizations to conceive incentives and instruments that work jointly across organizations rather than at only one of the health care organizations involved. Such an approach is likely to favor a more symmetrical pattern of collaboration between primary and secondary care.
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Affiliation(s)
- Antonella La Rocca
- Akershus University Hospital, Sykehusveien 25, Lørenskog, 1478 Norway
- Department of Innovation and Economic Organization, BI Norwegian Business School, Nydalsveien 37, Oslo, 0484 Norway
| | - Thomas Hoholm
- Akershus University Hospital, Sykehusveien 25, Lørenskog, 1478 Norway
- Department of Innovation and Economic Organization, BI Norwegian Business School, Nydalsveien 37, Oslo, 0484 Norway
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Rustad EC, Cronfalk BS, Furnes B, Dysvik E. Continuity of Care during Care Transition: Nurses’ Experiences and Challenges. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojn.2017.72023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gjevjon ER, Romøren TI, Bragstad LK, Hellesø R. Older Patients’ and Next of Kin’s Perspectives on Continuity in Long-Term Home Health Care. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/1084822315626001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study explored how 125 older patients and 92 next of kin experienced and assessed continuity in long-term home health care. Data were collected by means of structured interviews. A majority of the patients indicated that having a high number of health care personnel involved in their care was not problematic. For patients, informed and skilled health personnel along with knowing the visiting personnel may compensate for a high number of personnel. For next of kin, accepting a high number of personnel was related to the carers being informed about the patient’s situation. This study indicates that, in terms of patient satisfaction, the overall quality of care is more important than the number of people providing the care.
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Laitinen H, Kaunonen M, Åstedt-Kurki P. The impact of using electronic patient records on practices of reading and writing. Health Informatics J 2015; 20:235-49. [PMID: 25411220 DOI: 10.1177/1460458213492445] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the use of electronic patient records in daily practice. In four wards of a large hospital district in Finland, N = 43 patients' care and activities were observed and analysed in terms of the Grounded Theory method. The findings revealed that using electronic patient records created a particular process of writing and reading. Wireless technology enabled simultaneous patient involvement and point-of-care documentation, additionally supporting real-time reading. Remote and retrospective documentation was distant in terms of both space and time. The remoteness caused double documentation, reduced accuracy and less-efficient use of time. 'Non-reading' practices were witnessed in retrospective reading, causing delays in patient care and increase in workload. Similarly, if documentation was insufficient or non-existent, the consequences were found to be detrimental to the patients. The use of an electronic patient record system has a significant impact on patient care. Therefore, it is crucial to develop wireless technology and interdisciplinary collaboration in order to improve and support high-quality patient care.
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Affiliation(s)
- Heleena Laitinen
- School of Health Sciences, Nursing Science, University of Tampere, FinlandDepartment of Musculoskeletal Diseases, Tampere University Hospital, Finland Science Centre, Pirkanmaa Hospital District, FinlandTampere University of Applied Sciences, Finland
| | - Marja Kaunonen
- School of Health Sciences, Nursing Science, University of Tampere, Finland Science Centre, Pirkanmaa Hospital District, Finland
| | - Paivi Åstedt-Kurki
- School of Health Sciences, Nursing Science, University of Tampere, Finland Science Centre, Pirkanmaa Hospital District, Finland
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Steele Gray C, Miller D, Kuluski K, Cott C. Tying eHealth Tools to Patient Needs: Exploring the Use of eHealth for Community-Dwelling Patients With Complex Chronic Disease and Disability. JMIR Res Protoc 2014; 3:e67. [PMID: 25428028 PMCID: PMC4260075 DOI: 10.2196/resprot.3500] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/30/2014] [Accepted: 10/19/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health policy makers have recently shifted attention towards examining high users of health care, in particular patients with complex chronic disease and disability (CCDD) characterized as having multimorbidities and care needs that require ongoing use of services. The adoption of eHealth technologies may be a key strategy in supporting and providing care for these patients; however, these technologies need to address the specific needs of patients with CCDD. This paper describes the first phase of a multiphased patient-centered research project aimed at developing eHealth technology for patients with CCDD. OBJECTIVE As part of the development of new eHealth technologies to support patients with CCDD in primary care settings, we sought to determine the perceived needs of these patients with respect to (1) the kinds of health and health service issues that are important to them, (2) the information that should be collected and how it could be collected in order to help meet their needs, and (3) their views on the challenges/barriers to using eHealth mobile apps to collect the information. METHODS Focus groups were conducted with community-dwelling patients with CCDD and caregivers. An interpretive description research design was used to identify the perceived needs of participants and the information sharing and eHealth technologies that could support those needs. Analysis was conducted concurrently with data collection. Coding of transcripts from four focus groups was conducted by 3 authors. QSR NVivo 10 software was used to manage coding. RESULTS There were 14 total participants in the focus groups. The average age of participants was 64.4 years; 9 participants were female, and 11 were born in Canada. Participants identified a need for open two-way communication and dialogue between themselves and their providers, and better information sharing between providers in order to support continuity and coordination of care. Access issues were mainly around wait times for appointments, challenges with transportation, and costs. A visual depiction of these perceived needs and their relation to each other is included as part of the discussion, which will be used to guide development of our eHealth technologies. Participants recognized the potential for eHealth technologies to support and improve their care but also expressed common concerns regarding their adoption. Specifically, they mentioned privacy and data security, accessibility, the loss of necessary visits, increased social isolation, provider burden, downloading responsibility onto patients for care management, entry errors, training requirements, and potentially confusing interfaces. CONCLUSIONS From the perspective of our participants, there is a significant potential for eHealth tools to support patients with CCDD in community and primary care settings, but we need to be wary of the potential downfalls of adopting eHealth technologies and pay special attention to patient-identified needs and concerns. eHealth tools that support ongoing patient-provider interaction, patient self-management (such as telemonitoring), and provider-provider interactions (through electronic health record integration) could be of most benefit to patients similar to those in our study.
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Affiliation(s)
- Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Toronto, ON, Canada.
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Mostert-Phipps N, Pottas D, Korpela M. Improving continuity of care through the use of electronic records: a South African perspective. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2012.10874244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- N Mostert-Phipps
- Institute for ICT Advancement, School of ICT, Faculty of Engineering, The Built Environment, and Information Technology Nelson Mandela Metropolitan University
| | - D Pottas
- Institute for ICT Advancement, School of ICT, Faculty of Engineering, The Built Environment, and Information Technology Nelson Mandela Metropolitan University
| | - M Korpela
- Institute for ICT Advancement, School of ICT, Faculty of Engineering, The Built Environment, and Information Technology Nelson Mandela Metropolitan University
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Allen D, Rixson L. How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? INT J EVID-BASED HEA 2012; 6:78-110. [PMID: 21631815 DOI: 10.1111/j.1744-1609.2007.00098.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED EXECUTIVE SUMMARY: BACKGROUND Across the developed world, we are witnessing an increasing emphasis on the need for more closely coordinated forms of health and social care provision. Integrated care pathways (ICPs) have emerged as a response to this aspiration and are believed by many to address the factors which contribute to service integration. ICPs map out a patient's journey, providing coordination of services for users. They aim to have: 'the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome'. The value for ICPs in supporting the delivery of care across organisational boundaries, providing greater consistency in practice, improving service continuity and increasing collaboration has been advocated by many. However, there is little evidence to support their use, and the need for systematic evaluations in order to measure their effectiveness has been widely identified. A recent Cochrane review assessed the effects of ICPs on functional outcome, process of care, quality of life and hospitalisation costs of inpatients with acute stroke, but did not specifically focus on service integration or its derivatives. To the best of our knowledge, no such systematic review of the literature exists. OBJECTIVES • To systematically review all high-quality studies which have evaluated the impact of care pathway technologies on 'service integration' and its derivatives in stroke care • To examine how elements of service integration are defined in such studies • To examine the type of evidence utilised to measure service integration • To analyse the weight of evidence used to support claims about the effectiveness of ICPs on improving service integration • To produce recommendations for ICP developers, users and evaluators. INCLUSION CRITERIA Types of participants The review focused on the care of adult patients who had suffered a stroke. It included the full spectrum of services - acute care, rehabilitation and long-term support - in hospital and community settings. Types of intervention(s)/phenomena of interest Integrated care pathways were the intervention of interest, defined for the purpose of this review as 'a multidisciplinary tool to improve the quality and efficiency of evidence based care and is used as a communication tool between professionals to manage and standardise the outcome orientated care' Here 'multidisciplinary' is taken to refer to the involvement of two or more disciplines. Types of outcomes 'Service integration' was the outcome of interest however, this was defined and measured in the selected studies. Types of studies This review was concerned with how 'service integration' was defined in evaluations of ICPs; the type of evidence utilised in measuring the impact of the intervention and the weight of evidence to support the effectiveness of care pathway technologies on 'service integration'. Studies that made an explicit link between ICPs and service integration were included in the review. Evidence generated from randomised controlled trials, quasi-experimental, qualitative and health economics research was sought. The search was limited to publications after 1980, coinciding with the emergence of ICPs in the healthcare context. Assessment for inclusion of foreign papers was based on the English-language abstract, where available. These were included only if an English translation was available. EXCLUSION CRITERIA This review excluded studies that: • focused only on a single aspect of stroke care (e.g. dysphasia) • evaluated ICPs as part of a wider program of service development • did not make an explicit link between ICPs and service integration • did not meet the definition of ICP utilised for the purposes of the review • focused exclusively on the outcomes of variance analysis SEARCH STRATEGY In order to avoid replication, the Joanna Briggs Institute for Evidence Based Nursing and Midwifery Database and the Cochrane Library were searched to establish that no systematic reviews existed and none were in progress. A three-stage search strategy was then used to identify both published and unpublished studies (see Appendix III). DATA COLLECTION Our search strategy located 2123 papers, of which 39 were retrieved for further evaluation. We critically appraised seven papers, representing five studies. These were all evaluation studies and, as is typical in this field, comprised a range of study designs and data collection methods. Owing to the diversity of the study types included in the review, we developed a single-appraisal checklist and data-extraction tool which could be applied to all research designs.(32) The tool drew on the Joanna Briggs Institute (JBI) appraisal checklists for experimental studies and interpretive and critical research, and also incorporated specific information and issues which were relevant for our purposes (see Appendix VI). This extends the thinking outlined in Lyne et al.(31) in which, drawing on Campbell and Stanley's classic paper, the case is made for developing an appraisal tool which is applicable to all types of evaluation, irrespective of study design. In assessing the quality of the papers, we were sympathetic to the methodological challenges of evaluating complex interventions such as ICPs. We were also cognisant of the very real constraints in which service evaluations are frequently undertaken in healthcare contexts. In accordance with the aims of this particular review, we have included studies, which are methodologically weaker than is typical of many systematic reviews because, in our view, in the absence of stronger evidence, they yield useful information. DATA SYNTHESIS Given the heterogeneity of the included studies, meta-analysis and/or qualitative synthesis was not possible. A narrative summary of the study findings is presented. RESULTS 1 ICPs can be effective in ensuring that patients receive relevant clinical interventions and/or assessments in a timely manner, although these improvements may reflect better documentation rather than actual changes in practice. 2 ICPs can be effective in improving the documentation of rehabilitation goals, documentation of communication with patients, carers (diagnosis, prognosis and follow-up arrangements) and documentation of notification of primary care physicians of discharge. However, this can create additional burdens of work for staff. 3 Early studies of ICP-managed care in the acute stroke context have demonstrated reduced length of stay without any associated adverse effects on discharge destination, morbidity or mortality. These effects do not reach statistical significance, however, and may reflect wider changes in service provision and a general trend towards reduced length of hospital stay. While later studies in the acute and rehabilitation contexts do not reveal any significant reduction in length of stay, they do report greater documented use of certain clinical interventions and assessments, suggesting that ICPs can be effective in mobilising hospital resources around the patient. 4 ICPs implemented in the context of acute stroke care can be effective in reducing the occurrence of urinary tract infections, although we do not know whether this can be attributed to improved service integration. 5 ICP management in stroke rehabilitation may not be flexible enough to meet diverse patient needs and can result in insufficient attention to higher-level functioning and carer needs influencing perceptions of quality of life. 6 ICP management may assist in clarifying role boundaries and a shared understanding of the work, but this can result in some members of the disciplinary team perceiving that their contribution is not appropriately reflected in the documentation. 7 There is some evidence that ICPs may be effective in changing professional behaviours in the desired direction where there is scope for improvement, but in situations in which multidisciplinary working is effective, their positive effects may be limited. Furthermore, it is far from clear what the active ingredients of ICPs actually are. Kwan et al. suggest that it was the process of ICP development that had most impact on behaviours rather than the use of the artefact per se.(20) 8 None of the studies assessed the balance of costs and benefits of ICP use. Therefore, we do not know whether the costs of ICP development and implementation are justified by any of the reported benefits. CONCLUSIONS Implications for practice There is some evidence that ICPs may support certain elements of service integration in the context of stroke care. This seems to be as a result of their ability to support the timely implementation of clinical interventions and the mobilisation of resources around the patient without incurring additional increases in length of stay. ICPs appear to be most successful in improving service coordination in the acute stroke context where patient care trajectories are predictable. Their value in the context of rehabilitation settings in which recovery pathways are more variable is less clear. There is some evidence that ICPs may be effective in bringing about behavioural changes in contexts where deficiencies in service provision have been identified. Their value in contexts where inter-professional working is well established is less clear. While earlier before and after studies show a reduction in length of stay in ICP-managed care, this may reflect wider healthcare trends, and the failure of later studies to demonstrate further reductions suggests that there may be limits as to how far this can continue to be reduced. There is some evidence to suggest that ICPs bring about improvements in documentation, but we do not know how far documented practice reflects actual practice. It is unclear how ICPs have their effects and the relative importance of the process of development and the artefact in use. (ABSTRACT TRUNCATED)
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Affiliation(s)
- Davina Allen
- Wales Centre for Evidence Based Care: A Collaborating Centre of the Joanna Briggs Institute, Nursing, Health and Social Care Research Centre, Cardiff School of Nursing and Midwifery Studies, Cardiff University, Cardiff, UK
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GJEVJON EDITHR, ROMØREN TORI, KJØS BENTEØ, HELLESØ RAGNHILD. Continuity of care in home health-care practice: two management paradoxes. J Nurs Manag 2012; 21:182-90. [DOI: 10.1111/j.1365-2834.2012.01366.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE We conducted a review of the literature to determine the impact of health information technologies (HITs) on nurses and nursing care. BACKGROUND Nurses' effective use of HIT has the potential to produce a positive impact on nursing-sensitive patient outcomes, patient safety, and quality of care. METHODS A review of the literature produced 564 unique references of which 74 were selected for review. RESULTS Findings suggest that (1) HIT improves the quality of nursing documentation; (2) HIT reduces medication administration errors; (3) nurses are generally satisfied with HIT and have positive attitudes about it; and (4) nurse involvement in all stages of HIT design and implementation, and effective leadership throughout these processes, can improve HIT. CONCLUSION HIT has had positive influences on nurse satisfaction and patient care. Effective nursing leadership can positively influence the effective development, dissemination, and use of HIT.
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Electronic exchange of discharge summaries between hospital and municipal care from health personnel's perspectives. Int J Integr Care 2010; 10:e039. [PMID: 20421964 PMCID: PMC2859705 DOI: 10.5334/ijic.527] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 03/01/2010] [Accepted: 03/11/2010] [Indexed: 11/30/2022] Open
Abstract
Introduction Information and communication technologies (ICT) are seen as potentially powerful tools that may promote integration of care across organisational boundaries. Here, we present findings from a study of a Norwegian project where an electronic interdisciplinary discharge summary was implemented to improve communication and information exchange between the municipal care service and the associated hospital. Objective To investigate the implications of introduction and use of the electronic discharge summary for health staff, and relate it to the potential for promoting integration of care across the hospital-municipality boundary. Methods We conducted semi-structured interviews with 49 health care providers. The material was analysed using a three-step process to identify the main themes and categories. Findings The study showed that the electronic discharge summary contributed to changes in health staff's work processes as well as increased legibility of summaries, and enabled municipal care staff to be better prepared for receiving patients, even though the information content mostly remained unaltered and was not always accurate. Conclusion Introduction of electronic discharge summaries did not result in a significant increase in integration of care. However, the project was a catalyst for the collaborating participants to address their interaction from new perspectives.
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Syed-Mohamad SM, Ali SH, Mat-Husin MN. Professional Practice and Innovation: The Development and Design of an Electronic Patient Record Using Open Source Web-Based Technology. Health Inf Manag 2010; 39:30-35. [PMID: 28683624 DOI: 10.1177/183335831003900105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper describes the method used to develop the One Stop Crisis Centre (OSCC) Portal, an open-source web-based electronic patient record system (EPR) for the One Stop Crisis Center, Hospital Universiti Sains Malaysia (HUSM) in Kelantan, Malaysia. Features and functionalities of the system are presented to demonstrate the workflow. Use of the OSCC Portal improved data integration and data communication and contributed to improvements in care management. With implementation of the OSCC portal, improved coordination between disciplines and standardisation of data in HUSM were noticed. It is expected that this will in turn result in improved data confidentiality and data integrity. The collected data will also be useful for quality assessment and research. Other low-resource centers with limited computer hardware and access to open-source software could benefit from this endeavour.
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Affiliation(s)
| | - Siti Hawa Ali
- Siti Hawa Ali MA BA(SocSc), CQSW, Coordinator of OSCC HUSM, The School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, MALAYSIA
| | - Mohd Nazri Mat-Husin
- Mohd Nazri Mat-Husin BSc(IT), IT Officer, The School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan MALAYSIA
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Cultural diversity between hospital and community nurses: implications for continuity of care. Int J Integr Care 2010; 10:e036. [PMID: 20422021 PMCID: PMC2858515 DOI: 10.5334/ijic.508] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 12/15/2009] [Accepted: 01/19/2010] [Indexed: 11/29/2022] Open
Abstract
Introduction Health care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains. Challenges In this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’. Discussion We propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.
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Bowles KH, Pham J, O'Connor M, Horowitz DA. Information Deficits in Home Care: A Barrier to Evidence-Based Disease Management. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2009. [DOI: 10.1177/1084822309353145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A disease management study conducted in home care with 303 patients with diabetes, heart failure, or both revealed information deficits that make disease and quality management difficult. Nurses used a guideline checklist to indicate the amount and type of information available to them on admission and by the end of the episode of care. Nurses reported having data on 7% to 94% of the data elements. Whether a lipid profile had been done, the HbA1C (glycosolated hemoglobin test, also called a hemoglobin A1C) levels, or ejection fractions were known for 7%, 17%, and 18%, respectively. When nurses reported information related to ACE-I use (N = 183), they reported that 76% of patients were on ACE-I (angiotensin-converting enzyme inhibitor) or acceptable alternative for heart failure. But no information was reported on ACE-I use for 12% of the patients (N = 24). Potential solutions to these deficits in information and quality include increased use of guidelines in home care, guideline checklists, information transfer forms, nurse activism to request information, and the adoption of the electronic health record.
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Affiliation(s)
- Kathryn H. Bowles
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA,
| | - Julie Pham
- Stanford Hospital & Clinics, Stanford, CA, USA
| | - Melissa O'Connor
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Ellitt GR, Brien JAE, Asiani P, Chen TF. Quality Patient Care and Pharmacists' Role in Its Continuity—A Systematic Review. Ann Pharmacother 2009; 43:677-91. [PMID: 19336645 DOI: 10.1345/aph.1l505] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background:Continuity of care is important for the delivery of quality health care. Despite the abundance of research on this concept in the medical and nursing literature, there is a lack of consensus on its definition. As pharmacists have moved beyond their historical product-centered practice, a source of patient-centered research on continuity of care for practice application is required.Objective:To determine the scope of research in which pharmacists were directly involved in patients' continuity of care and to examine how the phrase continuity of care was defined and applied in practice.Methods:A working definition of continuity of care and a tool for relevance quality assessment of search articles were developed. MEDLINE, International Pharmaceutical Abstracts, EMBASE, and the Cochrane Collaboration evidence-based medicine reviews and bibliographies were searched (1996–March 2008). Reporting clarity was assessed by the Consolidated Standards of Reporting Trials checklist and outcomes were grouped by economic, clinical, and/or humanistic classification.Results:The search yielded 21 clinical and randomized controlled trials, including 11 pharmacist-only and 10 multidisciplinary studies. A broad range of research topics was identified and detailed analysis provided ready reference for considerations of research replication or practice application. Studies revealed a range of research aims, settings, subject characteristics, attrition rates and group sizes, interventions, measurement tools, outcomes, and definitions of continuity of care. Research focused on patients with depression (n = 4), cardiovascular disease {n = 4), diabetes (n = 2), and dyslipidemia (n = 1); specific drugs included non–tricyclic antidepressants, cardiovascular drugs, and benzodiazepines. From the proposed endpoints of economic cost (n = 6) and clinical (n = 14) and humanistic (n = 16) outcomes, 15 studies reported statistically significant results.Conclusions:Medication management at primary, secondary, and tertiary levels of care indicated an expanded role and collaboration of pharmacists in continuity of care. However, the exclusion of disadvantaged patients in 19 studies is at odds with continuity of care for these patients, who may have been the most in need for the same reason that they were excluded.
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Affiliation(s)
- Glena R Ellitt
- MSafetySc, Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Jo-anne E Brien
- Clinical Pharmacy and ProDean, Faculty of Pharmacy, The University of Sydney; Conjoint Professor, Faculty of Medicine, University of New South Wales, Sydney
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Timpka T, Olvander C, Hallberg N. Information system needs in health promotion: a case study of the Safe Community programme using requirements engineering methods. Health Informatics J 2008; 14:183-93. [PMID: 18775825 DOI: 10.1177/1081180x08092829] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The international Safe Community programme was used as the setting for a case study to explore the need for information system support in health promotion programmes. The 14 Safe Communities active in Sweden during 2002 were invited to participate and 13 accepted. A questionnaire on computer usage and a critical incident technique instrument were distributed. Sharing of management information, creating social capital for safety promotion, and injury data recording were found to be key areas that need to be further supported by computer-based information systems. Most respondents reported having access to a personal computer workstation with standard office software. Interest in using more advanced computer applications was low, and there was considerable need for technical user support. Areas where information systems can be used to make health promotion practice more efficient were identified, and patterns of computers usage were described.
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Affiliation(s)
- Toomas Timpka
- Division of Social Medicine and Public Health, Department of Medical and Health Sciences, Faculty of Health Sciences Linköping University S-581 85 Linköping, Sweden.
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Abstract
Ethical issues related to electronic health records (EHRs) confront health personnel. Electronic health records create conflict among several ethical principals. Electronic health records may represent beneficence because they are alleged to increase access to health care, improve the quality of care and health, and decrease costs. Research, however, has not consistently demonstrated access for disadvantaged persons, the accuracy of EHRs, their positive effects on productivity, nor decreased costs. Should beneficence be universally acknowledged, conflicts exist with other ethical principles. Autonomy is jeopardized when patients' health data are shared or linked without the patients' knowledge. Fidelity is breached by the exposure of thousands of patients' health data through mistakes or theft. Lack of confidence in the security of health data may induce patients to conceal sensitive information. As a consequence, their treatment may be compromised. Justice is breached when persons, because of their socioeconomic class or age, do not have equal access to health information resources and public health services. Health personnel, leaders, and policy makers should discuss the ethical implications of EHRs before the occurrence of conflicts among the ethical principles. Recommendations to guide health personnel, leaders, and policy makers are provided.
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How has the impact of ‘care pathway technologies’ on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? INT J EVID-BASED HEA 2008. [DOI: 10.1097/01258363-200803000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Allen D, Rixson L. How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? ACTA ACUST UNITED AC 2008; 6:583-632. [PMID: 27819972 DOI: 10.11124/01938924-200806150-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Across the developed world, we are witnessing an increasing emphasis on the need for more closely coordinated forms of health and social care provision. Integrated care pathways (ICPs) have emerged as a response to this aspiration and are believed by many to address the factors which contribute to service integration. ICPs map out a patient's journey, providing coordination of services for users. They aim to have: 'the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome'. The value for ICPs in supporting the delivery of care across organisational boundaries, providing greater consistency in practice, improving service continuity and increasing collaboration has been advocated by many. However, there is little evidence to support their use, and the need for systematic evaluations in order to measure their effectiveness has been widely identified. A recent Cochrane review assessed the effects of ICPs on functional outcome, process of care, quality of life and hospitalisation costs of inpatients with acute stroke, but did not specifically focus on service integration or its derivatives. To the best of our knowledge, no such systematic review of the literature exists. OBJECTIVES INCLUSION CRITERIA: Types of participants The review focused on the care of adult patients who had suffered a stroke. It included the full spectrum of services - acute care, rehabilitation and long-term support - in hospital and community settings.Types of intervention(s)/phenomena of interest Integrated care pathways were the intervention of interest, defined for the purpose of this review as 'a multidisciplinary tool to improve the quality and efficiency of evidence based care and is used as a communication tool between professionals to manage and standardise the outcome orientated care'. Here 'multidisciplinary' is taken to refer to the involvement of two or more disciplines.Types of outcomes Service integration' was the outcome of interest however, this was defined and measured in the selected studies.Types of studies This review was concerned with how 'service integration' was defined in evaluations of ICPs; the type of evidence utilised in measuring the impact of the intervention and the weight of evidence to support the effectiveness of care pathway technologies on 'service integration'. Studies that made an explicit link between ICPs and service integration were included in the review. Evidence generated from randomised controlled trials, quasi-experimental, qualitative and health economics research was sought. The search was limited to publications after 1980, coinciding with the emergence of ICPs in the healthcare context. Assessment for inclusion of foreign papers was based on the English-language abstract, where available. These were included only if an English translation was available. EXCLUSION CRITERIA This review excluded studies that: SEARCH STRATEGY: In order to avoid replication, the Joanna Briggs Institute for Evidence Based Nursing and Midwifery Database and the Cochrane Library were searched to establish that no systematic reviews existed and none were in progress. A three-stage search strategy was then used to identify both published and unpublished studies (see ). DATA COLLECTION Our search strategy located 2123 papers, of which 39 were retrieved for further evaluation. We critically appraised seven papers, representing five studies. These were all evaluation studies and, as is typical in this field, comprised a range of study designs and data collection methods. Owing to the diversity of the study types included in the review, we developed a single-appraisal checklist and data-extractiontool which could be applied to all research designs. The tool drew on the Joanna Briggs Institute (JBI) appraisal checklists for experimental studies and interpretive and critical research, and also incorporated specific information and issues which were relevant for our purposes (see ). This extends the thinking outlined in Lyne et al. in which, drawing on Campbell and Stanley's classic paper, the case is made for developing an appraisal tool which is applicable to all types of evaluation, irrespective of study design.In assessing the quality of the papers, we were sympathetic to the methodological challenges of evaluating complex interventions such as ICPs. We were also cognisant of the very real constraints in which service evaluations are frequently undertaken in healthcare contexts. In accordance with the aims of this particular review, we have included studies, which are methodologically weaker than is typical of many systematic reviews because, in our view, in the absence of stronger evidence, they yield useful information. DATA SYNTHESIS Given the heterogeneity of the included studies, meta-analysis and/or qualitative synthesis was not possible. A narrative summary of the study findings is presented. RESULTS Therefore, we do not know whether the costs of ICP development and implementation are justified by any of the reported benefits. CONCLUSIONS Implications for practice There is some evidence that ICPs may support certain elements of service integration in the context of stroke care. This seems to be as a result of their ability to support the timely implementation of clinical interventions and the mobilisation of resources around the patient without incurring additional increases in length of stay. ICPs appear to be most successful in improving service coordination in the acute stroke context where patient care trajectories are predictable. Their value in the context of rehabilitation settings in which recovery pathways are more variable is less clear. There is some evidence that ICPs may be effective in bringing about behavioural changes in contexts where deficiencies in service provision have been identified. Their value in contexts where inter-professional working is well established is less clear. While earlier before and after studies show a reduction in length of stay in ICP-managed care, this may reflect wider healthcare trends, and the failure of later studies to demonstrate further reductions suggests that there may be limits as to how far this can continue to be reduced. There is some evidence to suggest that ICPs bring about improvements in documentation, but we do not know how far documented practice reflects actual practice. It is unclear how ICPs have their effects and the relative importance of the process of development and the artefact in use. As none of the studies reviewed included an economic evaluation, moreover, it remains unclear whether the benefits of ICPs justify the costs of their implementation.
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Affiliation(s)
- Davina Allen
- 1. Wales Centre for Evidence Based Care: A Collaborating Centre of the Joanna Briggs Institute, Nursing, Health and Social Care Research Centre, Cardiff School of Nursing and Midwifery Studies, Cardiff University, Cardiff, UK 2. Originally published in the International Journal of Evidence-based Healthcare in 2008
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Hellesø R, Sorensen L, Lorensen M. Nurses’ information management across complex health care organizations. Int J Med Inform 2005; 74:960-72. [PMID: 16099200 DOI: 10.1016/j.ijmedinf.2005.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED The purpose of this study was to describe the information management used by hospital and home care nurses for patients in need of continuing care after an episode of hospitalization. METHOD A prospective descriptive design was used. In total 287 hospital nurses and 220 home care nurses were asked to complete a questionnaire before and after the hospital implemented nursing documentation integrated in the electronic patient record (EPR). RESULTS Discrepancies between the policies expressed by the health care organizations and the authorities in formal documents and the information management used by the nurses were identified. Differences were also found between nurses in hospital and home care with regard to how they assessed the information management during patient admission, throughout the patient's hospital stay and at the patient's discharge. The perceived differences decreased, however, after the hospital introduced electronic nursing documentation. The study shows a need to contextualize and customize the information that nurses exchange. In addition technological problems with the lack of integrated EPR systems between the hospital and the home health care as well as different practice models in the two organizations entail complex information handling during a patient's trajectory through the health system.
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Affiliation(s)
- Ragnhild Hellesø
- Faculty of Medicine, Institute of Nursing and Health Sciences, University of Oslo, P.O. Box 1153 Blindern, NO-0318 Oslo, Norway.
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