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Endalamaw A, Zewdie A, Wolka E, Assefa Y. Care models for individuals with chronic multimorbidity: lessons for low- and middle-income countries. BMC Health Serv Res 2024; 24:895. [PMID: 39103802 DOI: 10.1186/s12913-024-11351-y] [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: 05/31/2024] [Accepted: 07/23/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Patients with multiple long-term conditions requires understanding the existing care models to address their complex and multifaceted health needs. However, current literature lacks a comprehensive overview of the essential components, impacts, challenges, and facilitators of these care models, prompting this scoping review. METHODS A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews guideline. Our search encompassed articles from PubMed, Web of Science, EMBASE, SCOPUS, and Google Scholar. The World Health Organization's health system framework was utilized to synthesis the findings. This framework comprises six building blocks (service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance) and eight key characteristics of good service delivery models (access, coverage, quality, safety, improved health, responsiveness, social and financial risk protection, and improved efficiency). Findings were synthesized qualitatively to identify components, impacts, barriers, and facilitators of care models. RESULTS A care model represents various collective interventions in the healthcare delivery aimed at achieving desired outcomes. The names of these care models are derived from core activities or major responsibilities, involved healthcare teams, diseases conditions, eligible clients, purposes, and care settings. Notable care models include the Integrated, Collaborative, Integrated-Collaborative, Guided, Nurse-led, Geriatric, and Chronic care models, as well as All-inclusive Care Model for the Elderly, IMPACT clinic, and Geriatric Patient-Aligned Care Teams (GeriPACT). Other care models (include Care Management Plus, Value Stream Mapping, Preventive Home Visits, Transition Care, Self-Management, and Care Coordination) have supplemented the main ones. Care models improved quality of care (such as access, patient-centeredness, timeliness, safety, efficiency), cost of care, and quality of life for patients that were facilitated by presence of shared mission, system and function integration, availability of resources, and supportive tools. CONCLUSIONS Care models were implemented for the purpose of enhancing quality of care, health outcomes, cost efficiency, and patient satisfaction by considering careful recruitment of eligible clients, appropriate selection of service delivery settings, and robust organizational arrangements involving leadership roles, healthcare teams, financial support, and health information systems. The distinct team compositions and their roles in service provision processes differentiate care models.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Kling SMR, Aleshin MA, Saliba-Gustafsson EA, Garvert DW, Brown-Johnson CG, Amano A, Kwong BY, Calugar A, Shaw JG, Ko JM, Winget M. Evolution of a Project to Improve Inpatient-to-Outpatient Dermatology Care Transitions: Mixed Methods Evaluation. JMIR DERMATOLOGY 2023; 6:e43389. [PMID: 37632927 PMCID: PMC10335331 DOI: 10.2196/43389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND In-hospital dermatological care has shifted from dedicated dermatology wards to consultation services, and some consulted patients may require postdischarge follow-up in outpatient dermatology. Safe and timely care transitions from inpatient-to-outpatient specialty care are critical for patient health, but communication around these transitions can be disjointed, and workflows can be complex. OBJECTIVE In this 3-phase quality improvement effort, we developed and evaluated an intervention that leveraged an electronic health record (EHR) feature, known as SmartPhrase, to enable a new workflow to improve transitions from inpatient care to outpatient dermatology. METHODS Phase 1 (February-March 2021) included interviews with patients and process mapping with key stakeholders to identify gaps and inform an intervention: a SmartPhrase table and associated workflow to promote collection of patient information needed for scheduling follow-up and closed-loop communication between dermatology and scheduling teams. In phase 2 (April-May 2021), semistructured interviews-with dermatologists (n=5), dermatology residents (n=5), and schedulers (n=6)-identified pain points and refinements. In phase 3, the intervention was evaluated by triangulating data from these interviews with measured changes in scheduling efficiency, visit completion, and messaging volume preimplementation (January-February 2021) and postimplementation (April-May 2021). RESULTS Preintervention pain points included unclear workflow for care transitions, limited patient input in follow-up planning, multiple messaging channels (eg, EHR based, email, and phone messages), and time-inefficient patient tracking. The intervention addressed most pain points; interviewees reported the intervention was easy to adopt and improved scheduling efficiency, workload, and patient involvement. More visits were completed within the desired timeframe of 14 days after discharge during the postimplementation period (21/47, 45%) than the preimplementation period (28/41, 68%; P=.03). The messaging workload also decreased from 88 scheduling-related messages sent for 25 patients before implementation to 30 messages for 8 patients after implementation. CONCLUSIONS Inpatient-to-outpatient specialty care transitions are complex and involve multiple stakeholders, thus requiring multifaceted solutions. With deliberate evaluation, broad stakeholder input, and iteration, we designed and implemented a successful solution using a standard EHR feature, SmartPhrase, integrated into a standardized workflow to improve the timeliness of posthospital specialty care and reduce workload.
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Affiliation(s)
- Samantha M R Kling
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Maria A Aleshin
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Erika A Saliba-Gustafsson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Donn W Garvert
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Cati G Brown-Johnson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Alexis Amano
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ana Calugar
- Ambulatory Quality Department, Stanford Health Care, Stanford, CA, United States
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Justin M Ko
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Marcy Winget
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Nicolet A, Perraudin C, Krucien N, Wagner J, Peytremann-Bridevaux I, Marti J. Preferences of older adults for healthcare models designed to improve care coordination: evidence from Western Switzerland. Health Policy 2023; 132:104819. [PMID: 37060718 DOI: 10.1016/j.healthpol.2023.104819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/02/2022] [Accepted: 04/04/2023] [Indexed: 04/08/2023]
Abstract
Implementing innovations in care delivery in Switzerland is challenging due to the fragmented nature of the system and the specificities of the political process (i.e., direct democracy, decentralized decision-making). In this context, it is particularly important to account for population preferences when designing policies. We designed a discrete choice experiment to study population preferences for coordination-improving care models. Specifically, we assessed the relative importance of model characteristics (i.e., insurance premium, presence of care coordinator, access to specialists, use of EMR, cost-sharing for chronic patients, incentives for informal care), and predicted uptake under different policy scenarios. We accounted for heterogeneity in preferences for the status quo option using an error component logit model. Respondents attached the highest importance to the price attribute (i.e. insurance premium) (0.31, CI: 0.27- 0.36) and to the presence of a care coordinator (0.27, CI: 0.23 - 0.31). Policy scenarios showed for instance that gatekeeping would be preferred to free access to specialists if the model includes a GP or an interprofessional team as a care coordinator. Although attachment to the status quo is high in the studied population, there are potential ways to improve acceptance of alternative care models by implementation of positively valued innovations.
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Campagna V, Mitchell E, Krsnak J. Addressing Social Determinants of Health: A Care Coordination Approach for Professional Case Managers. Prof Case Manag 2022; 27:263-270. [PMID: 36206117 DOI: 10.1097/ncm.0000000000000590] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Social determinants of health (SDOH) continue to gain attention as the factors that weigh heavily on physical and mental health. In response, professional case managers need to develop a deeper understanding of the entrenched nature of SDOH, particularly the spiraling and compounding effects of economic, environmental, and social factors on the health and well-being of individuals and populations. Professional case managers are essential to helping identify both the barriers experienced by individuals in accessing and receiving the care they need and the resources to eliminate or mitigate those barriers. These responsibilities should be most keenly felt by case managers who are board-certified and therefore held accountable by codes of ethics to ensure justice and fairness. By embedding greater awareness of SDOH into the case management process-from intake and assessment through implementation, evaluation, and across care transitions-case managers can establish rapport with clients (known as "patients" in some care settings) and support improved outcomes through best practices in care coordination, thus contributing to the Triple Aim of improving the health of people and populations and reducing the per capita cost of care. PRIMARY PRACTICE SETTINGS SDOH impact individuals across the health and human services, including acute care, subacute care, primary care, community-based care, and workers' compensation. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Case management plays a vital role in providing people with episodic care and ensuring adequate follow-up. The latter includes if and how people are able to access the ongoing care they need, including medications (access and affordability), doctors' visits, therapies and other services, healthy nutrition, and more. However, a lack of affordability undermines an individual's ability to receive preventive care and treatment of chronic illnesses and potentially more serious and life-threatening conditions such as cancer. Compounding the impact of affordability can be a lack of transportation that inhibits access to health care professionals, which can affect individuals in both rural and inner-city environments. Although poverty and homelessness play a direct role in SDOH, case managers cannot assume which clients are impacted by these factors and which are not. Higher costs of living, loss of job or reduced income, unexpected expenses, and death of, or divorce from, a partner/spouse can negatively impact a client's ability to access and afford care. With this understanding, case managers can meet individuals where they are to explore how SDOH affects their lives, without judgment, bias, or assumption.
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Affiliation(s)
- Vivian Campagna
- Vivian Campagna, DNP, RN-BC, CCM, is the Chief Industry Relations Officer (CIRO) for the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies more than 50,000 professional case managers and disability management specialists. The Commission oversees the process of case manager certification with its CCM credential and the process of disability management specialist certification with its CDMS credential. Vivian has been involved in case management for more than 30 years
- Ellen Mitchell, MA, RN, CCM, is the Director of Education and Industry Relations for CCMC. Ellen has more than 25 years of experience in the field of hospital case management and has presented nationally on topics of interest to the specialty. She is integral in the development and implementation of continuing education for case managers through needs assessment and identification of current and future trends impacting health care and care coordination
- Jean Krsnak, MSN, MBA, RN, CCM, is a CCMC Commissioner. At the time of this writing, she was an Acute Care Case Manager at UC Irvine Medical Center and has recently retired. She has had more than 20 years of experience as a registered nurse, in a variety of roles including clinician, staff educator, consultant, and case manager. Her experience was primarily in academic centers and across settings including critical care, medical and surgical telemetry, and oncology
| | - Ellen Mitchell
- Vivian Campagna, DNP, RN-BC, CCM, is the Chief Industry Relations Officer (CIRO) for the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies more than 50,000 professional case managers and disability management specialists. The Commission oversees the process of case manager certification with its CCM credential and the process of disability management specialist certification with its CDMS credential. Vivian has been involved in case management for more than 30 years
- Ellen Mitchell, MA, RN, CCM, is the Director of Education and Industry Relations for CCMC. Ellen has more than 25 years of experience in the field of hospital case management and has presented nationally on topics of interest to the specialty. She is integral in the development and implementation of continuing education for case managers through needs assessment and identification of current and future trends impacting health care and care coordination
- Jean Krsnak, MSN, MBA, RN, CCM, is a CCMC Commissioner. At the time of this writing, she was an Acute Care Case Manager at UC Irvine Medical Center and has recently retired. She has had more than 20 years of experience as a registered nurse, in a variety of roles including clinician, staff educator, consultant, and case manager. Her experience was primarily in academic centers and across settings including critical care, medical and surgical telemetry, and oncology
| | - Jean Krsnak
- Vivian Campagna, DNP, RN-BC, CCM, is the Chief Industry Relations Officer (CIRO) for the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies more than 50,000 professional case managers and disability management specialists. The Commission oversees the process of case manager certification with its CCM credential and the process of disability management specialist certification with its CDMS credential. Vivian has been involved in case management for more than 30 years
- Ellen Mitchell, MA, RN, CCM, is the Director of Education and Industry Relations for CCMC. Ellen has more than 25 years of experience in the field of hospital case management and has presented nationally on topics of interest to the specialty. She is integral in the development and implementation of continuing education for case managers through needs assessment and identification of current and future trends impacting health care and care coordination
- Jean Krsnak, MSN, MBA, RN, CCM, is a CCMC Commissioner. At the time of this writing, she was an Acute Care Case Manager at UC Irvine Medical Center and has recently retired. She has had more than 20 years of experience as a registered nurse, in a variety of roles including clinician, staff educator, consultant, and case manager. Her experience was primarily in academic centers and across settings including critical care, medical and surgical telemetry, and oncology
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Smith MA, Yu M, Huling JD, Wang X, DeLonay A, Jaffery J. Impactability Modeling for Reducing Medicare Accountable Care Organization Payments and Hospital Events in High-Need High-Cost Patients: Longitudinal Cohort Study. J Med Internet Res 2022; 24:e29420. [PMID: 35699983 PMCID: PMC9237769 DOI: 10.2196/29420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background Impactability modeling promises to help solve the nationwide crisis in caring for high-need high-cost patients by matching specific case management programs with patients using a “benefit” or “impactability” score, but there are limitations in tailoring each model to a specific program and population. Objective We evaluated the impact on Medicare accountable care organization savings from developing a benefit score for patients enrolled in a historic case management program, prospectively implementing the score, and evaluating the results in a new case management program. Methods We conducted a longitudinal cohort study of 76,140 patients in a Medicare accountable care organization with multiple before-and-after measures of the outcome, using linked electronic health records and Medicare claims data from 2012 to 2019. There were 489 patients in the historic case management program, with 1550 matched comparison patients, and 830 patients in the new program, with 2368 matched comparison patients. The historic program targeted high-risk patients and assigned a centrally located registered nurse and social worker to each patient. The new program targeted high- and moderate-risk patients and assigned a nurse physically located in a primary care clinic. Our primary outcomes were any unplanned hospital events (admissions, observation stays, and emergency department visits), count of event-days, and Medicare payments. Results In the historic program, as expected, high-benefit patients enrolled in case management had fewer events, fewer event-days, and an average US $1.15 million reduction in Medicare payments per 100 patients over the subsequent year when compared with the findings in matched comparison patients. For the new program, high-benefit high-risk patients enrolled in case management had fewer events, while high-benefit moderate-risk patients enrolled in case management did not differ from matched comparison patients. Conclusions Although there was evidence that a benefit score could be extended to a new case management program for similar (ie, high-risk) patients, there was no evidence that it could be extended to a moderate-risk population. Extending a score to a new program and population should include evaluation of program outcomes within key subgroups. With increased attention on value-based care, policy makers and measure developers should consider ways to incorporate impactability modeling into program design and evaluation.
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Affiliation(s)
- Maureen A Smith
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States.,Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Menggang Yu
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Jared D Huling
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, United States
| | - Xinyi Wang
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Allie DeLonay
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Jonathan Jaffery
- University of Wisconsin Health Office of Population Health, Madison, WI, United States.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
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6
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Kling SMR, Saliba-Gustafsson EA, Winget M, Aleshin MA, Garvert DW, Amano A, Brown-Johnson CG, Kwong BY, Calugar A, El-Banna G, Shaw JG, Asch SM, Ko JM. Teledermatology to Facilitate Patient Care Transitions from Inpatient to Outpatient Dermatology: a Mixed Methods Evaluation (Preprint). J Med Internet Res 2022; 24:e38792. [PMID: 35921146 PMCID: PMC9386584 DOI: 10.2196/38792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 01/26/2023] Open
Abstract
Background Both clinicians and patients have increasingly turned to telemedicine to improve care access, even in physical examination–dependent specialties such as dermatology. However, little is known about whether teledermatology supports effective and timely transitions from inpatient to outpatient care, which is a common care coordination gap. Objective Using mixed methods, this study sought to retrospectively evaluate how teledermatology affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care. Methods Patient-level encounter scheduling data were used to compare the number and proportion of patients who were scheduled and received in-clinic or video dermatology follow-ups within 14 and 90 days after discharge across 3 phases: June to September 2019 (before teledermatology), June to September 2020 (early teledermatology), and February to May 2021 (sustained teledermatology). The time from discharge to scheduling and completion of patient follow-up visits for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions of teledermatology for postdischarge patients. Results More patients completed follow-up within 90 days after discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). Thus, the clinic’s capacity to provide follow-up to patients transitioning from inpatient increased from baseline by 36% in the early (101 from 74) and sustained (100 from 74) teledermatology periods. During early teledermatology use, 61.4% (62/101) of the follow-ups were conducted via video. This decreased significantly to 47% (47/100) in the following year, when COVID-19–related restrictions started to lift (P=.04), indicating more targeted but still substantial use. The proportion of patients who were followed up within the recommended 14 days after discharge did not differ significantly between video and in-clinic visits during the early (33/62, 53% vs 15/39, 38%; P=.15) or sustained (26/53, 60% vs 28/47, 49%; P=.29) teledermatology periods. Interviewees agreed that teledermatology would continue to be offered. Most considered postdischarge follow-up patients to be ideal candidates for teledermatology as they had undergone a recent in-person assessment and might have difficulty attending in-clinic visits because of competing health priorities. Some reported patients needing technological support. Ultimately, most agreed that the choice of follow-up care modality should be the patient’s own. Conclusions Teledermatology could be an important tool for maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during the pandemic, although the timeliness of care transitions did not improve. Ultimately, the care modality should be determined through communication with patients to incorporate their and their caregivers’ preferences.
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Affiliation(s)
- Samantha M R Kling
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Erika A Saliba-Gustafsson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Marcy Winget
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Maria A Aleshin
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Donn W Garvert
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Alexis Amano
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Cati G Brown-Johnson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ana Calugar
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ghida El-Banna
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Steven M Asch
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Heath Care System, Menlo Park, CA, United States
| | - Justin M Ko
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
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Song N, Frean M, Covington CT, Tietschert M, Ling E, Bahadurzada H, Kerrissey M, Friedberg M, Singer SJ. Patients' Perceptions of Integrated Care Among Medicare Beneficiaries by Level of Need for Health Services. Med Care Res Rev 2022; 79:640-649. [PMID: 35012390 DOI: 10.1177/10775587211067897] [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: 11/17/2022]
Abstract
Requirements for integrating care across providers, settings, and over time increase with patients' needs. Health care providers' ability to offer care that patients experience as integrated may vary among patients with different levels of need. We explore the variation in patients' perceptions of integrated care among Medicare beneficiaries based on the beneficiary's level of need using ordinary least square regression for each of four high-need groups: beneficiaries (a) with complex chronic conditions, (b) with frailties, (c) below 65 with disability, and (d) with any (of the first three) high needs. We control for beneficiary demographics and other factors affecting integrated care, and we conduct sensitivity analyses controlling for multiple individual chronic conditions. We find significant positive associations with level of need for provider support for self-directed care and medication and home health management. Controlling for multiple individual chronic conditions reduces effect sizes and number of significant relationships.
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Affiliation(s)
- Nancy Song
- Stanford University School of Medicine, CA, USA
| | - Molly Frean
- University of Pennsylvania, Philadelphia, USA
| | | | | | - Emilia Ling
- Stanford University School of Medicine, CA, USA
| | | | | | | | - Sara J Singer
- Stanford University School of Medicine, CA, USA.,Stanford Graduate School of Business, CA, USA
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Berry LL, Awdish RLA, Letchuman S, Steffensen KD. Trust-Based Partnerships Are Essential - and Achievable - in Health Care Service. Mayo Clin Proc 2021; 96:1896-1906. [PMID: 34090685 DOI: 10.1016/j.mayocp.2021.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/04/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
When people think about trust in the context of health care, they typically focus on whether patients trust the competence of doctors and other health professionals. But for health care to reach its full potential as a service, trust must also include the notion of partnership, whereby patients see their clinicians as reliable, caring, shared decision-makers who provide ongoing "healing" in its broadest sense. Four interrelated service-quality concepts are central to fostering trust-based partnerships in health care: empathetic creativity, discretionary effort, seamless service, and fear mitigation. Health systems and institutions that prioritize trust-based partnerships with patients have put these concepts into practice using several concrete approaches: investing in organizational culture; hiring health professionals for their values, not just their skills; promoting continuous learning; attending to the power of language in all care interactions; offering patients "go-to" sources for timely assistance; and creating systems and structures that have trust built into their very design. It is in the real-world implementation of trust-based partnership that health care can reclaim its core mission.
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Affiliation(s)
- Leonard L Berry
- Mays Business School, Texas A&M University, College Station, TX; Institute for Healthcare Improvement, Boston, MA.
| | - Rana L A Awdish
- Pulmonary Hypertension Program, Department of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI
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Walker RJ, Segon A, Good J, Nagavally S, Gupta N, Levine D, Neuner J, Egede LE. Differences in length of stay by teaching team status in an academic medical center in the Midwestern United States. Hosp Pract (1995) 2021; 49:119-126. [PMID: 33499682 DOI: 10.1080/21548331.2021.1882238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Background: Given the high cost of inpatient stays, hospital systems are investigating ways to decrease lengths of stay while ensuring high-quality care. The goal of this study was to determine if patients in teaching teams (hospitalist teams with residents and interns) had a higher length of stay after adjusting for relevant confounders compared to hospitalist-only teams (staffed only by attending physicians).Methods: Using a retrospective design, we investigated differences in length of stay for 17,577 inpatient encounters over a 2-year period. Length of stay was calculated based on the time between hospital admission and hospital discharge with no removal of outliers. Encounters were assigned to teams based on the discharge provider. Teams were grouped based on whether they were teaching teams or nonteaching teams. Since the length of stay was not normally distributed, it was modeled first using generalized linear models with gamma distribution and log link, and secondly by quantile regression. Models were adjusted for age, gender, race, medicine vs. non-medicine unit, MS-DRGs, and comorbidities.Results: Using gamma models to account for the skewed nature of the data, the length of stay for encounters assigned to teaching teams was 0.56 days longer (β = 0.10 95% CI 0.06 0.14) than for nonteaching teams after adjustment. Using quantile regression, teaching teams had encounters on average 0.63 days longer (95% CI 0.44 0.81) than nonteaching teams at the 75th percentile and 1.19 days longer (95% CI 0.77 1.61) compared to nonteaching teams at the 90th percentile after adjustment.Conclusions: After adjusting for demographics and clinical factors, teaching teams on average had lengths of stay that were over half day longer than nonteaching teams. In addition, for the longest encounters, differences between teaching and nonteaching teams were over 1-day difference. Given these results, process improvement opportunities exist within teaching teams regarding length of stay, particularly for longer encounters.
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Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ankur Segon
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer Good
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sneha Nagavally
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Navdeep Gupta
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Doug Levine
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joan Neuner
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, 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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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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van Moerbeke A, Magdelijns F, Cleutjens F, Boonen A, van Onna M. Development and Evaluation of a Clinic for Elderly Patients with Rheumatoid Arthritis and Multimorbidity: A Pilot Study. ACR Open Rheumatol 2021; 3:34-40. [PMID: 33381919 PMCID: PMC7811693 DOI: 10.1002/acr2.11213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
Objective Integrating patient’s and physician’s goals, especially in elderly patients with multimorbidity, might ultimately improve care. Efforts to develop such care innovations in patients with rheumatoid arthritis (RA) are lacking. The objective of our study was to develop and to pilot test a clinic for elderly patients with RA and multimorbidity. Methods First, a referral strategy for and the content of an Elderly Multimorbidity Clinic (EMC) was developed. Next, the EMC was implemented, and it primarily focused on the personal goals of patients and medication review. The EMC was evaluated in a quantitative–qualitative approach. Results Referral considered useful by the rheumatologist was chosen as the referral criterion. A rheumatologist and internist–geriatrician provided care to referred patients (≥ 55 years) at the EMC during three visits over 1 year. Twenty patients with RA participated in the pilot study (mean age 76.8±7.7 years; 30% male). Only 12 (60%) patients attended the first follow‐up consultation, and three (15%) attended the second follow‐up consultation. During any follow‐up visit, 9/12 (75%) patients achieved one or more goals. Examples of accomplished goals were reduction of medication and improvement of mobility. In 19/20 (95%) patients, medication was remediated (stop medication for 13 patients; start medication for five patients) during the first visit. After 1 year, medication was changed back in 10 patients. Rheumatologists revealed uncertainty about meaningful referral, and patients and rheumatologists mentioned high (caregiver) burden because of extra visits as reasons for not attending follow‐up. Patients were satisfied with the care provided. Conclusion This goal‐directed EMC led to the accomplishment of at least one goal in 75% of patients. Sustained benefits could not be demonstrated because of low follow‐up.
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Affiliation(s)
| | | | - Fiona Cleutjens
- Expertisecentrum voor Chronisch Orgaanfalen Expertisecentrum voor Chronisch Orgaanfalen (CIRO), Horn, the Netherlands
| | - Annelies Boonen
- Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marloes van Onna
- Maastricht University Medical Center, Maastricht, the Netherlands
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Colla C, Yang W, Mainor AJ, Meara E, Ouayogode MH, Lewis VA, Shortell S, Fisher E. Organizational integration, practice capabilities, and outcomes in clinically complex medicare beneficiaries. Health Serv Res 2020; 55 Suppl 3:1085-1097. [PMID: 33104254 PMCID: PMC7720705 DOI: 10.1111/1475-6773.13580] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To assess the association between clinical integration and financial integration, quality-focused care delivery processes, and beneficiary utilization and outcomes. DATA SOURCES Multiphysician practices in the 2017-2018 National Survey of Healthcare Organizations and Systems (response rate 47%) and 2017 Medicare claims data. STUDY DESIGN Cross-sectional study of Medicare beneficiaries attributed to physician practices, focusing on two domains of integration: clinical (coordination of patient services, use of protocols, individual clinician measures, access to information) and financial (financial management and planning across operating units). We examined the association between integration domains, the adoption of quality-focused care delivery processes, beneficiary utilization and health-related outcomes, and price-adjusted spending using linear regression adjusting for practice and beneficiary characteristics, weighting to account for sampling and nonresponse. DATA COLLECTION/EXTRACTION METHODS 1 604 580 fee-for-service Medicare beneficiaries aged 66 or older attributed to 2113 practices. Of these, 414 209 beneficiaries were considered clinically complex (frailty or 2 + chronic conditions). PRINCIPAL FINDINGS Financial integration and clinical integration were weakly correlated (correlation coefficient = 0.19). Clinical integration was associated with significantly greater adoption of quality-focused care delivery processes, while financial integration was associated with lower adoption of these processes. Integration was not generally associated with reduced utilization or better beneficiary-level health-related outcomes, but both clinical integration and financial integration were associated with lower spending in both the complex and noncomplex cohorts: (clinical complex cohort: -$2518, [95% CI: -3324, -1712]; clinical noncomplex cohort: -$255 [95% CI: -413, -97]; financial complex cohort: -$997 [95% CI: -$1320, -$679]; and financial noncomplex cohort: -$143 [95% CI: -210, -$76]). CONCLUSIONS Higher levels of financial integration were not associated with improved care delivery or with better health-related beneficiary outcomes. Nonfinancial forms of integration deserve greater attention, as practices scoring high in clinical integration are more likely to adopt quality-focused care delivery processes and have greater associated reductions in spending in complex patients.
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Affiliation(s)
- Carrie Colla
- The Dartmouth Institute for Health Policy and Clinical PracticeGeisel School of MedicineLebanonNew HampshireUSA
| | - Wendy Yang
- Geisel School of MedicineThe Dartmouth Institute for Health Policy and Clinical PracticeLebanonNew HampshireUSA
| | - Alexander J. Mainor
- Geisel School of MedicineThe Dartmouth Institute for Health Policy and Clinical PracticeLebanonNew HampshireUSA
| | - Ellen Meara
- Department of Health Policy and ManagementHarvard University T H Chan School of Public HealthBostonMassachusettsUSA
| | - Marietou H. Ouayogode
- Department of Population Health SciencesUniversity of Wisconsin MadisonMadisonWisconsinUSA
| | - Valerie A. Lewis
- Department of Health Policy and ManagementGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Elliott Fisher
- Geisel School of MedicineThe Dartmouth Institute for Health Policy and Clinical PracticeLebanonNew HampshireUSA
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Khullar D, Zhang Y, Kaushal R. Potentially Preventable Spending Among High-Cost Medicare Patients: Implications for Healthcare Delivery. J Gen Intern Med 2020; 35:2845-2852. [PMID: 32103440 PMCID: PMC7573047 DOI: 10.1007/s11606-020-05691-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/08/2019] [Accepted: 01/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND High-cost patients account for a disproportionate share of healthcare spending. The proportion and distribution of potentially preventable spending among subgroups of high-cost patients are largely unknown. OBJECTIVE To examine the distribution of potentially preventable spending among high-cost Medicare patients overall and potentially preventable spending associated with each high-cost category. DESIGN A cross-sectional study. We merged Medicare claims and social determinants of health data to group patients into high-cost categories and quantify potentially preventable spending. PATIENTS A total of 556,053 Medicare fee-for-service and dual-eligible beneficiaries with at least one healthcare encounter in the New York metropolitan area in 2014. MAIN MEASURES High-cost patients were mapped into 10 non-mutually exclusive categories. The primary outcome was episodic spending associated with preventable ED visits, preventable hospitalizations, and unplanned 30-day readmissions. KEY RESULTS Overall, potentially preventable spending accounted for 10.4% of overall spending in 2014. Preventable spending accounted for 13.3% of total spending among high-cost patients and 4.9% among non-high-cost patients (P < 0.001). Among high-cost patients, 44.0% experienced at least one potentially preventable encounter compared with 11.4% of non-high-cost patients (P < 0.001), and high-cost patients accounted for 71.5% of total preventable spending. High-cost patients had on average $11,502 in potentially preventable spending-more than 20 times more than non-high-cost patients ($510). High-cost patients in the seriously ill, frail, or serious mental illness categories accounted for the highest proportion of potentially preventable spending overall, while end-stage renal disease, serious illness, and opioid use disorder were associated with the highest preventable spending per patient. CONCLUSION Potentially preventable spending was concentrated among high-cost patients who were seriously ill, frail, or had a serious mental illness. Interventions targeting these subgroups may be helpful for reducing preventable utilization.
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Affiliation(s)
- Dhruv Khullar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA.
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- NewYork-Presbyterian Hospital, New York, NY, USA.
| | - Yongkang Zhang
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Rainu Kaushal
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
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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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Carlson ED, Chandrasekaran S, Wohlgemuth P, Parsons J. Unified interdisciplinary communication using a mobile technology. J Dent Educ 2020; 85:1175-1177. [PMID: 32946114 DOI: 10.1002/jdd.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/22/2020] [Accepted: 09/13/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Emanouela D Carlson
- Division of Endodontics, Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Sangeetha Chandrasekaran
- Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Pierre Wohlgemuth
- Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Joseph Parsons
- Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
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Berry LL, Keiningham T, Aksoy L, Deming KA. When Cancer Centers Mislead Prospective Patients. JCO Oncol Pract 2020; 16:219-222. [DOI: 10.1200/jop.19.00783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Leonard L. Berry
- Mays Business School, Texas A&M University, College Station, TX
- Institute for Healthcare Improvement, Boston, MA
| | - Timothy Keiningham
- St John’s University, The Peter J. Tobin College of Business, Queens, NY
| | - Lerzan Aksoy
- Fordham University, Gabelli School of Business, Bronx, NY
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Pharmacist-led transitions-of-care services in primary care settings: Opportunities, experiences, and challenges. J Am Pharm Assoc (2003) 2020; 60:443-449. [DOI: 10.1016/j.japh.2019.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/22/2019] [Accepted: 11/14/2019] [Indexed: 11/21/2022]
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A "Behind-the-Scenes" Look at Interprofessional Care Coordination: How Person-Centered Care in Safety-Net Health System Complex Care Clinics Produce Better Outcomes. Int J Integr Care 2020; 20:5. [PMID: 32405282 PMCID: PMC7207252 DOI: 10.5334/ijic.4734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction: While the effectiveness of team-based care and wrap-around services for high utilizers is clear, how complex care clinics deliver effective, person-centered care to these vulnerable populations is not well understood. This paper describes how interactions among interprofessional team members enabled individualized, rapid responses to the complex needs of vulnerable patients at the Virginia Commonwealth University Health System’s Complex Care Clinic. Methods: Researchers attended twenty weekly care coordination meetings, audio-recorded the proceedings, and wrote brief observational field notes. Researchers also qualitatively interviewed ten clinic team members. Emergent coding based on grounded theory and a consensus process were used to identify and describe key themes. Results: Analysis resulted in three themes that evidence the structures, processes, and interactions which contributed to the ability to provide person-centred care: team-based communication strategies, interprofessional problem-solving, and personalized patient engagement efforts. Conclusion: Our study suggests that in care coordination meetings team members were able to strategize, brainstorm, and reflect on how to better care for patients. Specifically, flexible team leadership opened an inter-disciplinary communicative space to foster conversations, which revealed connections between the physical, and socio-emotional components of patients’ lives and hidden factors undermining progress, while proactive strategies prevented patient’s rapid deterioration and unnecessary use of inappropriate health services.
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Smith MA, Nordby PA, Yu M, Jaffery J. A practical model for research with learning health systems: Building and implementing effective complex case management. APPLIED ERGONOMICS 2020; 84:103023. [PMID: 31983393 DOI: 10.1016/j.apergo.2019.103023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/27/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
For researchers to contribute meaningfully to the creation of learning health systems, practical tools are required to operationalize existing conceptual frameworks. We describe a model currently in use by the University of Wisconsin Health Innovation Program (HIP). The HIP model consolidates and enhances existing learning health system frameworks by defining specific steps needed to create sustainable change based on research conducted within the health system. As an example of the model's application, we describe its use to improve patient identification for the University of Wisconsin health system's case management program. Our case study shows the importance of culture, infrastructure, and strong leadership support in realizing a learning health systems research project and creating sustainable change within the health system. By articulating the foundational elements and steps to conduct research with learning health systems, our model supports researchers in achieving the challenge of moving learning health systems from concept to action.
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Affiliation(s)
- Maureen A Smith
- Department of Population Health Sciences, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA; Department of Family Medicine and Community Health, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA; Health Innovation Program, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA.
| | - Peter A Nordby
- Health Innovation Program, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA
| | - Menggang Yu
- Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jonathan Jaffery
- Office of Population Health, UW Health, Madison, WI, USA; Department of Medicine, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA
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Garnett D, Hardy L, Fitzgerald E, Fisher T, Graham L, Overcash J. Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer. Clin J Oncol Nurs 2020; 24:65-74. [PMID: 31961839 DOI: 10.1188/20.cjon.65-74] [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: 11/17/2022]
Abstract
BACKGROUND The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.
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Affiliation(s)
- Doris Garnett
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | | | | | - Taylor Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Lisa Graham
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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Austin T, Chreim S, Grudniewicz A. Examining health care providers' and middle-level managers' readiness for change: a qualitative study. BMC Health Serv Res 2020; 20:47. [PMID: 31952525 PMCID: PMC6969476 DOI: 10.1186/s12913-020-4897-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline providers or individuals in non-managerial positions and offers limited attention to individuals in middle management positions who are expected to lead frontline providers in change implementation. Yet middle-level managers are also recipients of changes that are planned and decreed by those in higher positions. This study sought to examine both frontline provider and middle manager readiness for change in the context of primary care program integration. Methods Using a qualitative case study approach, we examined how frontline providers and middle managers experienced six readiness factors: discrepancy, appropriateness, valence, efficacy, fairness and trust in management. Data were collected through documents, meeting observation and semi-structured interviews with frontline providers and middle managers involved in the change. Results The findings highlighted similarities and differences in readiness experiences of frontline providers and middle managers. Across both types of participants, we found that the notion of valence should be expanded to consider individuals’ evaluation of benefits to patients and the health system; efficacy applies to both content and process of change; fairness and trust in management findings require further exploration to determine their appropriateness to be incorporated in models of readiness for change; and trust in management (or lack of trust) has a cascading influence across the levels in the organization. Conclusions Our study makes a contribution by nuancing and extending conceptualizations of individual readiness factors, and by highlighting the central role of middle manager readiness for change. Implications of the study include the need to consider readiness factors prior to the implementation of change and the importance of fostering readiness throughout all levels of the organization.
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Affiliation(s)
- Tujuanna Austin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, K1N 6N5, Canada.
| | - Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, K1N 6N5, Canada
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Abstract
OBJECTIVE To elucidate the types of patients cared for by physician assistants (PAs), specifically older adults and those with complex medical conditions. METHODS A nationwide survey was sent to PAs asking about their practice demographics, including the complexity of their patients and the types of treatment they provide; 676 responded. RESULTS Less than 2% of PAs specialize in geriatrics but 92.1% of PAs see patients over age 65 years. Most PAs see patients with conditions associated with aging, including hypertension (85.8%) and osteoarthritis (82.1%) as well as those with three or more comorbidities (54.8%) or who are medically complex (52.8%). CONCLUSIONS Although few PAs work exclusively in geriatrics, most PAs are providing medical care for older adults and patients with complex healthcare needs. PAs should be considered to fill healthcare needs that will continue to exist when caring for this patient population.
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Abstract
OBJECTIVE Few studies report the impact of depression on inflammatory bowel disease (IBD)-related hospitalizations. We evaluated the association between depression and pediatric IBD-related hospitalizations. Our primary aim was to test the hypothesis that depression is associated with hospital length of stay (LOS); our secondary goal was to evaluate if patients with depression are at higher risk for undergoing additional imaging and procedures. METHODS Data were extracted from the 2012 Kids Inpatient Database (KID), the largest nationally representative publicly available all-payer pediatric inpatient cross-sectional database in the United States. Hospitalizations for patients less than 21 years with a primary diagnosis Crohn disease (CD) or ulcerative colitis (UC) by ICD-9 code were included. Multivariable logistic regression was used to predict long LOS controlling for patient- and hospital-level variables and for potential disease confounders. RESULTS For primary IBD-related hospitalizations (N = 8222), depression was associated with prolonged LOS (odds ratio [OR] 1.50; 95% confidence interval [CI] 1.19-1.90) and total parenteral nutrition use (OR 1.54; 95% CI 1.04-2.27). Depression was not associated with increased likelihood of surgery (OR 0.97; 95% CI 0.72-1.30), endoscopy (OR 0.91; 95% CI 0.74-1.14), blood transfusion (OR 0.85; 95% CI 0.58-1.23), or abdominal imaging (OR 1.15; 95% CI 0.53-2.53). CONCLUSIONS Depression is associated with prolonged LOS in pediatric patients with IBD, even when controlling for gastrointestinal disease severity. Future research evaluating the efficacy of standardized depression screening and early intervention may be beneficial to improving inpatient outcomes in this population.
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Williams MD, Asiedu GB, Finnie D, Neely C, Egginton J, Finney Rutten LJ, Jacobson RM. Sustainable care coordination: a qualitative study of primary care provider, administrator, and insurer perspectives. BMC Health Serv Res 2019; 19:92. [PMID: 30709349 PMCID: PMC6359857 DOI: 10.1186/s12913-019-3916-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/18/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Care coordination has been a common tool for practices seeking to manage complex patients, yet there remains confusion about the most effective and sustainable model. Research exists on opinions of providers of care coordination but there is limited information on perspectives of those in the insurance industry about key elements. We sought to gather opinions from primary care providers and administrators in Minnesota who were involved in a CMS (Center for Medicare and Medicaid Services) transformational grant implementing COMPASS (Care Of Mental, Physical And Substance-use Syndromes), an evidence-based model of care coordination for depressed patients comorbid with diabetes and/or cardiovascular disease. We then sought to compare these views with those of private insurance representatives in Minnesota. METHODS We used qualitative methods to conducted forty-two key informant interviews with primary care providers (n = 15); administrators (n = 15); and insurers (n = 12). We analyzed the recorded and transcribed data, once de-identified, using a frameworks analysis approach. RESULTS We identified six primary themes: 1) a defined scope, rationale, and key partnerships for building comprehensive care coordination programs, 2) effective information exchange, 3) a trained and available workforce, 4) the need for a business model and a financially justifiable program, 5) a need for evaluation and ongoing improvement of care coordination, and 6) the importance of patient and family engagement. Overall consensus across stakeholder groups was high including a call for payment reform to support a valued service. Despite their role in paying for care, insurance representatives did not stress reduced utilization as more important than other outcomes. CONCLUSIONS Primary care providers and administrators from different organizations and backgrounds, all with experience in COMPASS, in large part agreed with insurance representatives on the main elements of a sustainable model and the need for health reform to sustain this service.
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Affiliation(s)
| | | | - Dawn Finnie
- Mayo Clinic, 200 1st St SW, Rochester, MN 55905 USA
| | - Claire Neely
- Institute for Clinical Systems Improvement, Minneapolis, MN USA
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Marino M, de Belvis AG, Tanzariello M, Dotti E, Bucci S, Colotto M, Ricciardi W, Boccia S. Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach? INTERNATIONAL JOURNAL OF CARE COORDINATION 2018. [DOI: 10.1177/2053434518817019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centeredness of care. We conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods MEDLINE, Scopus and EBSCO were searched. We reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilization outcomes, cost and cost-effectiveness). Results Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilization rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalized on a large scale. Discussion We found out a favourable impact of integrated care models/methods on health outcomes, care utilization and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. Thus, we propose a value-based framework for the evaluation of these services.
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Affronti ML. Introduction. Semin Oncol Nurs 2018; 34:417-419. [PMID: 30446381 DOI: 10.1016/j.soncn.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mary Lou Affronti
- Associate Professor, The Duke University School of Nursing, Durham, NC; Primary Investigator, Nurse Practitioner, The Duke Preston Robert Tisch Brain Tumor Center, Division of Medical Neuro-Oncology, Department of Neurosurgery, Duke Cancer Institute, Duke Health, Durham, NC.
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. Understanding new models of integrated care in developed countries: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06290] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BackgroundThe NHS has been challenged to adopt new integrated models of service delivery that are tailored to local populations. Evidence from the international literature is needed to support the development and implementation of these new models of care.ObjectivesThe study aimed to carry out a systematic review of international evidence to enhance understanding of the mechanisms whereby new models of service delivery have an impact on health-care outcomes.DesignThe study combined rigorous and systematic methods for identification of literature, together with innovative methods for synthesis and presentation of findings.SettingAny setting.ParticipantsPatients receiving a health-care service and/or staff delivering services.InterventionsChanges to service delivery that increase integration and co-ordination of health and health-related services.Main outcome measuresOutcomes related to the delivery of services, including the views and perceptions of patients/service users and staff.Study designEmpirical work of a quantitative or qualitative design.Data sourcesWe searched electronic databases (between October 2016 and March 2017) for research published from 2006 onwards in databases including MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index, Social Science Citation Index and The Cochrane Library. We also searched relevant websites, screened reference lists and citation searched on a previous review.Review methodsThe identified evidence was synthesised in three ways. First, data from included studies were used to develop an evidence-based logic model, and a narrative summary reports the elements of the pathway. Second, we examined the strength of evidence underpinning reported outcomes and impacts using a comparative four-item rating system. Third, we developed an applicability framework to further scrutinise and characterise the evidence.ResultsWe included 267 studies in the review. The findings detail the complex pathway from new models to impacts, with evidence regarding elements of new models of integrated care, targets for change, process change, influencing factors, service-level outcomes and system-wide impacts. A number of positive outcomes were reported in the literature, with stronger evidence of perceived increased patient satisfaction and improved quality of care and access to care. There was stronger UK-only evidence of reduced outpatient appointments and waiting times. Evidence was inconsistent regarding other outcomes and system-wide impacts such as levels of activity and costs. There was an indication that new models have particular potential with patients who have complex needs.LimitationsDefining new models of integrated care is challenging, and there is the potential that our study excluded potentially relevant literature. The review was extensive, with diverse study populations and interventions that precluded the statistical summary of effectiveness.ConclusionsThere is stronger evidence that new models of integrated care may enhance patient satisfaction and perceived quality and increase access; however, the evidence regarding other outcomes is unclear. The study recommends factors to be considered during the implementation of new models.Future workLinks between elements of new models and outcomes require further study, together with research in a wider variety of populations.Study registrationThis study is registered as PROSPERO CRD37725.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Erskine J, Castelli M, Hunter D, Hungin A. The persistent problem of integrated care in English NHS hospitals. J Health Organ Manag 2018; 32:532-544. [PMID: 29969348 PMCID: PMC6091655 DOI: 10.1108/jhom-01-2018-0020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to determine whether some aspects of the distinctive Mayo Clinic care model could be translated into English National Health Service (NHS) hospital settings, to overcome the fragmented and episodic nature of non-emergency patient care. Design/methodology/approach The authors used a rapid review to assess the literature on integrated clinical care in hospital settings and critical analysis of links between Mayo Clinic's care model and the organisation's performance and associated patient outcomes. Findings The literature directly concerned with Mayo Clinic's distinctive ethos and approach to patient care is limited in scope and largely confined to "grey" sources or to authors and institutions with links to Mayo Clinic. The authors found only two peer-reviewed articles which offer critical analysis of the contribution of the Mayo model to the performance of the organisation. Research limitations/implications Mayo Clinic is not the only organisation to practice integrated, in-hospital clinical care; however, it is widely regarded as an exemplar. Practical implications There are barriers to implementing a Mayo-style model in English NHS hospitals, but they are not insurmountable and could lead to much better coordination of care for some patients. Social implications The study shows that there is an appetite among NHS patients and staff for better coordinated, multi-specialty care within NHS hospitals. Originality/value In the English NHS integrated care generally aims to improve coordination between primary, community and secondary care, but problems remain of fragmented care for non-emergency hospital patients. Use of a Mayo-type care model, within hospital settings, could offer significant benefits to this patient group, particularly for multi-morbid patients.
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Affiliation(s)
| | - Michele Castelli
- Institute of Health and Society, Newcastle University , Newcastle upon Tyne, UK
| | - David Hunter
- Institute of Health and Society, Newcastle University , Newcastle upon Tyne, UK
| | - Amritpal Hungin
- Institute of Health and Society, Newcastle University , Newcastle upon Tyne, UK
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Busnel C, Marjollet L, Perrier-Gros-Claude O. Complexité des prises en soins à domicile : développement d’un outil d’évaluation infirmier et résultat d’une étude d’acceptabilité. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.refiri.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res 2018; 18:350. [PMID: 29747651 PMCID: PMC5946491 DOI: 10.1186/s12913-018-3161-3] [Citation(s) in RCA: 301] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/29/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION Prospero registration number: 42016037725 .
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Maxine Johnson
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Duncan Chambers
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
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Sander LD, Albert M, Okeke N, Kravet S, Rediger K, Conway SJ, McGuire MJ. Building a Medicaid Ambulatory Complex Care Program Within an Urban Medical Home. Popul Health Manag 2018; 21:446-453. [PMID: 29620961 DOI: 10.1089/pop.2017.0200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Five percent of Medicaid patients account for 50% of total costs. Preventable costs are often incurred by patients with complex medical, behavioral, and social needs who disproportionately utilize acute care services. Evidence for design, implementation, and evaluation of complex care programs in the urban Medicaid population is lacking. The article provides a description of a complex care program (CCP), challenges, and early outcomes based on a pre-post evaluation. The CCP was located within an existing urban medical home. Patients were eligible if they lived within 10 miles of the clinic and had at least 2 inpatient visits and/or 3 emergency room visits within the prior 6 months. Ambulatory Care Groups® were used to predict estimated total costs of patients, who were included if potential cost savings exceeded $5000. Patient experience and quality of care were assessed using validated measures and costs. Return on investment was calculated based on investment and cost savings. Costs include visits (clinic, specialty, and emergency room), hospital admissions, medications, tests and services, as well as salary and benefits of clinical staff. Eighty-six of 211 eligible patients (41%) were enrolled during the first 18 months of the pilot program. There were positive trends in quality metrics and patient satisfaction. The pre-post evaluation demonstrated a reduction in emergency room visits and hospitalizations (67% and 65%, respectively), which resulted in a 2.2:1 return on investment. This article offers lessons learned to colleagues considering population health approaches in the care of high-risk Medicaid patients.
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Affiliation(s)
- Laura D Sander
- 1 Johns Hopkins Community Physicians , Baltimore, Maryland.,2 Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Michael Albert
- 1 Johns Hopkins Community Physicians , Baltimore, Maryland.,2 Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Nkem Okeke
- 3 Johns Hopkins Healthcare LLC , Glen Burnie, Maryland
| | - Steven Kravet
- 1 Johns Hopkins Community Physicians , Baltimore, Maryland.,2 Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | - Sarah Johnson Conway
- 2 Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Maura J McGuire
- 1 Johns Hopkins Community Physicians , Baltimore, Maryland.,2 Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
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Leijten FR, Struckmann V, van Ginneken E, Czypionka T, Kraus M, Reiss M, Tsiachristas A, Boland M, de Bont A, Bal R, Busse R, Rutten-van Mölken M. The SELFIE framework for integrated care for multi-morbidity: Development and description. Health Policy 2018; 122:12-22. [DOI: 10.1016/j.healthpol.2017.06.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 12/17/2022]
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Derrett S, Gunter KE, Samaranayaka A, Singer SJ, Nocon RS, Quinn MT, Breheny M, Campbell A, Schaefer CT, Heuer LJ, Chin MH. Development and Testing of the Provider and Staff Perceptions of Integrated Care (PSPIC) Survey. Med Care Res Rev 2017; 76:807-829. [PMID: 29231130 DOI: 10.1177/1077558717745936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article discusses development and testing of the Provider and Staff Perceptions of Integrated Care Survey, a 21-item questionnaire, informed by Singer and colleagues' seven-construct framework. Questionnaires were sent to 2,936 providers and staff at 100 federally qualified health centers and other safety net clinics in 10 Midwestern U.S. states; 332 were ineligible, leaving 2,604 potential participants. Following 4 mailings, 781 (30%) responded from 97 health centers. Item analyses, exploratory factor analysis, and confirmatory factor analysis were undertaken. Exploratory factor analysis suggests four latent factors: Teams and Care Continuity, Patient Centeredness, Coordination with External Providers, and Coordination with Community Resources. Confirmatory factor analysis confirmed these factor groupings. For the total sample, Cronbach's alpha exceeded 0.7 for each latent factor. Descriptive responses to each of the 21 Provider and Staff Perceptions of Integrated Care questions appear to have potential in identifying areas that providers and staff recognize as care integration strengths, and areas that may warrant improvement.
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Affiliation(s)
| | | | | | | | | | | | - Mary Breheny
- Massey University, Palmerston North, New Zealand
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Struckmann V, Leijten FRM, van Ginneken E, Kraus M, Reiss M, Spranger A, Boland MRS, Czypionka T, Busse R, Rutten-van Mölken M. Relevant models and elements of integrated care for multi-morbidity: Results of a scoping review. Health Policy 2017; 122:23-35. [PMID: 29031933 DOI: 10.1016/j.healthpol.2017.08.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 08/19/2017] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In order to provide adequate care for the growing group of persons with multi-morbidity, innovative integrated care programmes are appearing. The aims of the current scoping review were to i) identify relevant models and elements of integrated care for multi-morbidity and ii) to subsequently identify which of these models and elements are applied in integrated care programmes for multi-morbidity. METHODS A scoping review was conducted in the following scientific databases: Cochrane, Embase, PubMed, PsycInfo, Scopus, Sociological Abstracts, Social Services Abstracts, and Web of Science. A search strategy encompassing a) models, elements and programmes, b) integrated care, and c) multi-morbidity was used to identify both models and elements (aim 1) and implemented programmes of integrated care for multi-morbidity (aim 2). Data extraction was done by two independent reviewers. Besides general information on publications (e.g. publication year, geographical region, study design, and target group), data was extracted on models and elements that publications refer to, as well as which models and elements are applied in recently implemented programmes in the EU and US. RESULTS In the review 11,641 articles were identified. After title and abstract screening, 272 articles remained. Full text screening resulted in the inclusion of 92 articles on models and elements, and 50 articles on programmes, of which 16 were unique programmes in the EU (n=11) and US (n=5). Wagner's Chronic Care Model (CCM) and the Guided Care Model (GCM) were most often referred to (CCM n=31; GCM n=6); the majority of the other models found were only referred to once (aim 1). Both the CCM and GCM focus on integrated care in general and do not explicitly focus on multi-morbidity. Identified elements of integrated care were clustered according to the WHO health system building blocks. Most elements pertained to 'service delivery'. Across all components, the five elements referred to most often are person-centred care, holistic or needs assessment, integration and coordination of care services and/or professionals, collaboration, and self-management (aim 1). Most (n=10) of the 16 identified implemented programmes for multi-morbidity referred to the CCM (aim 2). Of all identified programmes, the elements most often included were self-management, comprehensive assessment, interdisciplinary care or collaboration, person-centred care and electronic information system (aim 2). CONCLUSION Most models and elements found in the literature focus on integrated care in general and do not explicitly focus on multi-morbidity. In line with this, most programmes identified in the literature build on the CCM. A comprehensive framework that better accounts for the complexities resulting from multi-morbidity is needed.
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Affiliation(s)
- Verena Struckmann
- Berlin University of Technology, Department of Health Care Management, Germany.
| | - Fenna R M Leijten
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | - Ewout van Ginneken
- WHO Observatory on Health Systems and Policies, Berlin University of Technology, Department of Health Care Management, Germany
| | | | | | - Anne Spranger
- Berlin University of Technology, Department of Health Care Management, Germany
| | - Melinde R S Boland
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | | | - Reinhard Busse
- Berlin University of Technology, Department of Health Care Management, Germany
| | - Maureen Rutten-van Mölken
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, The Netherlands
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Vest JR, Grannis SJ, Haut DP, Halverson PK, Menachemi N. Using structured and unstructured data to identify patients' need for services that address the social determinants of health. Int J Med Inform 2017; 107:101-106. [PMID: 29029685 DOI: 10.1016/j.ijmedinf.2017.09.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/16/2017] [Accepted: 09/19/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Increasingly, health care providers are adopting population health management approaches that address the social determinants of health (SDH). However, effectively identifying patients needing services that address a SDH in primary care settings is challenging. The purpose of the current study is to explore how various data sources can identify adult primary care patients that are in need of services that address SDH. METHODS A cross-sectional study described patients in need of SDH services offered by a safety-net hospital's federally qualified health center clinics. SDH services of social work, behavioral health, nutrition counseling, respiratory therapy, financial planning, medical-legal partnership assistance, patient navigation, and pharmacist consultation were offered on a co-located basis and were identified using structured billing and scheduling data, and unstructured electronic health record data. We report the prevalence of the eight different SDH service needs and the patient characteristics associated with service need. Moreover, characteristics of patients with SDH services need documented in structured data sources were compared with those documented by unstructured data sources. RESULTS More than half (53%) of patients needed SDH services. Those in need of such services tended to be female, older, more medically complex, and higher utilizers of services. Structured and unstructured data sources exhibited poor agreement on patient SDH services need. Patients with SDH services need documented by unstructured data tended to be more complex. DISCUSSION The need for SDH services among a safety-net population is high. Identifying patients in need of such services requires multiple data sources with structured and unstructured data.
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Affiliation(s)
- Joshua R Vest
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States; Regenstrief Institute, Indianapolis, IN, United States.
| | - Shaun J Grannis
- Regenstrief Institute, Indianapolis, IN, United States; Indiana University School of Medicine, Indianapolis, IN, United States
| | - Dawn P Haut
- Eskenazi Health, Indianapolis, IN, United States
| | - Paul K Halverson
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States; Regenstrief Institute, Indianapolis, IN, United States; Indiana University School of Medicine, Indianapolis, IN, United States
| | - Nir Menachemi
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States; Regenstrief Institute, Indianapolis, IN, United States
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Palmer K, Marengoni A, Forjaz MJ, Jureviciene E, Laatikainen T, Mammarella F, Muth C, Navickas R, Prados-Torres A, Rijken M, Rothe U, Souchet L, Valderas J, Vontetsianos T, Zaletel J, Onder G. Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). Health Policy 2017; 122:4-11. [PMID: 28967492 DOI: 10.1016/j.healthpol.2017.09.006] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 03/20/2017] [Accepted: 09/08/2017] [Indexed: 12/20/2022]
Abstract
Patients with multimorbidity have complex health needs but, due to the current traditional disease-oriented approach, they face a highly fragmented form of care that leads to inefficient, ineffective, and possibly harmful clinical interventions. There is limited evidence on available integrated and multidimensional care pathways for multimorbid patients. An expert consensus meeting was held to develop a framework for care of multimorbid patients that can be applied across Europe, within a project funded by the European Union; the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). The experts included a diverse group representing care providers and patients, and included general practitioners, family medicine physicians, neurologists, geriatricians, internists, cardiologists, endocrinologists, diabetologists, epidemiologists, psychologists, and representatives from patient organizations. Sixteen components across five domains were identified (Delivery of Care; Decision Support; Self Management Support; Information Systems and Technology; and Social and Community Resources). The description and aim of each component are described in these guidelines, along with a summary of key characteristics and relevance to multimorbid patients. Due to the lack of evidence-based recommendations specific to multimorbid patients, this care model needs to be assessed and validated in different European settings to examine specifically how multimorbid patients will benefit from this care model, and whether certain components have more importance than others.
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Affiliation(s)
- Katie Palmer
- The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy.
| | - Alessandra Marengoni
- The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 23, 25123, Brescia, Italy
| | - Maria João Forjaz
- National School of Public Health, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
| | - Elena Jureviciene
- Vilnius University Hospital Santariskiu Klinikos (VULSK), g. 2, Vilnius, Lithuania
| | - Tiina Laatikainen
- National Institute for Health and Welfare, University of Eastern Finland, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Federica Mammarella
- The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy
| | - Christiane Muth
- Institute of General Practice, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany
| | - Rokas Navickas
- Vilnius University Hospital Santariskiu Klinikos (VULSK), g. 2, Vilnius, Lithuania
| | - Alexandra Prados-Torres
- Aragon Health Sciences Institute, IIS Aragón, REDISSEC (ISCIII), University of Zaragoza, Pl +2, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, The Netherlands
| | - Ulrike Rothe
- Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Laurène Souchet
- European Patients' Forum (EPF) 31 rue du Commerce, 1000 Brussels, Belgium
| | - Jose Valderas
- Health Services & Policy Research, University of Exeter, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, United Kingdom
| | - Theodore Vontetsianos
- Sotiria General Hospital/1st RHA of Attica, Athens, 152 Mesogion Av., Athens 11527, Greece
| | - Jelka Zaletel
- National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia
| | - Graziano Onder
- The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy; Department of Geriatrics, Centre on Aging (CEMI), Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
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Welch JL, Meek J, Bartlett Ellis RJ, Ambuehl R, Decker BS. PATTERNS OF HEALTHCARE ENCOUNTERS EXPERIENCED BY PATIENTS WITH CHRONIC KIDNEY DISEASE. J Ren Care 2017; 43:209-218. [PMID: 28371226 DOI: 10.1111/jorc.12200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patterns of healthcare encounters by patients in each stage of chronic kidney disease (CKD) have not been fully described. OBJECTIVE This study describes patterns of healthcare resource use by patients with CKD. DESIGN A retrospective descriptive design was used. PARTICIPANTS Patients with Stages 1-5 CKD were identified in five existing de-identified healthcare insurance claims databases in the United States using codes from the International Classification of Diseases (ICD-9-CM). MEASUREMENTS The databases contained more than 23,660,000 claims records from over 11 million subscribers who were continuously enrolled in a single 2014 health plan. All CKD patients' 2014 claims were extracted, yielding 1,987 unique people with 110,594 healthcare encounters. RESULTS Healthcare resources are used to manage the causes of CKD and its multiple effects on health, and thus the number of healthcare encounters among people with more advanced disease was, as expected, relatively higher. There were more hospitalisations, emergency department visits and specialist encounters in this group. Surprisingly, however, even people in earlier stages of kidney disease experienced a median of 14-17 healthcare encounters during a single calendar year. CONCLUSIONS Understanding patterns of healthcare encounters provides important information about the transition experiences of patients with CKD. Exploring ways to reduce the risks associated with transitions in care may prevent problems with home medication management, frequent emergency department visits and potentially avoidable hospitalisations.
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Affiliation(s)
- Janet L Welch
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Julie Meek
- Indiana University School of Nursing, Hendersonville, North Carolina, USA
| | | | | | - Brian S Decker
- Indiana University School of Medicine, Indianapolis, Indiana, USA
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Huynh J, Donnelly LR, Brondani MA. Exploring dental student participation in interdisciplinary care team conferences in long-term care. Gerodontology 2017; 34:249-256. [PMID: 28168829 DOI: 10.1111/ger.12259] [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] [Accepted: 12/23/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to explore how the participation of dental hygiene students in interdisciplinary care conferences conducted in long-term care (LTC) facilities influenced the staff's awareness of oral health, the student's provision of care as well as the student's ability to work on an interdisciplinary team. BACKGROUND Oral health in LTC continues to be poor despite many educational and clinical interventions. The care of a frail elder requires an interdisciplinary team approach, yet dental professionals are often absent from these teams. As an educational intervention, dental hygiene students, in addition to providing clinical care to residents and education to staff in a LTC facility, have been participating in interdisciplinary care conferences for 4 years. METHODS Nine LTC facility staff and eight students participated in two focus groups and five personal interviews to discuss their experiences of the care conferences. Narratives were transcribed verbatim and thematic analysis was conducted. RESULTS Four major themes emerged that described the essence of the experience of involving dental professionals within interdisciplinary care conference: (i) addressing oral health, (ii) reciprocal learning, (iii) dealing with complexity and (iv) impact of collaborative care. CONCLUSION Overall, students found the educational intervention to be worthwhile that allowed for the development of interdisciplinary skills and a greater understanding of dental geriatrics. The dental support in care conferences was welcomed by the staff as it facilitated a new way of exchanging knowledge and experiences so that a more holistic approach to care could be undertaken by all.
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Affiliation(s)
- Jeremy Huynh
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Leeann R Donnelly
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Mario A Brondani
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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Ulbrich EM, Mattei ÂT, de Fátima Mantovani M, Bittencourt Madureira A, Puchalski Kalinke L. Care models for people with chronic diseases: integrative review. INVESTIGACION Y EDUCACION EN ENFERMERIA 2017; 35:8-16. [PMID: 29767919 DOI: 10.17533/udea.iee.v35n1a02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 01/31/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To identify the care models and the impact of the use of these in the care of people with chronic diseases reported in the literature in the years 2000 to 2014. METHODS Integrative literature review in which the following guiding question was adopted: Which care models are used in the care of patients with chronic diseases and what impacts can be verified through their application? We consulted the bibliographic databases Virtual Health Library, LILACS, MEDLINE, Spanish Bibliographic Index of Health Sciences and the Database of Nursing. RESULTS The sample consisted of 17 articles on the topic of interest. Three categories emerged from the analysis: health care costs, model-based care experience, and patient autonomy. The articles addressed self-management, case management and care model for people with chronic diseases. The major impacts on the use of the models were: a better relationship between the patient and the health professional, an increase in the autonomy of the person with chronic illness, and a reduction in personal and health care expenditure. CONCLUSIONS The use of care models for people with chronic diseases presents benefits to the patient and to the health system. Nurses must actively participate in the application of these care models of people with this type of illness.
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McCaffrey R, Reinoso H. Transformational Leadership: A Model for Advanced Practice Holistic Nurses. J Holist Nurs 2016; 35:397-404. [DOI: 10.1177/0898010116685242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Engel PA, Spencer J, Paul T, Boardman JB. The Geriatrics in Primary Care Demonstration: Integrating Comprehensive Geriatric Care into the Medical Home: Preliminary Data. J Am Geriatr Soc 2016; 64:875-9. [PMID: 27100583 DOI: 10.1111/jgs.14026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Three thousand nine hundred thirty-one veterans aged 75 and older receive primary care (PC) in two large practices of the Department of Veterans Affairs (VA) Boston Healthcare System. Cognitive and functional disabilities are endemic in this group, creating needs that predictably exceed available or appropriate resources. To address this problem, Geriatrics in Primary Care (GPC) embeds geriatric services directly into primary care. An on-site consulting geriatrician and geriatric nurse care manager work directly with PC colleagues in medicine, nursing, social work, pharmacy, and mental health within the VA medical home. This design delivers interdisciplinary geriatric care within PC that emphasizes comprehensive evaluations, care management, planned transitions, informed resource use, and a shift in care focus from multiple subspecialties to PC. Four hundred thirty-five veterans enrolled during the project's 4-year course. Complex, fragmented care was evident in a series of 50 individuals (aged 82 ± 7) enrolled during Months 1 to 6. The year before, these individuals made 372 medical or surgical subspecialty clinic visits (7.4 ± 9.8); 34% attended five or more subspecialty clinics, 48% had dementia, and 18% lacked family caregivers. During the first year after enrollment the mean number of subspecialty clinic visits declined significantly (4.7 ± 5.0, P = .01), whereas the number of PC-based visits remained stable (3.1 ± 1.5 and 3.3 ± 1.5, respectively, P = .50). Telephone contact by GPC (2.3 ± 2.0) and collaboration with PC clinicians replaced routine follow-up geriatric care. GPC facilitated planned transitions to rehabilitation centers (n = 5), home hospice (n = 2), dementia units (n = 3), and home care (n = 37). GPC provides efficient, comprehensive geriatric care and case management while preserving established relationships between patients and the PC team. Preliminary results suggest "care defragmentation," as reflected by a significant reduction in subspecialty clinic use. Model simplicity and flexibility facilitated ready implementation.
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Affiliation(s)
- Peter A Engel
- Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jacqueline Spencer
- Harvard Medical School, Boston, Massachusetts.,Primary and Ambulatory Care, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Todd Paul
- Department of Nursing, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Judith B Boardman
- Department of Nursing, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
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Bowers A, Owen R, Heller T. Care coordination experiences of people with disabilities enrolled in medicaid managed care. Disabil Rehabil 2016; 39:2207-2214. [DOI: 10.1080/09638288.2016.1219773] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Anne Bowers
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois, USA
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Kuluski K, Gandhi S, Diong C, Steele Gray C, Bronskill SE. Patterns of community follow-up, subsequent health service use and survival among young and mid-life adults discharged from chronic care hospitals: a retrospective cohort study. BMC Health Serv Res 2016; 16:382. [PMID: 27522347 PMCID: PMC4983410 DOI: 10.1186/s12913-016-1631-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/04/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite the demand for rehabilitation and chronic care services across the life course, policy and care strategies tend to focus on older adults and overlook medically complex younger adult populations. This study examined young and mid-life adults discharged from tertiary chronic care hospitals in order to describe their health service use and to examine the association between patterns of timely community follow-up, and subsequent health outcomes. METHODS This population-based retrospective cohort study used linked administrative data to identify 1,906 individuals aged 18-64 years and discharged alive from tertiary chronic care hospitals in Ontario, Canada between April 1, 2005 and March 31, 2006. Multivariate Cox proportional hazard models were used to examine the effect of community follow-up within 7 days of discharge (home care and/or a primary care physician visit or neither) on time to first hospitalization and emergency department (ED) visit. Five-year survival was examined using Kaplan-Meier survival curves. RESULTS The cohort had a high prevalence of multi-morbidity and use of hospital, emergency services and physician services was high in the year following discharge. Most individuals received follow-up care from a primary care physician and/or home care within 7 days of discharge while 30 % received neither. Within 1 year of discharge, 18 % of individuals died. Among those who survived, time to acute care hospitalization in the year following discharge was significantly longer among those who received both a home care and a physician follow-up visit compared to those who received neither. No significant associations were found between community follow-up and ED visits within 1 year. CONCLUSIONS Immediate community follow-up may reduce subsequent use of acute care services. Future research should determine why some individuals, who would likely benefit from services, are not receiving them including barriers to access.
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Affiliation(s)
- Kerry Kuluski
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System (Bridgepoint Hospital Site), 1 Bridgepoint Drive, Toronto, ON M4M 2B5 Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3 M6 Canada
| | - Sima Gandhi
- Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON M4N 3 M5 Canada
| | - Christina Diong
- Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON M4N 3 M5 Canada
| | - Carolyn Steele Gray
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System (Bridgepoint Hospital Site), 1 Bridgepoint Drive, Toronto, ON M4M 2B5 Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3 M6 Canada
| | - Susan E. Bronskill
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3 M6 Canada
- Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON M4N 3 M5 Canada
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Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: A systematic literature review. Health Policy 2016; 120:818-32. [DOI: 10.1016/j.healthpol.2016.04.002] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 12/21/2022]
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Impact of financial agreements in European chronic care on health care expenditure growth. Health Policy 2016; 120:420-30. [DOI: 10.1016/j.healthpol.2016.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 02/18/2016] [Accepted: 02/24/2016] [Indexed: 11/23/2022]
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Friedman A, Howard J, Shaw EK, Cohen DJ, Shahidi L, Ferrante JM. Facilitators and Barriers to Care Coordination in Patient-centered Medical Homes (PCMHs) from Coordinators' Perspectives. J Am Board Fam Med 2016; 29:90-101. [PMID: 26769881 PMCID: PMC4809054 DOI: 10.3122/jabfm.2016.01.150175] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Care coordinators are increasingly featured in patient-centered medical home (PCMH) projects, yet little research examines how coordinators themselves define and experience their role. This is the first study describing experiences of care coordinators across the US from their own perspectives. METHODS This qualitative study used a 5-month private, online discussion forum to gather data from 25 care coordinators from PCMH practices representing diversity in practice size, setting, and type. Participants answered questions and interacted with one another, creating an online social learning collaborative while allowing for data collection for research. RESULTS Coordinators identified barriers and facilitators in their work at the organization/system level, the interpersonal level, and the individual level. Some factors emerged as both barriers and facilitators, including the functionality of clinical information technology; the availability of community resources; interactions with clinicians and other health care facilities; interactions with patients; and self-care practices for mental health and wellness. Colocation and full integration into practices were other key facilitators, whereas excessive case loads and data management responsibilities were felt to be important barriers. CONCLUSIONS While all the barriers and facilitators were important to performing coordinators' roles, relationship building materialized as key to effective care coordination, whether with clinicians, patients, or outside organizations. We discuss implications for practice and provide suggestions for further research.
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Affiliation(s)
- Asia Friedman
- From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS).
| | - Jenna Howard
- From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS)
| | - Eric K Shaw
- From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS)
| | - Deborah J Cohen
- From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS)
| | - Laleh Shahidi
- From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS)
| | - Jeanne M Ferrante
- From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS)
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Care coordination of multimorbidity: a scoping study. JOURNAL OF COMORBIDITY 2015; 5:15-28. [PMID: 29090157 PMCID: PMC5636034 DOI: 10.15256/joc.2015.5.39] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 03/05/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND A key challenge in healthcare systems worldwide is the large number of patients who suffer from multimorbidity; despite this, most systems are organized within a single-disease framework. OBJECTIVE The present study addresses two issues: the characteristics and preconditions of care coordination for patients with multimorbidity; and the factors that promote or inhibit care coordination at the levels of provider organizations and healthcare professionals. DESIGN The analysis is based on a scoping study, which combines a systematic literature search with a qualitative thematic analysis. The search was conducted in November 2013 and included the PubMed, CINAHL, and Web of Science databases, as well as the Cochrane Library, websites of relevant organizations and a hand-search of reference lists. The analysis included studies with a wide range of designs, from industrialized countries, in English, German and the Scandinavian languages, which focused on both multimorbidity/comorbidity and coordination of integrated care. RESULTS The analysis included 47 of the 226 identified studies. The central theme emerging was complexity. This related to both specific medical conditions of patients with multimorbidity (case complexity) and the organization of care delivery at the levels of provider organizations and healthcare professionals (care complexity). CONCLUSIONS In terms of how to approach care coordination, one approach is to reduce complexity and the other is to embrace complexity. Either way, future research must take a more explicit stance on complexity and also gain a better understanding of the role of professionals as a prerequisite for the development of new care coordination interventions.
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