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Heng MTM, Seng GYT, Lee ES. Challenges of care coordination for complex patients among family medicine residents in a community ambulatory clinic: a qualitative study. BMC MEDICAL EDUCATION 2024; 24:562. [PMID: 38783242 PMCID: PMC11119012 DOI: 10.1186/s12909-024-05543-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Care coordination has been identified as one of five focuses of HealthierSG. Family medicine residents are expected to collaborate with other healthcare professionals for complex patients by the end of residency. However, many residents felt that it was challenging to coordinate care effectively among healthcare stakeholders. However, to date, no qualitative studies have explored these challenges. Therefore, this study aimed to understand the challenges encountered by family medicine residents when coordinating care for complex patients. METHODS This was a qualitative descriptive study in which semi structured in-depth interviews were conducted and guided by a topic guide. Total population sampling of 15 third-year family medicine residents in the National Healthcare Group Polyclinics was performed. The interviews were performed over Zoom and were transcribed. Thematic analysis was subsequently performed to analyse the transcripts. Coding was performed iteratively by two independent researchers. Disagreements were adjudicated by a third coder. A coding framework was agreed upon. Potential themes were then independently developed based on the coding framework. RESULTS Six themes emerged from the data, namely, interprofessional communications, accessibility, personal knowledge, time constraints, patient factors and caregiver dissent. CONCLUSION Challenges faced by family medicine residents are multifaceted. While a few are systemic and pertain to the broader healthcare framework, others, such as issues of unfamiliarity with institutional workflows, community resources, and confidentiality, pertain to the microcosm of residency itself. These are reversible areas for improvement. These challenges can be addressed during planning of residency curricula to better equip family medicine residents with coordinating care for complex patients in the future.
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Affiliation(s)
- Moses Tan Mong Heng
- National Healthcare Group Polyclinics, 21 Geylang East Central, Singapore, 389707, Singapore.
| | - Gilbert Yeo Tian Seng
- Department of Transitional Care, Woodlands Health, 17 Woodlands Dr 17, Singapore, 737628, Singapore
| | - Eng Sing Lee
- National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus @ one-north, Singapore, 138543, Singapore
- Lee Kong Chian School of Medicine, Singapore, 11 Mandalay Road, 308207, Singapore
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Mabuza LH, Moshabela M. Understanding of 'generalist medical practice' in South African medical schools. Afr J Prim Health Care Fam Med 2024; 16:e1-e13. [PMID: 38572858 PMCID: PMC11019042 DOI: 10.4102/phcfm.v16i1.4324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND In South Africa, medical students are expected to have acquired a generalist competence in medical practice on completion of their training. However, what the students and their preceptors understand by 'generalist medical practice' has not been established in South African medical schools. AIM This study aimed to explore what the students and their preceptors understood by 'generalist medical practice'. SETTING Four South African medical schools: Sefako Makgatho Health Sciences University, University of KwaZulu-Natal, Walter Sisulu University and the University of the Witwatersrand. METHODS The exploratory descriptive qualitative design was used. Sixteen focus group discussions (FGDs) and 27 one-on-one interviews were conducted among students and their preceptors, respectively. Participants were recruited through purposive sampling. The inductive and deductive data analysis methods were used. The MAXQDA 2020 (Analytics Pro) software was used to arrange data, yielding 2179 data segments. RESULTS Ten themes were identified: (1) basic knowledge of medicine, (2) first point of contact with all patients regardless of their presenting problems, (3) broad field of common conditions prevalent in the community, (4) dealing with the undifferentiated patient without a diagnosis, (5) stabilising emergencies before referral, (6) continuity, (7) coordinated and (8) holistic patient care, necessitating nurturance of doctor-patient relationship, (9) health promotion and disease prevention, and (10) operating mainly in primary health care settings. CONCLUSION The understanding of 'generalist medical practice' in accordance with internationally accepted principles augurs well in training undergraduate medical students on the subject. However, interdepartmental collaboration on the subject needs further exploration.Contribution: The study's findings can be used as a guide upon which the students' preceptors and their students can reflect during the training in generalist medical practice.
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Kong X, Zhang Y, Li R, Yang L, Xian Y, He M, Song K, Jia A, Sun Q, Ren Y. Factors influencing the bariatric surgery treatment of bariatric surgery candidates in underdeveloped areas of China. BMC Surg 2024; 24:82. [PMID: 38443901 PMCID: PMC10913241 DOI: 10.1186/s12893-024-02373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND From year to year, the proportion of people living with overweight and obesity in China rises, along with the prevalence of diseases linked to obesity. Although bariatric surgery is gaining popularity, there are still several issues with its promotion compared to Western nations. Since less developed places in China are more widespread due to disparities in the development of different regions, there has been little exploration of the factors that might be related to acceptance of bariatric surgery in these regions. METHODS Patients who visited the Department of Gastrointestinal Surgery at the North Sichuan Medical College Affiliated Hospital from 2018 to 2022 and had obesity or other relevant metabolic problems were surveyed using a questionnaire. The relationship between demographic factors, socioeconomic status, and acceptance of bariatric surgery was analyzed. RESULTS Of 334 patients, 171 had bariatric surgery. BMI, education level, marriage history, medical insurance, family support, and a history of type 2 diabetes were all linked to having bariatric surgery, according to a univariate analysis. In a multivariate analysis, BMI (P = 0.02), education (P = 0.02), family support (P<0.001), medical insurance coverage (P<0.001), and history of type 2 diabetes (P = 0.004) were all positively associated with a willingness to have bariatric surgery. Among 163 non-bariatric patients with obesity, 15.3% were not opposed to surgery but preferred trying medication first, 54.6% leaned towards medical therapy, and 30% were hesitant. Additionally, a majority of patients (48.55%) often lacked adequate knowledge about weight reduction therapy. Age, height, gender, smoking, drinking, family history of type 2 diabetes, education, and marital status did not significantly differ (P > 0.05). CONCLUSIONS Many patients are concerned about the safety of surgical treatment and the possibility of regaining weight. Due to the relatively high cost of bariatric surgery, they tend to choose medical treatment. To enhance the acceptance of bariatric surgery in underdeveloped regions of China, it is crucial to focus on disseminating knowledge about bariatric surgery, offer pertinent health education to the community, and foster support from patients' families. The government should pay more attention to obesity and provide support in the form of medical insurance.
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Affiliation(s)
- Xiangxin Kong
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
- North Sichuan Medical College, Nanchong, 637000, China
| | - Yuan Zhang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
- North Sichuan Medical College, Nanchong, 637000, China
| | - Ruoer Li
- North Sichuan Medical College, Nanchong, 637000, China
| | - Lei Yang
- North Sichuan Medical College, Nanchong, 637000, China
| | - Yin Xian
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
- North Sichuan Medical College, Nanchong, 637000, China
| | - Ming He
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
- North Sichuan Medical College, Nanchong, 637000, China
| | - Ke Song
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
- North Sichuan Medical College, Nanchong, 637000, China
| | - Aimei Jia
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
- North Sichuan Medical College, Nanchong, 637000, China
| | - Qin Sun
- North Sichuan Medical College, Nanchong, 637000, China.
| | - Yixing Ren
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
- North Sichuan Medical College, Nanchong, 637000, China.
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Ryskina KL, Geng Z, Raghavan S, Waddell KJ, Burke RE. Association between Timing of Clinical Evaluation by a Physician or Advanced Practitioner and Risk of Rehospitalization in Older Adults Admitted to a Skilled Nursing Facility Following Hospitalization: A Cohort Study. J Am Med Dir Assoc 2023; 24:1881-1887. [PMID: 37837998 PMCID: PMC10840785 DOI: 10.1016/j.jamda.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES How transitional care services are provided to patients receiving post-acute care in skilled nursing facilities (SNFs) is not well understood. We aimed to determine the association of timing of physician or advanced practice provider (APP) visit after SNF admission with rehospitalization risk in a national cohort of older adults. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS 2,482,616 Medicare fee-for-service beneficiaries aged ≥66 years who entered an SNF for post-acute care following hospitalization. METHODS We measured the relative risk of being rehospitalized within 14 days of SNF admission as a function of time to the first PAP visit, using time to follow-up as a time-dependent covariate, adjusted for patient demographics and clinical characteristics. We also evaluated whether findings extended across groups with different SNF prognosis on admission. RESULTS Patients seen sooner after admission to an SNF (0-1 days) were less likely to be rehospitalized compared to patients seen later (≥2 days). The relative difference was similar across different risk groups. CONCLUSIONS AND IMPLICATIONS Timely evaluation by a physician or APP after SNF admission may protect against rehospitalization. Investment in the workforce such as training programs, practice innovations, and equitable reimbursement for SNF visits after hospital discharge may mitigate labor shortages that were exacerbated by the COVID pandemic.
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Affiliation(s)
- Kira L Ryskina
- Division of General Internal Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Zhi Geng
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Sridharan Raghavan
- US Department of Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, USA
| | - Kimberly J Waddell
- Division of General Internal Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E Burke
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA; Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
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Amberger OA, Glushan A, Müller A, Beyer M, Karimova K. Overview article: Impact of primary and secondary care collaboration on hospitalization for chronic heart failure: Two comparative studies. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 182-183:125-129. [PMID: 37806814 DOI: 10.1016/j.zefq.2023.08.002] [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: 08/09/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION In the past decade, a legal framework was created in Germany that promotes intense collaboration at the interface between primary and secondary care. This overview article distinguishes between the effects of two complementary programs aimed at improving ambulatory care in Baden-Wuerttemberg: (1) general practitioner-centered care (GPCC), which strengthens the role of general practitioners, and (2) collaborative cardiology care (CCC), which coordinates primary and cardiology care. METHODS The overview article presents two already published studies that assess the impact of the programs on hospitalizations in patients with chronic heart failure (CHF) based on claims data from 2016. The hospitalization rate of patients enrolled in GPCC (N=75,096) and CCC (N=13,404) were compared with corresponding control groups (N=65,618 and N=8,776 respectively). RESULTS The hospitalization rate in GPCC was lower than in the control group (risk ratio 0.97; 95% CI: 0.95-0.99, P=0.0024). GPCC patients with CHF that received specialist cardiology care as part of CCC had significantly lower hospitalization rates than those receiving standard cardiology care (risk ratio 0.92; 0.88-0.97, P=0.0014). DISCUSSION This overwiew study shows that reforming medical care and compensation at the interface between general practice and specialist care can lead to fewer hospital admissions in patients with CHF. CONCLUSION Overall, this article underlines the importance of collaboration between primary care physicians and specialists for patients with CHF that are receiving ambulatory care.
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Affiliation(s)
- Olga A Amberger
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Germany.
| | - Anastasiya Glushan
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | - Angelina Müller
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | - Martin Beyer
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | - Kateryna Karimova
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Germany
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Austin AM, Schaefer AP, Arakelyan M, Freyleue SD, Goodman DC, Leyenaar JK. Specialties Providing Ambulatory Care and Associated Health Care Utilization and Quality for Children With Medical Complexity. Acad Pediatr 2023; 23:1542-1552. [PMID: 37468062 PMCID: PMC10792122 DOI: 10.1016/j.acap.2023.07.002] [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: 03/20/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Although children with medical complexity (CMC) have substantial health care needs, the extent to which they receive ambulatory care from primary care versus specialist clinicians is unknown. We aimed to determine the predominant specialty providing ambulatory care to CMC (primary care or specialty discipline), the extent to which specialists deliver well-child care, and associations between having a specialty predominant provider and health care utilization and quality. METHODS In a retrospective cohort analysis of 2012-17 all-payer claims data from Colorado, New Hampshire, and Massachusetts, we identified the predominant specialty providing ambulatory care for CMC <18 years. Propensity score weighting was used to create a balanced sample of CMC and assess differences in outcomes, including adequate well-child care, continuity of care, emergency visits, and hospitalizations, between CMC with a primary care versus specialty predominant provider. RESULTS Among 67,218 CMC, 75.3% (n = 50,584) received the plurality of care from a primary care discipline. Body system involvement, age > 2 years, urban residence, and cooccurring disabilities were associated with predominantly receiving care from specialists. After propensity score weighting, there were no significant differences between CMC with a primary care or specialist "predominant specialty seen" (PSS) in ambulatory visit counts, adequate well-child care, hospitalizations, or overall continuity of care. Specialists were the sole providers of well-child care and vaccines for 49.9% and 53.1% of CMC with a specialist PSS. CONCLUSIONS Most CMC received the plurality of care from primary care disciplines, and there were no substantial differences in overall utilization or quality based on the PSS.
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Affiliation(s)
- Andrea M Austin
- The Dartmouth Institute for Health Policy and Clinical Practice (AM Austin, AP Schaefer, SD Freyleue, D Goodman, and JK Leyenaar), Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Andrew P Schaefer
- The Dartmouth Institute for Health Policy and Clinical Practice (AM Austin, AP Schaefer, SD Freyleue, D Goodman, and JK Leyenaar), Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Mary Arakelyan
- Department of Pediatrics (M Arakelyan and JK Leyenaar), Dartmouth Health Children's, Lebanon, NH
| | - Seneca D Freyleue
- The Dartmouth Institute for Health Policy and Clinical Practice (AM Austin, AP Schaefer, SD Freyleue, D Goodman, and JK Leyenaar), Geisel School of Medicine at Dartmouth, Hanover, NH
| | - David C Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice (AM Austin, AP Schaefer, SD Freyleue, D Goodman, and JK Leyenaar), Geisel School of Medicine at Dartmouth, Hanover, NH
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy and Clinical Practice (AM Austin, AP Schaefer, SD Freyleue, D Goodman, and JK Leyenaar), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics (M Arakelyan and JK Leyenaar), Dartmouth Health Children's, Lebanon, NH.
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Oostra DL, Fierkens C, Alewijnse MEJ, Olde Rikkert MGM, Nieuwboer MS, Perry M. Implementation of interprofessional digital communication tools in primary care for frail older adults: An interview study. J Interprof Care 2022; 37:362-370. [PMID: 35862572 PMCID: PMC10153063 DOI: 10.1080/13561820.2022.2086858] [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: 10/17/2022]
Abstract
Communication and coordination between primary healthcare professionals and informal caregivers involved in the care for frail older adults is suboptimal and could benefit from interprofessional digital communication tools. Implementation in daily practice however frequently fails. We aim to identify generic barriers and facilitators experienced by healthcare professionals and informal caregivers during implementation of interprofessional communication tools to improve their long-term use. Qualitative content analysis using individual semi-structured interviews was used for evaluating three different digital communication tools used by interprofessional primary care networks for frail older adults by 28 professionals and 10 caregivers. After transcription and open coding, categories and themes were identified. Barriers and facilitators were related to: tool characteristics, context of use, involvement of professionals and caregivers. The tool improved availability, approachability and users' involvement. The large number of digital systems professionals simultaneously use, and different work agreements hampered tool use. The tools facilitated care coordination, and professionals declared to be better informed about patients' current situations. Overall, interprofessional digital communication tools can facilitate communication in networks for primary elderly care. However, integration between digital systems is needed to reduce the number of tools. Organizations and policy makers have an important role in realizing the tools' long-term use.
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Affiliation(s)
- Dorien L Oostra
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carlien Fierkens
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marloes E J Alewijnse
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Geriatric Medicine, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Minke S Nieuwboer
- Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Academy of Health and Vitality, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marieke Perry
- Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Geriatric Medicine, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
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Agha L, Ericson KM, Geissler KH, Rebitzer JB. Team Relationships and Performance: Evidence from Healthcare Referral Networks. MANAGEMENT SCIENCE 2022; 68:3175-3973. [PMID: 35875601 PMCID: PMC9307056 DOI: 10.1287/mnsc.2021.4091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We examine the teams that emerge when a primary care physician (PCP) refers patients to specialists. When PCPs concentrate their specialist referrals-for instance, by sending their cardiology patients to fewer distinct cardiologists-repeat interactions between PCPs and specialists are encouraged. Repeated interactions provide more opportunities and incentives to develop productive team relationships. Using data from the Massachusetts All Payer Claims Database, we construct a new measure of PCP team referral concentration and document that it varies widely across PCPs, even among PCPs in the same organization. Chronically ill patients treated by PCPs with a one standard deviation higher team referral concentration have 4% lower health care utilization on average, with no discernible reduction in quality. We corroborate this finding using a national sample of Medicare claims and show that it holds under various identification strategies that account for observed and unobserved patient and physician characteristics. The results suggest that repeated PCP-specialist interactions improve team performance.
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Affiliation(s)
| | | | - Kimberley H Geissler
- University of Massachusetts at Amherst School of Public Health and Health Sciences
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Resource Use Among Diabetes Patients Who Mainly Visit Primary Care Physicians Versus Medical Specialists: a Retrospective Cohort Study. J Gen Intern Med 2022; 37:283-289. [PMID: 33796983 PMCID: PMC8811114 DOI: 10.1007/s11606-021-06710-y] [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] [Received: 10/22/2020] [Accepted: 03/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND It is not uncommon for medical specialists to predominantly care for patients with certain chronic conditions rather than primary care physicians (PCPs), yet the resource implications from such patterns of care are not well understood. OBJECTIVE To assess resource use of diabetes patients who predominantly visit a PCP versus a medical specialist. DESIGN Retrospective cohort study of diabetes patients aging into the traditional Medicare program. Patients were attributed to a PCP or medical specialist annually based on a preponderance of ambulatory care visits and categorized according to whether attribution changed year to year. Propensity score weighting was used to balance baseline demographic characteristics, diabetes complications, and underlying health conditions between patients attributed to PCPs and to medical specialists. Spending and utilization were measured up to 3 patient-years. SUBJECTS A total of 141,558 patient-years. MAIN MEASURES Total visits, unique physicians, hospital admissions, emergency department visits, procedures, imaging, and tests. KEY RESULTS Each year, roughly 70% of patients maintained attribution to a PCP and 15% to a medical specialist relative to the previous year. After propensity weighting, patients continuously attributed to a PCP versus medical specialist from 1 year to the next had lower average total payer payments ($10,326 [SD $57,386] versus $14,971 [SD $74,112], P<0.0001) and lower total patient out-of-pocket payments ($1,707 [SD $6,020] versus $2,443 [SD $7,984], P<0.0001). Rates of hospitalization, emergency department visits, procedures, imaging, and tests were lower among patients attributed to PCPs as well. CONCLUSIONS Older adults with diabetes who receive more of their ambulatory care from a PCP instead of a medical specialist show evidence of lower resource use.
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The Feasibility of a Primary Care Based Navigation Service to Support Access to Health and Social Resources: The Access to Resources in the Community (ARC) Model. Int J Integr Care 2022; 22:13. [PMID: 36474646 PMCID: PMC9695153 DOI: 10.5334/ijic.6500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 10/28/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION We established a patient centric navigation model embedded in primary care (PC) to support access to the broad range of health and social resources; the Access to Resources in the Community (ARC) model. METHODS We evaluated the feasibility of ARC using the rapid cycle evaluations of the intervention processes, patient and PC provider surveys, and navigator log data. PC providers enrolled were asked to refer patients in whom they identified a health and/or social need to the ARC navigator. RESULTS Participants: 26 family physicians in four practices, and 82 of the 131 patients they referred. ARC was easily integrated in PC practices and was especially valued in the non-interprofessional practices. Patient overall satisfaction was very high (89%). Sixty patients completed the post-intervention surveys, and 33 reported accessing one or more service(s). CONCLUSION The ARC Model is an innovative approach to reach and support a broad range of patients access needed resources. The Model is feasible and acceptable to PC providers and patients, and has demonstrated potential for improving patients' access to health and social resources. This study has informed a pragmatic randomized controlled trial to evaluate the ARC navigation to an existing web and telephone navigation service (Ontario 211).
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Schwab-Reese LM, Renner LM, King H, Miller RP, Forman D, Krumenacker JS, DeMaria AL. "They're very passionate about making sure that women stay healthy": a qualitative examination of women's experiences participating in a community paramedicine program. BMC Health Serv Res 2021; 21:1167. [PMID: 34706727 PMCID: PMC8550812 DOI: 10.1186/s12913-021-07192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community paramedicine programs (i.e., physician-directed preventive care by emergency medical services personnel embedded in communities) offer a novel approach to community-based health care. Project Swaddle, a community paramedicine program for mothers and their infants, seeks to address (directly or through referrals) the physical, mental, social, and economic needs of its participants. The objective of this process evaluation was to describe women's experiences in Project Swaddle. By understanding their experiences, our work begins to build the foundation for similar programs and future examinations of the efficacy and effectiveness of these approaches. METHODS We completed 21 interviews with women living in Indiana (July 2019-February 2020) who were currently participating in or had graduated from Project Swaddle. Interviews were audio-recorded, transcribed, and analyzed using a six-phase approach to thematic analysis. RESULTS Program enrollment was influenced by the community paramedics' experience and connections, as well as information received in the community from related clinics or organizations. Participants viewed the community paramedic as a trusted provider who supplied necessary health information and support and served as their advocate. In their role as physician extenders, the community paramedics enhanced patient care through monitoring critical situations, facilitating communication with other providers, and supporting routine healthcare. Women noted how community paramedics connected them to outside resources (i.e., other experts, tangible goods), which aimed to support their holistic health and wellbeing. CONCLUSIONS Results demonstrate Project Swaddle helped women connect with other healthcare providers, including increased access to mental health services. The community paramedics were able to help women establish care with primary care providers and pediatricians, then facilitate communication with these providers. Women were supported through their early motherhood experience, received education on parenting and taking control of their health, and gained access to resources that met their diverse needs.
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Affiliation(s)
- Laura M Schwab-Reese
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA.
| | - Lynette M Renner
- School of Social Work, College of Education and Human Development, University of Minnesota, St. Paul, MN, USA
| | - Hannah King
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - R Paul Miller
- City of Crawfordsville Fire Department, Crawfordsville, IN, USA
| | - Darren Forman
- City of Crawfordsville Fire Department, Crawfordsville, IN, USA
| | | | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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Perrault-Sequeira L, Torti J, Appleton A, Mathews M, Goldszmidt M. Discharging the complex patient - changing our focus to patients' networks of care providers. BMC Health Serv Res 2021; 21:950. [PMID: 34507571 PMCID: PMC8431846 DOI: 10.1186/s12913-021-06841-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background A disconnect exists between the idealized model of every patient having a family physician (FP) who acts as the central hub for care, and the reality of health care where patients must navigate a network of different providers. This disconnect is particularly evident when hospitalized multimorbid patients transition back into the community. These discharges are identified as high-risk due to lapses in care continuity. The aim of this study was to identify and explore the networks of care providers in a sample of hospitalized, complex patients, and better understand the nature of their attachments to these providers as a means of discovering novel approaches for improving discharge planning. Methods This was a constructivist grounded theory study. Data included interviews from 30 patients admitted to an inpatient internal medicine service of a midsized academic hospital in Ontario, Canada. Analysis and data collection proceeded iteratively with sampling progressing from purposive to theoretical. Results We identified network of care configurations commonly found in patients with multiple medical comorbidities receiving care from multiple different providers admitted to an internal medicine service. FPs and specialists form the network’s scaffold. The involvement of physicians in the network dictated not only how patients experienced transitions in care but the degree of reliance on social supports and personal capacities. The ideal for the multimorbid patient is an optimally involved FP that remains at the centre, even when patients require more subspecialized care. However, in cases where a rostered FP is non-existent or inadequate, increased involvement and advocacy from specialists is crucial. Conclusions Our results have implications for transition planning in hospitalized complex patients. Recognizing salient network features can help identify patients who would benefit from enhanced discharge support. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06841-2.
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Affiliation(s)
| | - Jacqueline Torti
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Centre for Education Research & Innovation - Western University, London, ON, Canada
| | - Andrew Appleton
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Maria Mathews
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Mark Goldszmidt
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Centre for Education Research & Innovation - Western University, London, ON, Canada
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The Effect of Clinicians' Personal Acquaintance on Specialty Care Coordination as the Sharing of an EHR Increases. J Ambul Care Manage 2021; 44:227-236. [PMID: 34016849 DOI: 10.1097/jac.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We used an online survey to measure how personal acquaintance with referring primary care providers (PCPs) affects specialists' experience of care coordination as use of a shared electronic health record (EHR) increases. Only 9% of specialists rated Overall Coordination as 9 or 10 out of 10. Personal acquaintance positively impacted Overall Coordination and all measured coordination subdomains. This effect was attenuated, but persisted, even at higher levels of EHR sharing. The impact of a shared EHR alone was limited to Overall Coordination and the Data Transfer subdomains. Health systems can improve coordination through investment in clinician relationships, while research should address the gaps in coordination even with widespread personal acquaintance and shared EHRs.
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Stolee P, Elliott J, Giguere AM, Mallinson S, Rockwood K, Sims Gould J, Baker R, Boscart V, Burns C, Byrne K, Carson J, Cook RJ, Costa AP, Giosa J, Grindrod K, Hajizadeh M, Hanson HM, Hastings S, Heckman G, Holroyd-Leduc J, Isaranuwatchai W, Kuspinar A, Meyer S, McMurray J, Puchyr P, Puchyr P, Theou O, Witteman H. Transforming primary care for older Canadians living with frailty: mixed methods study protocol for a complex primary care intervention. BMJ Open 2021; 11:e042911. [PMID: 33986044 PMCID: PMC8126280 DOI: 10.1136/bmjopen-2020-042911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Older Canadians living with frailty are high users of healthcare services; however, the healthcare system is not well designed to meet the complex needs of many older adults. Older persons look to their primary care practitioners to assess their needs and coordinate their care. They may need care from a variety of providers and services, but often this care is not well coordinated. Older adults and their family caregivers are the experts in their own needs and preferences, but often do not have a chance to participate fully in treatment decisions or care planning. As a result, older adults may have health problems that are not properly assessed, managed or treated, resulting in poorer health outcomes and higher economic and social costs. We will be implementing enhanced primary healthcare approaches for older patients, including risk screening, patient engagement and shared decision making and care coordination. These interventions will be tailored to the needs and circumstances of the primary care study sites. In this article, we describe our study protocol for implementing and testing these approaches. METHODS AND ANALYSIS Nine primary care sites in three Canadian provinces will participate in a multi-phase mixed methods study. In phase 1, baseline information will be collected through questionnaires and interviews with patients and healthcare providers (HCPs). In phase 2, HCPs and patients will be consulted to tailor the evidence-based interventions to site-specific needs and circumstances. In phase 3, sites will implement the tailored care model. Evaluation of the care model will include measures of patient and provider experience, a quality of life measure, qualitative interviews and economic evaluation. ETHICS AND DISSEMINATION This study has received ethics clearance from the host academic institutions: University of Calgary (REB17-0617), University of Waterloo (ORE#22446) and Université Laval (#MP-13-2019-1500 and 2017-2018-12-MP). Results will be disseminated through traditional means, including peer-reviewed publications and conferences and through an extensive network of knowledge user partners. TRIAL REGISTRATION NUMBER NCT03442426;Pre-results.
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Affiliation(s)
- Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Anik Mc Giguere
- Department of Family Medicine and Emergency Medicine, Universite Laval, Laval, Quebec, Canada
| | - Sara Mallinson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joanie Sims Gould
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Veronique Boscart
- School of Health and Life Sciences, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Catherine Burns
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Kerry Byrne
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Judith Carson
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Justine Giosa
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heather M Hanson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Stephanie Hastings
- Alberta Health Services, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - George Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | | | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for exceLlence in Economic Analysis Research (CLEAR), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Samantha Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Josephine McMurray
- School of Business and Economics/Health Studies, Wilfred Laurier University, Waterloo, Ontario, Canada
| | - Phyllis Puchyr
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Peter Puchyr
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Holly Witteman
- Department of Family Medicine and Emergency Medicine, Universite Laval, Laval, Quebec, Canada
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Grierson L, Vanstone M. The rich potential for education research in family medicine and general practice. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:753-763. [PMID: 32986222 DOI: 10.1007/s10459-020-09994-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
Medical education is a rapidly growing field of research, incorporating diverse disciplinary perspectives to assist physician trainees in developing the complex skills needed for practice. Education science is happening in many medical specialties; however, Family Medicine or General Practice settings have not seen a proportional share of theory-driven education research. The limited nature of education research in Family Medicine is surprising, given that there are several aspects of general practice that make it a particularly unique and interesting context to study issues of general importance to medical education, and there is a particular need for education research to further the discipline of Family Medicine. It is important that the community of medical education researchers in Family Medicine have a strong understanding and perspective on the breadth and potential impact of their work, and what this means for the training that occurs within and for the discipline. This Reflection aims to inform strategic thinking, collaboration, and innovation in medical education research as it pertains to Family Medicine. It does so by discussing four hallmarks of Family Medicine practice and outlining their independent and interactive potential for medical education research.
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Affiliation(s)
- Lawrence Grierson
- Department of Family Medicine, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, USA.
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, USA.
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, USA
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, USA
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Hawker K, Barnabe C, Barber CE. A scoping Review of tools used to assess patient Complexity in rheumatic disease. Health Expect 2021; 24:556-565. [PMID: 33595914 PMCID: PMC8077158 DOI: 10.1111/hex.13200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Patients with rheumatic diseases often have multiple comorbidities which may impact well-being leading to high psychosocial complexity. This scoping review was undertaken to identify complexity measures/tools used in rheumatology that could help in planning and coordinating care. METHODS MEDLINE, EMBASE and CINAHL were searched from database inception to 14 December 2019 using keywords and Medical Subject Headings for "care coordination", "complexity" and selected rheumatic diseases and known complexity measures/tools. Articles describing the development or use of complexity measures/tools in patients with adult rheumatologic diagnoses were included regardless of study design. Included articles were evaluated for risk of bias where applicable. RESULTS The search yielded 407 articles, 37 underwent full-text review and 2 were identified during a hand search with 9 included articles. Only 2 complexity tools used in populations of adult patients with rheumatic disease were identified: the SLENQ and the INTERMED. The SLENQ is a 97-item patient needs questionnaire developed for patients with systemic lupus (n = 1 study describing tool development) and applied in 5 cross-sectional studies. Three studies (a practice article, trial and a cross-sectional study) applied the INTERMED, a clinical interview to ascertain complexity and support coordinated care, in patients with rheumatologic diagnoses. CONCLUSIONS There is limited information on the use of patient complexity measures/tools in rheumatology. Such tools could be applied to coordinate multidisciplinary care and improve patient experience and outcomes. PATIENT CONTRIBUTION This scoping review will be presented to patient research partners involved in co-designing a future study on patient complexity in rheumatic disease.
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Affiliation(s)
- Kara Hawker
- Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Cheryl Barnabe
- Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Arthritis ResearchCanada
| | - Claire E.H. Barber
- Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Arthritis ResearchCanada
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17
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Ofei AM, Paarima Y. Perception of nurse managers’ care coordination practices among nurses at the unit level. INTERNATIONAL JOURNAL OF CARE COORDINATION 2021. [DOI: 10.1177/2053434521999978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Nursing practice demands coordination of activities within and across units to enable quality delivery of healthcare services. Nurse managers are best positioned to ensure effective care coordination at the operational level in the hospitals. The purpose of this study was to examine the care coordination practices of nurse managers at the unit level. Methods A quantitative exploratory descriptive approach using a cross-sectional survey design was used to collect data from 522 nurses in 19 hospitals in the Greater Accra region of Ghana. Descriptive and regression analyses were performed to describe the sample and to predict the behaviour of nurse managers. The systems model was used as a conceptual framework for the survey. Data collection was from October 2015 to March 2016. Results The response rate for collection of data was 95.7%. Nurse managers exhibited an acceptable level of care coordination practices. Nurse managers’ characteristics together predicted the care coordination practices at the unit (R2=0.111, p < 0.001). The unit, unit workload, experience as a nurse manager, and work duration with nurses were the significant predictors in the regression model. Discussion Care coordination is needed at the unit level to prevent conflict, overlapping, and constant interdepartmental friction which enables nurses to take a broad overview of coordinated care instead of myopic observation and reflection in the unit. Nurse managers are best positioned to coordinate care due to their vast professional knowledge and experience. Effective communication, good interpersonal relationship, and good listening skills are essential coordination practices critical to the efficiency of the unit.
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Affiliation(s)
| | - Yennuten Paarima
- University of Ghana, Ghana
- Barnes-Jewish College & Washington University, USA
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18
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Williams LJ, Waller K, Chenoweth RP, Ersig AL. Stakeholder perspectives: Communication, care coordination, and transitions in care for children with medical complexity. J SPEC PEDIATR NURS 2021; 26:e12314. [PMID: 33098752 PMCID: PMC8063923 DOI: 10.1111/jspn.12314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to obtain feedback on communication, care coordination, and transitions in care for hospitalized children with medical complexity (CMC). DESIGN AND METHODS This descriptive, mixed-methods study used online surveys with forced-choice and open-ended questions to obtain stakeholder feedback. Stakeholders included parents, healthcare providers, and nurses. Participants over 18 years of age were recruited from a Midwest children's hospital inpatient unit dedicated to care of CMC. Quantitative data were analyzed using t-tests and one-way analysis of variance. Qualitative description was used to analyze responses to open-ended questions. RESULTS Parents' ratings of communication, care coordination, and transitions in care were generally high. Transitions from other facilities to the emergency department and unit received lower ratings. Providers and nurses gave high ratings to overall care, communication among providers and nurses on the patient unit, and experiences with discharge; however, between unit communication and unit-based coordination received lower ratings. Providers and nurses had higher ratings for discharge preparation than parents (p ≤ .001). Three themes were identified in responses to the open-ended questions: establishing balanced and collaborative relationships between the care team and families, taking a proactive approach to care coordination, and the importance of an inclusive, interdisciplinary, and centralized approach to care coordination and communication. PRACTICE IMPLICATIONS Collaboration among all stakeholders is needed to achieve coordinated care, inclusive communication, and transitions with positive outcomes during hospitalization. Parents identified a need for consistent communication from care teams, with the primary inpatient team taking a lead role. Including parents in care coordination and transitions in care is key, as they are the experts in their children's health and well-being.
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Affiliation(s)
- Lori J Williams
- American Family Children's Hospital, Madison, Wisconsin, USA
| | | | - Rachel P Chenoweth
- The University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - Anne L Ersig
- The University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
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Schutz Leuthold M, Schwarz J, Marti J, Perraudin C, Hudon C, Peytremann-Bridevaux I, Senn N, Cohidon C. Protocol for an implementation and realist evaluation of a new organisational model for primary care practices in the canton of Vaud, Switzerland. BMJ Open 2020; 10:e040154. [PMID: 33303447 PMCID: PMC7733189 DOI: 10.1136/bmjopen-2020-040154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Continuity of care, especially for patients with complex needs, is a major challenge for healthcare systems in many high-income countries, including Switzerland. Since 2015, a collaborative project between Unisanté-Department of Family Medicine (DMF), some general practitioners (GPs) and canton of Vaud's public health authorities has sought to develop a new organisational model for the provision of primary care to ensure better care coordination and to provide adapted care deliveries to patients' healthcare needs. The model's main component is the addition of a primary care nurse to GPs practices. Three additional tools are individualised patient care plans, electronic medical records and patient empanelment. To assess this model, a 2-year pilot study has begun in nine GPs' practices in the canton. This paper presents the protocol for an evaluation of the implementation and effectiveness of the new organisational model. METHOD AND ANALYSIS We will conduct a before-and-after study using a mixed-methods and a realist approach. First, we will use quantitative and qualitative data to assess the new organisational model's implementation (feasibility, fidelity, acceptability and costs) and effectiveness (healthcare services use, patient experience, staff experience and patient-level costs). Combining this data with focus group data will enable a realist evaluation of the pilot project, which will help understand the elements of context and mechanism that affect implementation. ETHICS AND DISSEMINATION The evaluation will inform the canton of Vaud's health authorities about the limits of and perspectives for this organisational model. All results will also be made available to the practices and the patients involved. At the end of the project, we will propose organisational adaptations and a sustainable financial model for extending the model to other practices in the canton and potentially to the national level.The canton of Vaud's Human Research Ethics Committee approved the study, and Data Protection and Information Law Authority gave a favourable opinion concerning data processing procedures.
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Affiliation(s)
- Muriel Schutz Leuthold
- Département Médecine de famille, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Joelle Schwarz
- Département Médecine de famille, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Joachim Marti
- Département Epidémiologie et Systèmes de santé, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Clémence Perraudin
- Département des Policliniques, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Catherine Hudon
- Département de Médecine de Famille et Médecine d'Urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Peytremann-Bridevaux
- Département Epidémiologie et Systèmes de santé, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Nicolas Senn
- Département Médecine de famille, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Christine Cohidon
- Département Médecine de famille, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
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Ryskina KL, Foley KA, Karlawish JH, Uy JD, Lott B, Goldberg E, Hodgson NA. Expectations and experiences with physician care among patients receiving post-acute care in US skilled nursing facilities. BMC Geriatr 2020; 20:463. [PMID: 33172392 PMCID: PMC7653446 DOI: 10.1186/s12877-020-01869-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the US, post-acute care in skilled nursing facilities (SNFs) is common and outcomes vary greatly across facilities. Little is known about the expectations of patients and their caregivers about physician care during the hospital to SNF transition. Our objectives were to (1) describe the experiences and expectations of patients and their caregivers with SNF physicians in SNFs, and (2) identify patterns that differed between patients with vs. without cognitive impairment. METHODS This qualitative study used grounded theory approach to analyze data collected from semi-structured interviews at five SNFs in January-August 2018. Patients admitted for short-term SNF care 5-10 days prior were eligible to participate. Thematic analysis was performed to detect recurrent themes with a focus on modifiable aspects of physician care. Analysis was stratified by patient cognitive impairment (measured by the Montreal Cognitive Assessment at the time of the interview). RESULTS Fifty patients and six caregivers were interviewed. Major themes were: (1) patients had poor awareness of the physician in charge of their care; (2) they were dissatisfied with the frequency of interaction with the physician; and (3) participants valued the perception of receiving individualized care from the physician. Less cognitively impaired patients were more concerned about limited interactions with the physicians and were more likely to report attempts to seek out the physician. CONCLUSION Patient and caregiver expectations of SNF physicians were not well aligned with their experiences. SNFs aiming to improve satisfaction with care may focus efforts in this area, such as facilitating frequent communication between physicians, patients and caregivers.
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Affiliation(s)
- Kira L Ryskina
- Division of General Internal Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kierra A Foley
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Jason H Karlawish
- Division of Geriatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua D Uy
- Division of Geriatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Briana Lott
- VA Greater Los Angeles Healthcare System, West Los Angeles, CA, USA
| | - Erica Goldberg
- Department of Emergency Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy A Hodgson
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Vimalananda VG, Meterko M, Qian S, Wormwood JB, Solch MSW A, Fincke BG. Development and psychometric assessment of a survey to measure specialty care coordination as experienced by primary care providers. Health Serv Res 2020; 55:660-670. [PMID: 33460075 PMCID: PMC7518815 DOI: 10.1111/1475-6773.13310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the psychometric properties and construct validity of a survey of primary care providers' (PCPs') experience of specialty care coordination, which is a counterpart to our existing survey ("CSC-Specialist") that measures specialists' experience of specialty care coordination. DATA SOURCES We surveyed PCPs from Veterans Health Administration medical centers and community-based outpatient clinics nationwide (N = 1576) in April 2018. STUDY DESIGN We developed candidate items through literature review, existing surveys, PCP interviews, and expert opinion. We used exploratory and confirmatory factor analysis to develop scales and multivariable linear regression to determine their association with PCPs' overall experience of coordination. DATA COLLECTION The online survey included 23 candidate scale items about specialty care coordination and a single item asking respondents to rate their overall experience of specialty care coordination on a 0-10 scale. All VA PCPs were eligible. We sent survey invitations to PCPs following local Section Chiefs' email introduction (N = 926) and by directly emailing two random samples (N = 400 and N = 6653), overall response rate across the three nonoverlapping samples = 24 percent. PRINCIPAL FINDINGS Analyses identified 20 items forming 6 scales with strong psychometric properties and predictive power for overall coordination. Two scales are identical to CSC-Specialist scales: "Communication" (k = 3, α = 0.87) and "Data Transfer" (k = 2, α = 0.92); one is similar: "Relationships and Collaboration" (k = 6, α = 0.90). The three remaining scales address the PCP's unique perspective: "Role Clarity" (k = 3, α = 0.85), "Role Agreement" (k = 3, α = 0.75), and "Making Referrals" (k = 3, α = 0.75). The six scales together explained 67 percent of the variance in PCPs' overall coordination experience with specialists. CONCLUSIONS The Coordination of Specialty Care-Primary Care Provider Survey (CSC-PCP) is a novel 20-item survey that can be used in quality improvement or health services research, alone or in combination with the CSC-Specialist, to evaluate coordination of care as experienced by either or both participants.
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Affiliation(s)
- Varsha G. Vimalananda
- Center for Healthcare Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
- Section of Endocrinology, Diabetes and MetabolismBoston University School of MedicineBostonMassachusettsUSA
| | - Mark Meterko
- VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID – 10EA)Field‐Based at the Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
- Department of Health Law, Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Shirley Qian
- Center for Healthcare Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
| | - Jolie B. Wormwood
- Center for Healthcare Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
- Department of PsychologyUniversity of New HampshireDurhamNew HampshireUSA
| | - Amanda Solch MSW
- Center for Healthcare Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
| | - Benjamin Graeme Fincke
- Center for Healthcare Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
- Department of Health Law, Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
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Abstract
Background: Clearly identified professionals who are appointed for care coordination are invaluable for ensuring efficient coordination of health care services. However, challenges to identifying roles in palliative care are well documented in literature. Notably, in order to meet high demands on palliative home care settings, many care practitioners perform tasks that surpass the responsibilities and regulations of their role, including care coordination. Without clearly defined roles, standards of care cannot be guaranteed. Yet, little is understood about who plays the key role in palliative home care. Aim: The present study aims to address the gap in the research by identifying who plays a key role in coordination in palliative home care. Methods: Interviews with general practitioners (GPs), nurses and relatives of palliative patients were carried out in Swiss cantons (Vaud, Ticino, Luzern and Basel) to identify key coordinators of care. Interviews were analyzed using content analysis and presented using grounded theory. Results: Findings indicated that there was considerable ambiguity of the key coordinator role. 1) Causal conditions of this phenomenon were; informality of professional roles and lack of communication between team members, 2) Consequences of this included; conflicting understandings of key coordinator role and family members feeling overburdened, 3) Strategies adopted by interviewees included; adapting or taking control of care coordination. These findings are highly indicative of areas for improvement for care coordination in palliative home care settings. Specifically, they underline a profound need for clear communication between palliative care service providers regarding which professionals assume a key coordative role, or who are delegated a coordinative role at any given time. Crucially, since the findings reveal that relatives are intimately involved in care coordination, the findings point to a lack of adequate financial and psycho-social support for relatives of palliative patients who are burdened with coordination tasks, without the appropriate recompense.
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Nothelle S, Wolff J, Nkodo A, Litman J, Dunbar L, Boyd C. "It's Tricky": Care Managers' Perspectives on Interacting with Primary Care Clinicians. Popul Health Manag 2020; 24:338-344. [PMID: 32758066 DOI: 10.1089/pop.2020.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Care management programs that facilitate collaboration between care managers and primary care clinicians are more likely to be successful in improving chronic disease metrics than programs that do not facilitate such collaboration. The authors sought to understand care managers' perspectives on interacting with primary care clinicians. Semi-structured qualitative interviews were conducted with care managers (n = 29) from 3 health systems in and around a large, urban academic center. Interviews were audio recorded, transcribed verbatim, and iteratively analyzed using a grounded theory approach. Care managers worked for health plans (14%), outpatient specialty clinics (31%), hospitals and emergency departments (24%), and primary care offices (14%). Care managers identified the primary care clinician as leading patients' care and as essential to avoiding unnecessary utilization. Care managers described variability in and barriers to interacting with primary care clinicians. When possible, care managers use the electronic medical record to facilitate interaction rather than communicating directly (eg, phone call) with primary care clinicians. The role of the care manager varied across programs, contributing to primary care clinicians' poor understanding of what the care manager could provide. Consequently, primary care clinicians asked the care manager for help with tasks beyond his/her role. Care managers felt inferior to primary care clinicians, a potential result of the traditional medical hierarchy, which also hindered interactions. Although care managers view interactions with the primary care clinician as essential to the health of the patient, communication challenges, variability of the care manager's role, and medical hierarchy limit collaboration.
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Affiliation(s)
- Stephanie Nothelle
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amelie Nkodo
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Litman
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Linda Dunbar
- Johns Hopkins HealthCare, Baltimore, Maryland, USA
| | - Cynthia Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Siqueira do Prado L, Allemann S, Viprey M, Schott AM, Dediu D, Dima AL. Quantification and visualisation methods of data-driven chronic care delivery pathways: protocol for a systematic review and content analysis. BMJ Open 2020; 10:e033573. [PMID: 32193262 PMCID: PMC7150594 DOI: 10.1136/bmjopen-2019-033573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Chronic conditions require long periods of care and often involve repeated interactions with multiple healthcare providers. Faced with increasing illness burden and costs, healthcare systems are currently working towards integrated care to streamline these interactions and improve efficiency. To support this, one promising resource is the information on routine care delivery stored in various electronic healthcare databases (EHD). In chronic conditions, care delivery pathways (CDPs) can be constructed by linking multiple data sources and extracting time-stamped healthcare utilisation events and other medical data related to individual or groups of patients over specific time periods; CDPs may provide insights into current practice and ways of improving it. Several methods have been proposed in recent years to quantify and visualise CDPs. We present the protocol for a systematic review aiming to describe the content and development of CDP methods, to derive common recommendations for CDP construction. METHODS AND ANALYSIS This protocol followed the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols. A literature search will be performed in PubMed (MEDLINE), Scopus, IEEE, CINAHL and EMBASE, without date restrictions, to review published papers reporting data-driven chronic CDPs quantification and visualisation methods. We will describe them using several characteristics relevant for EHD use in long-term care, grouped into three domains: (1) clinical (what clinical information does the method use and how was it considered relevant?), (2) data science (what are the method's development and implementation characteristics?) and (3) behavioural (which behaviours and interactions does the method aim to promote among users and how?). Data extraction will be performed via deductive content analysis using previously defined characteristics and accompanied by an inductive analysis to identify and code additional relevant features. Results will be presented in descriptive format and used to compare current CDPs and generate recommendations for future CDP development initiatives. ETHICS AND DISSEMINATION Database searches will be initiated in May 2019. The review is expected to be completed by February 2020. Ethical approval is not required for this review. Results will be disseminated in peer-reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER CRD42019140494.
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Affiliation(s)
- Luiza Siqueira do Prado
- Health Services and Performance Research EA 7425, Université Claude Bernard Lyon 1, Lyon, France
| | - Samuel Allemann
- Health Services and Performance Research EA 7425, Université Claude Bernard Lyon 1, Lyon, France
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Marie Viprey
- Health Services and Performance Research EA 7425, Université Claude Bernard Lyon 1, Lyon, France
- Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Anne-Marie Schott
- Health Services and Performance Research EA 7425, Université Claude Bernard Lyon 1, Lyon, France
- Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Dan Dediu
- Laboratoire Dynamique du Langage UMR 5596, Université Lumière Lyon 2, Lyon, France
| | - Alexandra L Dima
- Health Services and Performance Research EA 7425, Université Claude Bernard Lyon 1, Lyon, France
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Ryskina KL, Yuan Y, Polsky D, Werner RM. Hospitalist Vs. Non-Hospitalist Care Outcomes and Costs for Medicare Beneficiaries Discharged to Skilled Nursing Facilities in 2012-2014. J Gen Intern Med 2020; 35:214-219. [PMID: 31637643 PMCID: PMC6957621 DOI: 10.1007/s11606-019-05459-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hospitals are increasingly at risk for post-acute care outcomes and spending, such as those in skilled nursing facilities (SNFs). While hospitalists are thought to improve patient outcomes of acute care, whether these effects extend to the post-acute setting in SNFs is unknown. OBJECTIVE To compare longer term outcomes of patients discharged to SNFs who were treated by hospitalists vs. non-hospitalists during their hospitalization. DESIGN This was a retrospective cohort study. PARTICIPANTS Participants are Medicare fee-for-service beneficiaries over 66 years of age who were hospitalized and discharged to a SNF in 2012-2014 (N = 2,839,779). MAIN MEASURES We estimated the effect of being treated by a hospitalist on 30-day rehospitalization and mortality, 60-day episode Medicare payments (Parts A and B), and successful discharge to community. Patients discharged to the community within 100 days of SNF admission who remained alive and not readmitted to a hospital or SNF for at least 30 days were considered successfully discharged. All outcomes were adjusted for demographics and clinical characteristics. To account for heterogeneity across facilities, we included hospital fixed effects. KEY RESULTS The 30-day rehospitalization rate was 17.59% for hospitalists' vs. 17.31% for non-hospitalists' patients (adjusted difference, 0.28%; 95% CI, 0.13 to 0.44). Sixty-day payments were $26,301 for hospitalists' vs. $25,996 for non-hospitalists' patients (adjusted difference, $305; 95% CI, $243 to $367). There was a non-significant trend toward lower successful discharge to the community rate (adjusted difference, - 0.26%; 95% CI, - 0.48 to - 0.04) and lower mortality for patients of hospitalists (adjusted difference, - 0.12%; 95% CI, - 0.22 to - 0.02). CONCLUSIONS Among hospitalized Medicare beneficiaries who were discharged to SNFs, readmissions and Medicare costs were slightly higher for stays under the care of hospitalists compared with those of non-hospitalist generalist physicians, but there was a non-significant trend toward lower mortality.
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Affiliation(s)
- Kira L Ryskina
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 12-30 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Yihao Yuan
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 12-30 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, USA
| | - Daniel Polsky
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 12-30 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel M Werner
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 12-30 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Crescenz VA Medical Center, Philadelphia, PA, USA
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Abstract
EXECUTIVE SUMMARY Organizing patient care and improving team coordination have been identified by the Institute of Medicine and the Agency for Healthcare Research and Quality as essential components of high-quality care. Research is lacking, however, on the measurement of care team coordination and its mechanisms. Using an organizational psychology framework developed by Okhuysen and Bechky (O&B) as a guide, the authors identify strengths and gaps in the existing literature related to the measurement of coordination and its associated constructs. The authors conducted a review of peer-reviewed articles in healthcare, management, and psychology journals that contain survey items that could be used to measure the domains in the O&B framework. An initial search yielded 468 articles published from 1978 to 2014, 37 of which came from healthcare journals. From this set, 1,401 candidate survey items were extracted from 74 articles. Of these, 279 items were categorized into at least one O&B domain. Retained items were drawn from scales representing 51 constructs related to teamwork, roles, trust, coordination broadly, and ancillary constructs. Two constructs, physical proximity and plans and rules, were directly represented both in the O&B framework and as standalone constructs in the literature. The remaining constructs contributed items that indirectly assess components of the O&B framework domains. Despite decades of research on coordination, valid survey items for measuring the mechanisms and integrating conditions described by the O&B framework as leading to successful team coordination are scarce, and virtually nonexistent in healthcare, as measures of care team coordination.
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Breton M, Smithman MA, Touati N, Boivin A, Loignon C, Dubois CA, Nour K, Lamoureux-Lamarche C, Brousselle A. Family Physicians Attaching New Patients From Centralized Waiting Lists: A Cross-Sectional Study. J Prim Care Community Health 2019; 9:2150132718795943. [PMID: 30129388 PMCID: PMC6104207 DOI: 10.1177/2150132718795943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE In response to more than 15% of Canadians not having a family physician, 7 provinces have implemented centralized waiting lists for unattached patients. The aim of this study is to analyze the association between family physicians' characteristics and their participation in centralized waiting lists. METHODS Cross-sectional observational study using administrative data in 5 local health networks in Quebec, between 2013 and 2015. All physicians who had attached at least 1 patient were included (n = 580). Multivariate linear regressions for the number of patients and proportion of vulnerable patients attached per physician were performed. RESULTS Physicians with more than 20 years of experience represented more than half of those who had participated in the centralized waiting lists and physicians in traditional primary care models represented more than 40%. Physicians' number of years of practice, primary care model, local health network, and the number of physicians participating in the centralized waiting lists per clinic influenced physicians' participation. Physicians with 0 to 4 years of experience and those practicing in network clinics were found to attach more patients. Practicing in a Centre Locaux de Services Communautaires (local community service center) was associated with attaching 19% more vulnerable patients compared with practicing in a Family Medicine Unit (teaching unit). CONCLUSION Centralized waiting lists seem to be used by early career physicians to build up their patient panels. However, because of the large number of them participating in the centralized waiting lists, physicians with more experience and those practicing in traditional models of primary care might be of interest for future measures to decrease the number of patients waiting for attachment in centralized waiting lists.
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Affiliation(s)
- Mylaine Breton
- 1 Université de Sherbrooke, Longueuil Campus, Longueuil, Quebec, Canada
| | | | - Nassera Touati
- 2 École nationale d'administration publique, Montreal, Quebec, Canada
| | | | - Christine Loignon
- 1 Université de Sherbrooke, Longueuil Campus, Longueuil, Quebec, Canada
| | | | - Kareen Nour
- 4 Centre intégré de santé et des services sociaux-Montérégie-Centre, Longueuil, Quebec, Canada
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28
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Amoakoh-Coleman M, Ansah E, Klipstein-Grobusch K, Arhinful D. Completeness of obstetric referral letters/notes from subdistrict to district level in three rural districts in Greater Accra region of Ghana: an implementation research using mixed methods. BMJ Open 2019; 9:e029785. [PMID: 31519675 PMCID: PMC6747881 DOI: 10.1136/bmjopen-2019-029785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the completeness of obstetric referral letters/notes at the district level of healthcare. DESIGN An implementation research within three districts in Greater Accra region using mixed methods. During baseline and intervention phases, referral processes for all obstetric referrals from lower level facilities seen at the district hospitals were documented including indications for referrals, availability and completeness of referral notes/forms. An assessment of before and after intervention availability and completeness of referral forms was carried out. Focus group discussions, non-participant observations and in-depth interviews with health workers and pregnant women were conducted for qualitative data. SETTING Three (3) districts in the Greater Accra region of Ghana. PARTICIPANTS Pregnant women referred from lower levels of care to and seen at the district hospital, health workers within the three districts and pregnant women attending antenatal clinic in the district and their family members or spouses. INTERVENTION An enhanced interfacility referral communication system consisting of training, provision of communication tools for facilities, formation of hospital referral teams and strengthening feedback mechanisms. OUTCOME Completeness of obstetric referral letters/notes. RESULTS Proportion of obstetric referrals with referral notes improved from 27.2% to 44.3% from the baseline to intervention period. Mean completeness (95% CI) of all forms was 71.3% (64.1% to 78.5%) for the study period, improving from 70.7% (60.4% to 80.9%) to 71.9% (61.1% to 82.7%) from baseline to intervention periods. Health workers reported they do not always provide referral notes and that most referral notes are not completely filled due to various reasons. CONCLUSIONS Most obstetric referrals did not have referral notes. The few notes provided were not completely filled. Interventions such as training of health workers, regular review of referral processes and use of electronic records can help improve both the provision of and completeness of the referral notes.
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Affiliation(s)
- Mary Amoakoh-Coleman
- Department of Epidemiology, University of Ghana, Noguchi Memorial Institute for Medical Research, Accra, Ghana
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Evelyn Ansah
- Center for Malaria Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Biostatistics and Epidemiology, School of Public Health, Wits University, Johannesburg-Braamfontein, South Africa
| | - Daniel Arhinful
- Department of Epidemiology, University of Ghana, Noguchi Memorial Institute for Medical Research, Accra, Ghana
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29
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Vimalananda VG, Fincke BG, Qian S, Waring ME, Seibert RG, Meterko M. Development and psychometric assessment of a novel survey to measure care coordination from the specialist's perspective. Health Serv Res 2019; 54:689-699. [PMID: 30941764 DOI: 10.1111/1475-6773.13148] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To develop an online survey of care coordination with primary care providers as experienced by medical specialists, evaluate its psychometric properties, and test its construct validity. DATA SOURCES Physicians (N = 633) from 13 medical specialties across the Veterans Health Administration. STUDY DESIGN We developed the survey based on prior work (literature review, specialist interviews) and by adapting existing measures and developing new items. Multitrait scaling analysis and confirmatory factor analysis were used to assess scale structure. We used multiple linear regression to examine the relationship of the final coordination scales to specialists' overall experience of care coordination. DATA COLLECTION November 2016-December 2016. PRINCIPAL FINDINGS Results suggest a 13-item, four-factor survey [Relationships (k = 4), Roles and Responsibilities (k = 4), Communication (k = 3), and Data Transfer (k = 2)] that measures the medical specialist experience of coordination with good internal consistency reliability, convergent validity, discriminant validity, and goodness of fit. Together, the four scales explained nearly 50 percent of the variance in specialists' overall experience of care coordination. CONCLUSIONS The 13-item Coordination of Specialty Care-Specialist Survey (CSC-Specialist) is the first of its kind. It can be used alone or embedded in other surveys to measure four domains of care coordination as experienced by medical specialists.
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Affiliation(s)
- Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, Massachusetts.,Section of Endocrinology, Diabetes and Metabolism, Boston University School of Medicine, Boston, Massachusetts
| | - Benjamin Graeme Fincke
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, Massachusetts.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Shirley Qian
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, Massachusetts
| | - Molly E Waring
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, Massachusetts.,Department of Allied Health Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, Connecticut
| | - Ryan G Seibert
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Mark Meterko
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts.,VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID - 10EA), Field-based at the Edith Nourse Rogers Memorial VA Medical Center, Bedford, Massachusetts
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30
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Ryskina KL, Yuan Y, Werner RM. Postacute care outcomes and medicare payments for patients treated by physicians and advanced practitioners who specialize in nursing home practice. Health Serv Res 2019; 54:564-574. [PMID: 30895600 DOI: 10.1111/1475-6773.13138] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To measure the association between clinician specialization in nursing home (NH) practice and outcomes of patients who received postacute care in skilled nursing facilities (SNFs). DATA SOURCES Medicare claims and NH assessments for 2 118 941 hospital discharges to 14 526 SNFs in January 2012-October 2014 and MD-PPAS data for 52 379 clinicians. STUDY DESIGN Generalist physicians and advanced practitioners with ≥ 90 percent of claims for NH-based care were considered NH specialists. The primary clinician during each SNF stay was determined based on plurality of claims during that stay. We estimated the effect of being treated by a NH specialist on 30-day rehospitalizations, successful discharge to community, and 60-day episode-of-care Medicare payments (Parts A and B). All models included patient demographics, clinical variables, and SNF fixed effects. PRINCIPAL FINDINGS Nursing home specialists' patients were less likely to be rehospitalized (14.71 percent vs 16.23 percent; adjusted difference, -1.51 percent, 95% CI -1.78 to -1.24), more likely to be successfully discharged to community (56.33 percent vs 55.49 percent; adjusted difference, 0.84 percent, 95% CI 0.54 to 1.14), but had higher 60-day Medicare payments ($31 628 vs $31 292; adjusted difference, $335; 95% CI $242 to $429). CONCLUSIONS Clinicians who specialize in NH practice may achieve better postacute care outcomes at slightly higher costs.
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Affiliation(s)
- Kira L Ryskina
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yihao Yuan
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel M Werner
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
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31
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Werdhani RA, Sulistomo AW, Herqutanto, Wirawan I, Rahajeng E, Sutomo AH, Mansyur M. Correlation of leadership and care coordinator performance among primary care physicians. J Multidiscip Healthc 2018; 11:691-698. [PMID: 30568454 PMCID: PMC6267771 DOI: 10.2147/jmdh.s174917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Primary care physicians have to deal with many aspects of the patients' health problem, which needs cooperation with other health professionals or even nonhealth individuals. To achieve effective results, the primary care physicians should have leadership and coordinating skills, especially when dealing with the health challenges in Asia Pacific region. The care coordinator role of primary care physicians is important to create the bridge between population and health. This study aims to determine the correlation between care coordinator performance and leadership factors among primary care physicians. Materials and methods A cross-sectional study was conducted, and data collection involved a total of 84 primary care physicians who were randomly selected from a total of 44 subdistricts and worked in 40 randomly selected village government-owned primary healthcare facilities in Jakarta. Pearson's correlation, independent t-test, and one-way ANOVA were used to measure the correlation between care coordination and clinical leadership, transformational leadership, commitment, job satisfaction, and organizational culture, as well as the sociodemographics of the physicians and the professional practice factors. Multiple regressions were conducted to determine the most important factors influencing care coordinator performance. Results Respondents were mainly female (94%) with an average age of 36 years and were mostly medical doctors without any additional postgraduate degrees (95.2%). There was no correlation between care coordinator scores and organizational culture or commitment. There were positive and significant correlations between care coordinator scores and clinical leadership score (r=0.66; P<0.001), transformational leadership score (r=0.54; P<0.001), job satisfaction score (r=0.31; P=0.004), physician's age (r=0.34; P=0.002), length of time since graduation (r=0.30; P=0.005), duration of employment at their health center (r=0.33; P=0.003), training in family medicine (P=0.04), and employment status (P=0.005). The most important factors in care coordinator performance were clinical leadership (r=0.53; P<0.001) and transformational leadership (r=0.23; P=0.03), with the total R 2 being 0.47. Conclusion Clinical leadership and transformational leadership were the most important factors for care coordinator performance. Therefore, the leadership skills of primary care physicians are important to be considered as a certain competency in practice to manage various resources and coordinate with related healthcare providers for controlling patients' illness as well as dealing with the challenges and managing the overall health.
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Affiliation(s)
- Retno Asti Werdhani
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia,
| | | | - Herqutanto
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia,
| | - Ismail Wirawan
- Department of Management, Faculty of Economy, Universitas Persada Indonesia, Jakarta, Indonesia
| | - Ekowati Rahajeng
- Researches and Development Unit, Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Adi Heru Sutomo
- Department of Family Medicine, Community, and Bioethics, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, .,SEAMEO-RECFON, Universitas Indonesia, Jakarta, Indonesia
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32
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Savoy A, Patel H, Flanagan ME, Daggy JK, Russ AL, Weiner M. Comparative usability evaluation of consultation order templates in a simulated primary care environment. APPLIED ERGONOMICS 2018; 73:22-32. [PMID: 30098639 DOI: 10.1016/j.apergo.2018.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/12/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
Communication breakdowns in the referral process negatively impact clinical workflow and patient safety. There is a lack of evidence demonstrating the impact of published design recommendations addressing contributing issues with consultation order templates. This study translated the recommendations into a computer-based prototype and conducted a comparative usability evaluation. With a scenario-based simulation, 30 clinicians (referrers) participated in a within-group, counterbalanced experiment comparing the prototype with their present electronic order entry system. The prototype significantly increased satisfaction (Cohen's d = 1.80, 95% CI [1.19, 2.41], p < .001), and required significantly less mental effort (d = 0.67 [0.14, 1.20], p < .001). Regarding efficiency, the prototype required significantly fewer mouse clicks (mean difference = 29 clicks, p < .001). Although overall task time did not differ significantly (d = -0.05 [-0.56, 0.47]), the prototype significantly quickened identification of the appropriate specialty clinic (mean difference = 12 s, d = 0.98 [0.43, 1.52], p < .001). The experimental evidence demonstrated that clinician-centered interfaces significantly improved system usability during ordering of consultations.
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Affiliation(s)
- April Savoy
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA;; Regenstrief Institute, Inc., Indianapolis, IN, USA; School of Business and Economics, Indiana University East, Richmond, IN, USA.
| | - Himalaya Patel
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | | | - Joanne K Daggy
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alissa L Russ
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA;; Regenstrief Institute, Inc., Indianapolis, IN, USA; College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Michael Weiner
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA;; Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
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33
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Patient, Primary Care Provider, and Specialist Perspectives on Specialty Care Coordination in an Integrated Health Care System. J Ambul Care Manage 2018; 41:15-24. [PMID: 29176459 DOI: 10.1097/jac.0000000000000219] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Successful coordination of specialty care requires understanding the perspectives of patients, primary care providers, and specialists-that is, the specialty care "triad." This study used qualitative methods to compare these perspectives in an integrated health care system, using diabetes specialty care as an exemplar. Primary care providers and endocrinologists relied on interclinician relationships to coordinate care. Clinicians rarely included patients or other staff in their conceptualization of specialty care coordination. Patients often assumed responsibility for specialty care coordination but struggled to succeed. We identified several opportunities to improve coordination across the triad. In an integrated medical system, the shared organizational structure can facilitate these efforts.
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Krikorian ML, Growdon AS, Chien AT. Assessment of Hospitalist-Subspecialist Agreement About Who Should Be in Charge and Comparison With Actual Assignment Practices. Hosp Pediatr 2018; 8:479-485. [PMID: 30049683 DOI: 10.1542/hpeds.2017-0177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND A key juncture in patient hospitalization is determining which type of physician should be primarily responsible for directing treatment. We (1) examine the frequency hospitalists and subspecialists agree on preferred assignments and (2) compare preferred assignment with actual assignment. METHODS Using a mixed methods approach, we first surveyed 66 physicians in 8 specialties about hospitalist assignments versus subspecialist assignments for 176 diagnoses at an academic children's hospital. Agreement was calculated by using the interrater reliability coefficient, Pi . We subsequently compared survey responses to actual hospitalization data from January 2009 to August 2015. RESULTS Specialty and physician response rates were 100% and 44%, respectively. For preferred assignment among hospitalists and specialists, some diagnoses (eg, gastroesophageal reflux, syncope) experienced high agreement (π = 0.714-1.000); other diagnoses (eg, Guillain-Barre, encephalopathy) had less agreement (π = 0.000-0.600). Hematologists and oncologists agreed among themselves most frequently (73%); endocrinologists agreed among themselves least frequently (9%). Perceptions of agreement were often higher than actual survey results. Of the 25 highest volume diagnoses, 7 were conditions with consensus (Pi ≥ 0.6) about assignment, and of those conditions, 6 were assigned to a subspecialist at least 50% of the time, although consensus indicated a hospitalist should have been assigned (1597 hospitalizations). CONCLUSIONS This is the first study used to analyze preferences of hospitalist-subspecialist assignment and show variation from actual practice. Although physicians assessed the same patient information, agreement on preferred assignment varied noticeably across diagnoses and subspecialties. With our results, we reveal potential challenges in integrating hospitalists with other specialists and provide evidence for standardizing certain aspects of physician roles.
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Affiliation(s)
- Mariam L Krikorian
- Department of Health Policy and Management, T.H. Chan School of Public Health Harvard University, Boston, Massachusetts; and
| | - Amanda S Growdon
- Department of General Pediatrics, Boston Children's Hospital, and Harvard University Medical School, Boston, Massachusetts
| | - Alyna T Chien
- Department of General Pediatrics, Boston Children's Hospital, and Harvard University Medical School, Boston, Massachusetts
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Ho S, Janiak E. Impact of a case management programme for women seeking later second-trimester abortion: the case of the Massachusetts Access Program. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 45:bmjsrh-2018-200095. [PMID: 30007910 DOI: 10.1136/bmjsrh-2018-200095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/22/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The Massachusetts Access Program is a statewide, centralised referral and case management program created to address barriers to later second-trimester abortions. This study outlines the scope of, describes provider experiences with, and evaluates provider acceptability of the Program. STUDY DESIGN We invited physicians, nurses and staff working in hospitals within the later abortion provider referral network to participate in a mixed-methods study that included a web-based quantitative survey and/or a semi-structured qualitative interview. We used descriptive statistics to analyse survey data and inductive coding methods to analyse interview data. RESULTS From 2007-2012, 15-28% of abortions performed in Massachusetts at 19 weeks or greater gestational age annually were scheduled through the Access Program. We received 16 completed surveys and conducted seven interviews with providers who routinely receive referrals for later abortions through the Program. Providers overall reported positive experiences with the Program and found it highly acceptable. They described that the transportation, accommodation and financial assistance enabled patients access to care. The specialised and updated knowledge of the Access Coordinator in regards to abortion care also allowed her to act as a resource for providers. CONCLUSIONS The Access Program, through its referral and case management network, was a valuable resource both to patients seeking later second-trimester abortions and providers involved in abortion care. It acts as one example of an effective, highly acceptable and potentially replicable intervention to reduce barriers to obtaining later second-trimester abortions.
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Affiliation(s)
- Stephanie Ho
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Elizabeth Janiak
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology Brigham, Women's Hospital, Boston, Massachusetts, USA
- Planned Parenthood League of Massachusetts, Boston, Massachusetts, USA
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Patel MP, Schettini P, O'Leary CP, Bosworth HB, Anderson JB, Shah KP. Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System. J Gen Intern Med 2018; 33. [PMID: 29532299 PMCID: PMC5910374 DOI: 10.1007/s11606-018-4392-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Ideally, a referral from a primary care physician (PCP) to a specialist results in a completed specialty appointment with results available to the PCP. This is defined as "closing the referral loop." As health systems grow more complex, regulatory bodies increase vigilance, and reimbursement shifts towards value, closing the referral loop becomes a patient safety, regulatory, and financial imperative. OBJECTIVE/DESIGN To assess the ability of a large health system to close the referral loop, we used electronic medical record (EMR)-generated data to analyze referrals from a large primary care network to 20 high-volume specialties between July 1, 2015 and June 30, 2016. MAIN MEASURES The primary metric was documented specialist appointment completion rate. Explanatory analyses included documented appointment scheduling rate, individual clinic differences, appointment wait times, and geographic distance to appointments. KEY RESULTS Of the 103,737 analyzed referral scheduling attempts, only 36,072 (34.8%) resulted in documented complete appointments. Low documented appointment scheduling rates (38.9% of scheduling attempts lacked appointment dates), individual clinic differences in closing the referral loop, and significant differences in wait times and distances to specialists between complete and incomplete appointments drove this gap. Other notable findings include high variation in wait times among specialties and correlation between high wait times and low documented appointment completion rates. CONCLUSIONS The rate of closing the referral loop in this health system is low. Low appointment scheduling rates, individual clinic differences, and patient access issues of wait times and geographic proximity explain much of the gap. This problem is likely common among large health systems with complex provider networks and referral scheduling. Strategies that improve scheduling, decrease variation among clinics, and improve patient access will likely improve rates of closing the referral loop. More research is necessary to determine the impact of these changes and other potential driving factors.
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Affiliation(s)
- Malhar P Patel
- Duke University School of Medicine, 8 Duke University Medical Center, Durham, NC, USA.
| | - Priscille Schettini
- Duke University School of Medicine, 8 Duke University Medical Center, Durham, NC, USA
| | - Colin P O'Leary
- Duke University School of Medicine, 8 Duke University Medical Center, Durham, NC, USA
| | - Hayden B Bosworth
- Duke University School of Medicine, 8 Duke University Medical Center, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - John B Anderson
- Duke Primary Care, Duke University Health System, Durham, NC, USA
| | - Kevin P Shah
- Duke Primary Care, Duke University Health System, Durham, NC, USA
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Boisserie-Lacroix L, Marquestaut O, de Stampa M. [Palliative care at home: patient care pathways and clinical characteristics]. SANTE PUBLIQUE 2018; 29:851-859. [PMID: 29473399 DOI: 10.3917/spub.176.0851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The great majority of French people express their desire to receive palliative care at home. The objective of this study was to describe the clinical care pathways and characteristics of patient receiving hospital at home palliative care. METHODS This study compared the care pathways and clinical characteristics of patients receiving palliative care at home in the Ile-de-France region in 2014. Retrospective data were extracted from the French medical information systems programme. RESULTS 817 patients receiving palliative care at home were included in the study. They were older, more often referred to hospital at home by a primary care physician, had shorter lengths of stay and more often died at home compared to patients without palliative care. Palliative care patients mainly presented cancer and received frequent technical nursing care. The oldest patients (≥ 75 years old) more often presented neurodegenerative diseases, were less often transferred to hospital, and more often died at home compared to younger patients. A higher proportion of home deaths was observed in nursing home residents and patients who died at home required less technical nursing care. CONCLUSION This study provides important information concerning admission to hospital at home, the frequent changes of places of care and the complexity of maintaining palliative care at home until the patient's death.
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Abstract
BACKGROUND Care coordinators (CCs) are increasingly employed in primary care as a means to improve health care quality, but little research examines the process by which CCs are integrated into practices. This case study provides an in-depth examination of this process and efforts to optimize the role. METHODS Two CCs' work was observed and assessed, and attempts were made to optimize the role using workflow modeling and "Plan-Do-Study-Act" cycles. Rolling qualitative analyses of field notes from key informant interviews and team meetings were conducted using iterative cycles of "immersion/crystallization" to identify emerging themes. RESULTS Expected roles of CCs included case management of high-risk patients, transitions of care, and population management. Case management was the least difficult to implement; transition management required more effort; and population management met with individual and institutional obstacles and was difficult to address. CONCLUSIONS The process by which CCs are integrated into primary care is not well understood and will require more attention to optimally use this role to improve health care quality. Understanding aspects of CCs' roles that are the least and most difficult to integrate may provide a starting place for developing best practices for implementation of this emerging role.
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Llewellyn H, Neerkin J, Thorne L, Wilson E, Jones L, Sampson EL, Townsley E, Low JTS. Social and structural conditions for the avoidance of advance care planning in neuro-oncology: a qualitative study. BMJ Open 2018; 8:e019057. [PMID: 29391365 PMCID: PMC5878249 DOI: 10.1136/bmjopen-2017-019057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary brain tumours newly affect >260 000 people each year worldwide. In the UK, every year >10 000 people are diagnosed with a brain tumour while >5000 die annually from the disease. Prognoses are poor, cognitive deterioration common and patients have prolonged palliative needs. Advance care planning (ACP) may enable early discussion of future care decisions. Although a core commitment in the UK healthcare strategy, and the shared responsibility of clinical teams, ACP appears uncommon in practice. Evidence around ACP practice in neuro-oncology is limited. OBJECTIVES We aimed to elicit key social and structural conditions contributing to the avoidance of ACP in neuro-oncology. DESIGN A cross-sectional qualitative study design was used. SETTING One tertiary care hospital in the UK. PARTICIPANTS Fifteen healthcare professionals working in neuro-oncology participated in this study, including neuro-oncologists, neurosurgeons, clinical nurse specialists, allied healthcare professionals and a neurologist. METHOD Semi-structured interviews were conducted with participants to explore their assumptions and experiences of ACP. Data were analysed thematically using the well-established framework method. RESULTS Participants recognised the importance of ACP but few had ever completed formal ACP documentation. We identified eight key factors, which we suggest comprise three main conditions for avoidance: (1) difficulties being a highly emotive, time-intensive practice requiring the right 'window of opportunity' and (2) presence and availability of others; (3) ambiguities in ACP definition, purpose and practice. Combined, these created a 'culture of shared avoidance'. CONCLUSION In busy clinical environments, 'shared responsibility' is interpreted as 'others' responsibility' laying the basis for a culture of avoidance. To address this, we suggest a 'generalists and specialists' model of ACP, wherein healthcare professionals undertake particular responsibilities. Healthcare professionals are already adopting this model informally, but without formalised structure it is likely to fail given a tendency for people to assume a generalist role.
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Affiliation(s)
- Henry Llewellyn
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Jane Neerkin
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lewis Thorne
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Elena Wilson
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Emma Townsley
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Joseph T S Low
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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Carter MW, Robbins CL, Gavin L, Moskosky S. Referral Practices Among U.S. Publicly Funded Health Centers That Offer Family Planning Services. J Womens Health (Larchmt) 2018; 27:994-1000. [PMID: 29377754 DOI: 10.1089/jwh.2017.6487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Referrals to other medical services are central to healthcare, including family planning service providers; however, little information exists on the nature of referral practices among health centers that offer family planning. MATERIALS AND METHODS We used a nationally representative survey of administrators from 1,615 publicly funded health centers that offered family planning in 2013-14 to describe the use of six referral practices. We focused on associations between various health center characteristics and frequent use of three active referral practices. RESULTS In the prior 3 months, a majority of health centers (73%) frequently asked clients about referrals at clients' next visit. Under half (43%) reported frequently following up with referral sources to find out if their clients had been seen. A third (32%) of all health centers reported frequently using three active referral practices. In adjusted analysis, Planned Parenthood clinics (adjusted odds ratio 0.55) and hospital-based clinics (AOR 0.39) had lower odds of using the three active referral practices compared with health departments, and Title X funding status was not associated with the outcome. The outcome was positively associated with serving rural areas (AOR 1.39), having a larger client volume (AOR 3.16), being a part of an insurance network (AOR 1.42), and using electronic health records (AOR 1.62). CONCLUSIONS Publicly funded family planning providers were heavily engaged in referrals. Specific referral practices varied widely and by type of care. More assessment of these and other aspects of referral systems and practices is needed to better characterize the quality of care.
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Affiliation(s)
- Marion W Carter
- 1 Division of STD Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Cheryl L Robbins
- 2 Division of Reproductive Health, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Loretta Gavin
- 3 Office of Population Affairs , Rockville, Maryland
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Voruganti T, Grunfeld E, Makuwaza T, Bender JL. Web-Based Tools for Text-Based Patient-Provider Communication in Chronic Conditions: Scoping Review. J Med Internet Res 2017; 19:e366. [PMID: 29079552 PMCID: PMC5681721 DOI: 10.2196/jmir.7987] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/24/2017] [Indexed: 01/30/2023] Open
Abstract
Background Patients with chronic conditions require ongoing care which not only necessitates support from health care providers outside appointments but also self-management. Web-based tools for text-based patient-provider communication, such as secure messaging, allow for sharing of contextual information and personal narrative in a simple accessible medium, empowering patients and enabling their providers to address emerging care needs. Objective The objectives of this study were to (1) conduct a systematic search of the published literature and the Internet for Web-based tools for text-based communication between patients and providers; (2) map tool characteristics, their intended use, contexts in which they were used, and by whom; (3) describe the nature of their evaluation; and (4) understand the terminology used to describe the tools. Methods We conducted a scoping review using the MEDLINE (Medical Literature Analysis and Retrieval System Online) and EMBASE (Excerpta Medica Database) databases. We summarized information on the characteristics of the tools (structure, functions, and communication paradigm), intended use, context and users, evaluation (study design and outcomes), and terminology. We performed a parallel search of the Internet to compare with tools identified in the published literature. Results We identified 54 papers describing 47 unique tools from 13 countries studied in the context of 68 chronic health conditions. The majority of tools (77%, 36/47) had functions in addition to communication (eg, viewable care plan, symptom diary, or tracker). Eight tools (17%, 8/47) were described as allowing patients to communicate with the team or multiple health care providers. Most of the tools were intended to support communication regarding symptom reporting (49%, 23/47), and lifestyle or behavior modification (36%, 17/47). The type of health care providers who used tools to communicate with patients were predominantly allied health professionals of various disciplines (30%, 14/47), nurses (23%, 11/47), and physicians (19%, 9/47), among others. Over half (52%, 25/48) of the tools were evaluated in randomized controlled trials, and 23 tools (48%, 23/48) were evaluated in nonrandomized studies. Terminology of tools varied by intervention type and functionality and did not consistently reflect a theme of communication. The majority of tools found in the Internet search were patient portals from 6 developers; none were found among published articles. Conclusions Web-based tools for text-based patient-provider communication were identified from a wide variety of clinical contexts and with varied functionality. Tools were most prevalent in contexts where intended use was self-management. Few tools for team-based communication were found, but this may become increasingly important as chronic disease care becomes more interdisciplinary.
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Affiliation(s)
- Teja Voruganti
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eva Grunfeld
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Tutsirai Makuwaza
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jacqueline L Bender
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ELLICSR Health, Wellness & Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Palanisamy R, Taskin N, Verville J. Impact of Trust and Technology on Interprofessional Collaboration in Healthcare Settings. INTERNATIONAL JOURNAL OF E-COLLABORATION 2017. [DOI: 10.4018/ijec.2017040102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The increases in complexity of patient care, healthcare costs, and technological advancements shifted the healthcare delivery to interprofessional collaborative care. The study aims for identifying the factors influencing the quality of team collaboration. The study examines the impact of trust and technology orientation on collaboration with the mediating effects of communication, coordination and cooperation. A questionnaire survey was conducted to gather data from healthcare professionals (N=216). Statistical analysis conducted for this study include correlations, factor analysis with reliability and validity tests and Partial Least Squares (PLS) method. The results of the study validate that (i) collaboration has positive and significant relationship with coordination, and cooperation; (ii) trust has positive and significant relationship with communication, coordination, and cooperation; and (iii) technology orientation has positive and significant relationship with cooperation but not with communication and coordination. The research and managerial implications of these factors are given in discussion. As with most empirical studies, the subjectivity of the opinion of respondents present some limitations to generalization. Other limitations include the lack of availability and use of standard measures for various constructs in the research model. The results can be used by healthcare professionals and managers to advance their understanding on the impact of trust and technology on collaboration mediating communication, coordination and cooperation practices. The significant value of this study is the identification of the factors influencing the quality of team collaboration in healthcare industry.
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Affiliation(s)
- Ramaraj Palanisamy
- Gerald Schwartz School of Business, St. Francis Xavier University, Antigonish, Canada
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Iliffe S, Wilcock J, Synek M, Carboch R, Hradcová D, Holmerová I. Case Management for People with Dementia and its Translations: A Discussion Paper. DEMENTIA 2017; 18:951-969. [DOI: 10.1177/1471301217697802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, University College London, UK
| | - Michal Synek
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic; Department of Sociology, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Radek Carboch
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic; Department of Sociology, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Dana Hradcová
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic
| | - Iva Holmerová
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic
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Zanello E, Calugi S, Sanders LM, Lenzi J, Faldella G, Rucci P, Fantini MP. Care coordination for children with special health care needs: a cohort study. Ital J Pediatr 2017; 43:18. [PMID: 28257651 PMCID: PMC5347827 DOI: 10.1186/s13052-017-0342-3] [Citation(s) in RCA: 7] [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: 09/21/2016] [Accepted: 02/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care coordination is widely recognized as a key element of care for patients with chronic and complex medical conditions and their families. In care for children with special health care needs the Family Pediatrician (FP) plays a central role as care coordinator. This study aims to evaluate the FPs' activities of care coordination for children with special health care needs in the pediatric primary care setting, using an on-line measurement tool. METHODS Within the prospective cohort study SpeNK (Special Needs Kids), newborns and children with special health care needs were recruited at discharge from three hospital facilities in Bologna province, from October 1st 2012 to September 30th 2014. Their FPs were invited to complete a questionnaire (SpeNK-FP) at each encounter for the patient during a 9-month period after hospital discharge. SpeNK-FP was developed by adapting the Care Coordination Measurement Tool (CCMT©) developed by Antonelli et al., to the Italian organizational context. The outcome of interest, derived from the questionnaire, is inappropriate use of services. RESULTS Forty FPs completed assessments for 49 children at each of 382 clinical encounters. The majority of children (71.4%) had special health care needs, without complicating social issues. FPs reported "no need for care coordination" in 50.8% of the encounters and 41.1% of records about patient needs requiring care coordination. The most common activity implemented to meet children's needs was telephone contact with a medical provider. According to FPs, 80% of encounters prevented inappropriate services use. In multivariate regression, pediatric-specialist contact (telephone or in person) was associated with reduced odds of physician report of preventable hospitalization (OR = 0.06, 95% CI 0.01-0.42, p = 0.005). CONCLUSIONS The study shows the potential for FPs in Italy to serve as care coordinators and facilitate the implementation of integrated care pathways for children with special health care needs.
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Affiliation(s)
- Elisa Zanello
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, Alma Mater Studiorum University of Bologna, Via San Giacomo 12, Bologna, 40126, Italy
| | - Simona Calugi
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, Alma Mater Studiorum University of Bologna, Via San Giacomo 12, Bologna, 40126, Italy
| | - Lee M Sanders
- Division of General Pediatrics, Senior Faculty, Center for Policy, Outcomes and Prevention (CPOP), Stanford University, 117 Encina Commons, Stanford, CA, 94305-6019, USA
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, Alma Mater Studiorum University of Bologna, Via San Giacomo 12, Bologna, 40126, Italy
| | - Giacomo Faldella
- Department of Medical and Surgical Sciences, Neonatology and Neonatal Intensive Care Unit, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 11, Bologna, 40138, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, Alma Mater Studiorum University of Bologna, Via San Giacomo 12, Bologna, 40126, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, Alma Mater Studiorum University of Bologna, Via San Giacomo 12, Bologna, 40126, Italy.
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Breton M, Green M, Kreindler S, Sutherland J, Jbilou J, Wong ST, Shaw J, Crooks VA, Contandriopoulos D, Smithman MA, Brousselle A. A comparative analysis of centralized waiting lists for patients without a primary care provider implemented in six Canadian provinces: study protocol. BMC Health Serv Res 2017; 17:60. [PMID: 28109279 PMCID: PMC5251310 DOI: 10.1186/s12913-017-2007-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Having a regular primary care provider (i.e., family physician or nurse practitioner) is widely considered to be a prerequisite for obtaining healthcare that is timely, accessible, continuous, comprehensive, and well-coordinated with other parts of the healthcare system. Yet, 4.6 million Canadians, approximately 15% of Canada's population, are unattached; that is, they do not have a regular primary care provider. To address the critical need for attachment, especially for more vulnerable patients, six Canadian provinces have implemented centralized waiting lists for unattached patients. These waiting lists centralize unattached patients' requests for a primary care provider in a given territory and match patients with providers. From the little information we have on each province's centralized waiting list, we know the way they work varies significantly from province to province. The main objective of this study is to compare the different models of centralized waiting lists for unattached patients implemented in six provinces of Canada to each other and to available scientific knowledge to make recommendations on ways to improve their design in an effort to increase attachment of patients to a primary care provider. METHODS A logic analysis approach developed in three steps will be used. Step 1: build logic models that describe each province's centralized waiting list through interviews with key stakeholders in each province; step 2: develop a conceptual framework, separate from the provincially informed logic models, that identifies key characteristics of centralized waiting lists for unattached patients and factors influencing their implementation through a literature review and interviews with experts; step 3: compare the logic models to the conceptual framework to make recommendations to improve centralized waiting lists in different provinces during a pan Canadian face-to-face exchange with decision-makers, clinicians and researchers. DISCUSSION This study is based on an inter-provincial learning exchange approach where we propose to compare centralized waiting lists and analyze variations in strategies used to increase attachment to a regular primary care provider. Fostering inter-provincial healthcare systems connectivity to improve centralized waiting lists' practices across Canada can lever attachment to a regular provider for timely access to continuous, comprehensive and coordinated healthcare for all Canadians and particular for those who are vulnerable.
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Affiliation(s)
- Mylaine Breton
- Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC J4K 0A8 Canada
| | - Michael Green
- Family Medicine and Public Health Sciences and CHSPR, Queen’s University, Abramsky Hall, 3rd Floor 21 Arch St., Kingston, ON K7L 3N6 Canada
| | - Sara Kreindler
- Manitoba Research Chair in Health System Innovation and Community Health Sciences, University of Manitoba, 200-1155 Concordia Ave., Winnipeg, MB R2K 2M9 Canada
| | - Jason Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Jalila Jbilou
- School of psychology, Université de Moncton, Centre de formation médicale du Nouveau-Brunswick, Pavillon Léopold-Taillon Université de Moncton, 18 Ave Antonine-Maillet, Moncton, NB E1A 3E9 Canada
| | - Sabrina T. Wong
- School of Nursing and Centre for Health Services and Policy Research in the School of Population and Public Health, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Jay Shaw
- Institute for Health System Solutions and Virtual Care, Women’s College Hospital, 76 Grenville Street, Toronto, ON M5S1B2 Canada
| | - Valorie A. Crooks
- Canada Research Chair in Health Service Geographies, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Damien Contandriopoulos
- Faculty of nursing, University of Montréal, 2375, chemin de la Côte-Ste-Catherine, Montréal, Québec H3T 1A8 Canada
| | - Mélanie Ann Smithman
- Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC J4K 0A8 Canada
| | - Astrid Brousselle
- Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC J4K 0A8 Canada
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Breton M, Smithman MA, Brousselle A, Loignon C, Touati N, Dubois CA, Nour K, Boivin A, Berbiche D, Roberge D. Assessing the performance of centralized waiting lists for patients without a regular family physician using clinical-administrative data. BMC FAMILY PRACTICE 2017; 18:1. [PMID: 28073347 PMCID: PMC5225629 DOI: 10.1186/s12875-016-0573-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022]
Abstract
Background With 4.6 million patients who do not have a regular family physician, Canada performs poorly compared to other OECD countries in terms of attachment to a family physician. To address this issue, several provinces have implemented centralized waiting lists to coordinate supply and demand for attachment to a family physician. Although significant resources are invested in these centralized waiting lists, no studies have measured their performance. In this article, we present a performance assessment of centralized waiting lists for unattached patients implemented in Quebec, Canada. Methods We based our approach on the Balanced Scorecard method. A committee of decision-makers, managers, healthcare professionals, and researchers selected five indicators for the performance assessment of centralized waiting lists, including both process and outcome indicators. We analyzed and compared clinical-administrative data from 86 centralized waiting lists (GACOs) located in 14 regions in Quebec, from April 1, 2013, to March 31, 2014. Results During the study period, although over 150,000 patients were attached to a family physician, new requests resulted in a 30% median increase in patients on waiting lists. An inverse correlation of average strength was found between the rates of patients attached to a family physician and the proportion of vulnerable patients attached to a family physician meaning that as more patients became attached to an FP through GACOs, the proportion of vulnerable patients became smaller (r = −0.31, p < 0.005). The results showed very large performance variations both among GACOs of different regions and among those of a same region for all performance indicators. Conclusions Centralized waiting lists for unattached patients in Quebec seem to be achieving their twofold objective of attaching patients to a family physician and giving priority to vulnerable patients. However, the demand for attachment seems to exceed the supply and there appears to be a tension between giving priority to vulnerable patients and attaching of a large number of patients. Results also showed heterogeneity in the performance of centralized waiting lists across Quebec. Finally, our findings suggest it is critical that similar mechanisms should use available data to identify the best strategies for reducing variations and improving performance. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0573-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mylaine Breton
- Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada.
| | - Mélanie Ann Smithman
- Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Astrid Brousselle
- Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Christine Loignon
- Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Nassera Touati
- École nationale d'administration publique (Montréal), 4750, avenue Henri-Julien, Office 5117, Montreal, QC, H2T 3E5, Canada
| | - Carl-Ardy Dubois
- Faculty of Nursing, University of Montreal, 2375, chemin de la Côte Ste-Catherine, Office 5103, Montreal, QC, H3T 1A8, Canada
| | - Kareen Nour
- Direction de santé publique, Centre intégré de santé et des services sociaux-Montérégie-Centre, 1255 rue Beauregard, Longueuil, QC, J4K 2M3, Canada
| | - Antoine Boivin
- University of Montreal Hospital Research Centre, University of Montreal, 900 Rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - Djamal Berbiche
- Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Danièle Roberge
- Charles-LeMoyne Hospital Research Centre, Sherbrooke University, Longueuil Campus, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
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Abstract
American health care is complex, fragmented, and arcane rather than being patient centered. Many patients have considerable difficulty navigating this system. As a result, care is less timely, safe, effective, and efficient. Since navigation problems are more likely for those who are sicker and less educated, they contribute to inequity. Early solutions proposed for this problem focused on the use of yet another specialized professional, the “navigator,” to help individuals find their way through the system so they get the care they need. The author defines the patient navigation problem and its probable consequences and argues that research and action are needed to (a) document the problem empirically, (b) identify underlying organizational structures and behaviors that can make navigation easy or difficult, and (c) assess whether and how policies, regulations, and improvement strategies can influence these structures and behaviors.
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Turvey CL, Roberts LJ. Recent developments in the use of online resources and mobile technologies to support mental health care. Int Rev Psychiatry 2016; 27:547-57. [PMID: 26523397 DOI: 10.3109/09540261.2015.1087975] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This review describes recent developments in online and mobile mental health applications, including a discussion of patient portals to support mental health care. These technologies are rapidly evolving, often before there is systematic investigation of their effectiveness. Though there are some reviews of the effectiveness of mental health mobile apps, perhaps the more significant development is innovation in technology evaluation as well as new models of interprofessional collaboration in developing behavioural health technologies. Online mental health programs have a strong evidence base. Their role in population health strategies needs further exploration, including the most effective use of limited clinical staff resources. Patient portals and personal health records serve to enhance mental health treatment also, though concerns specific to mental health must be addressed to support broader adoption of portals. Provider concerns about sharing psychiatric notes with patients hinder support for portals. Health information exchange for mental health information requires thoughtful consent management strategies so mental health patients can benefit. Finally, the broad array of health information technologies may overwhelm patients. User-friendly, well-designed, patient-centred health information technology homes may integrate these functions to promote a holistic approach to care plans and overall wellness. Such technology homes have special security needs and require providers and patients to be well informed about how best to use these technologies to support behavioural health interventions.
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Affiliation(s)
- Carolyn L Turvey
- a Department of Psychiatry, Carver College of Medicine , University of Iowa , Iowa City , Iowa
| | - Lisa J Roberts
- a Department of Psychiatry, Carver College of Medicine , University of Iowa , Iowa City , Iowa.,b AMC Health , New York , USA
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Zachary W, Maulitz RC, Zachary DA. What Causes Care Coordination Problems? A Case for Microanalysis. EGEMS (WASHINGTON, DC) 2016; 4:1230. [PMID: 27563685 PMCID: PMC4975569 DOI: 10.13063/2327-9214.1230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Care coordination (CC) is an important fulcrum for pursuing a range of health care goals. Current research and policy analyses have focused on aggregated data rather than on understanding what happens within individual cases. At the case level, CC emerges as a complex network of communications among providers over time, crossing and recrossing many organizational boundaries. Micro-level analysis is needed to understand where and how CC fails, as well as to identify best practices and root causes of problems. COORDINATION PROCESS DIAGRAMMING Coordination Process Diagramming (CPD) is a new framework for representing and analyzing CC arcs at the micro level, separating an arc into its participants and roles, communication structure, organizational structures, and transitions of care, all on a common time line. CONCLUSION Comparative CPD analysis across a sample of CC arcs identifies common CC problems and potential root causes, showing the potential value of the framework. The analyses also suggest intervention strategies that could be applied to attack the root causes of CC problems, including organizational changes, education and training, and additional health information technology development.
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Rattler TL, Walder AM, Feng H, Raphael JL. Care Coordination for Children With Sickle Cell Disease: A Longitudinal Study of Parent Perspectives and Acute Care Utilization. Am J Prev Med 2016; 51:S55-61. [PMID: 27320467 PMCID: PMC4916339 DOI: 10.1016/j.amepre.2016.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/13/2016] [Accepted: 01/27/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Care coordination (CC), a core element of the medical home, has the potential to reduce fragmented care and improve patient experience for children with sickle cell disease (SCD). This study aimed to (1) assess CC for pediatric SCD and (2) determine its association with acute care utilization-emergency department encounters and hospitalizations. It was hypothesized that CC would reduce acute care utilization. METHODS A longitudinal study of 101 children with SCD was conducted. Parents completed a survey instrument on enrollment. Utilization chart review was conducted 9 months post survey. Outcome variables were emergency department encounters and hospitalizations. Independent variables were parent-reported CC, satisfaction with communication between healthcare providers, and satisfaction with communication between healthcare providers and non-medical providers (e.g., schools, child care centers). Multivariate negative binomial regression was conducted to assess associations between CC and acute care utilization. Data were collected in 2011-2013 and analyzed in 2015. RESULTS One third of children had emergency department encounters and 30% had hospitalizations. At enrollment, 25% of parents reported receiving CC help and 20% reported need for extra CC. Most parents were satisfied with communication between physicians but only two thirds were satisfied with communication between their healthcare providers and non-medical providers. No significant associations were found between CC measures and acute care utilization. CONCLUSIONS Although parents report multiple CC deficiencies, no associations were found between CC and acute care utilization. Population-based studies are warranted to more definitively determine the association between CC and acute care utilization for children with SCD.
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Affiliation(s)
- Tiffany L Rattler
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas;.
| | - Annette M Walder
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Hua Feng
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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