Model of care for a changing healthcare system: are there foundational pillars for design?

Key aspects of the Saudi healthcare system reform and the potential impact on the main stakeholders: A qualitative study

Objectives

To explore and understand KSA's fundamental healthcare system reform, the potential changes and challenges, and their impacts on major stakeholders.

Methodology

To gain in-depth insights into healthcare leaders' perspectives regarding healthcare system reform in KSA, a qualitative research approach was used. Ten participants from diverse backgrounds were selected, representing various sectors in KSA: private, public, executive, consulting, and regulatory. This study was conducted between august 2022 and June 2023.

Findings

The findings revealed four key themes that shed light on healthcare system transformation in KSA and its effects: healthcare system reform, the impact of corporatization/privatization on healthcare providers, the impact of corporatization/privatization on health insurance, and the impact of corporatization/privatization on the workforce. Furthermore, the findings indicated that the ongoing transformation of the public sector toward privatization in KSA faces various challenges that affect most, if not all, stakeholders in the sector. However, the private sector possesses several strengths that can aid in addressing the challenges associated with the rapid transformation of the system. These strengths include familiarity with the market, robust financial management, extensive experience in coding and billing payers and insurance companies, efficient decision-making processes, flexibility, and maturity.

Conclusion

The study facilitated comprehensive insights into the transformation of KSA's healthcare system and the public sector's shift toward corporatization/privatization. The sector must enhance its capabilities by establishing specialized units and recruiting talent. Further studies are also needed to gain a deeper understanding of the obstacles hindering the transformation.

Models of palliative care for under-served populations in high-income countries: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to describe models of palliative care for under-served populations in high-income countries, defined as adults of culturally and linguistically diverse communities, low socioeconomic status, and/or residing in rural areas.

INTRODUCTION

Models of palliative care are processual, referring to the way palliative care services are delivered as people experience a condition, injury, or event. The aim of these models is to ensure people get the right care, at the right time, by the right team, in the right place. Evidence suggests there is a wide variety of models of palliative care, but what is not known is how these models can vary to meet the needs of under-served populations.

INCLUSION CRITERIA

This scoping review will consider articles that focus on models of palliative care for under-served populations, irrespective of sex, age, or primary diagnosis.

METHODS

MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), Emcare (Ovid), CINAHL (EBSCOhost), and Scopus will be searched for articles, irrespective of language, published from 2014. Two independent reviewers will screen titles and abstracts, followed by a full-text review of potentially relevant articles. Discrepancies will be reconciled with another reviewer. Two independent reviewers will extract data from included articles using a data extraction tool developed for this review. Results will be tabulated and/or presented diagrammatically, as well as summarized to explicitly address the objective of the review.

REVIEW REGISTRATION

Open Science Framework osf.io/x4ky3.

Implementing the Synergy Model: A Qualitative Descriptive Study

Hospitals across our nation are seeking to implement models of care that meet the primary goals of Quadruple Aim: Improved population health, cost-effective care delivery, and patient and provider satisfaction. In an effort to address the Quadruple Aim and our patients’ care needs, Hamilton Health Sciences (HHS) embarked on a model of care delivery redesign, beginning with nursing care delivery. From 2013 to 2018, 12 clinical programs at HHS implemented the Synergy Model with its accompanying synergy patient needs assessment tool for nurses to objectively assess patients’ acuity and dependency needs. Data on patients’ priority care needs were used to inform a nursing model of care redesign at HHS, including skill mix and staffing levels. This five-year project was an organization-wide quality improvement initiative. As part of the evaluation, HHS leaders partnered with health services nurse researchers to conduct a mixed methods study. This paper describes the evaluation outcomes from the qualitative component of the study, which included interviews with clinical nurse leaders and direct care nurses. Data were analyzed using descriptive thematic analysis. Some key findings were increased nurse awareness of patients’ holistic care needs and leaders’ capacity to plan staffing assignments based on patients’ priority care needs. Themes helped inform recommendations for key stakeholders, including nurse leaders and direct care nurses.

Application du modèle synergique au modèle de soins infirmiers en contexte de soins hospitaliers et ambulatoires – expérience de deux établissements en milieu urbain : Centre des sciences de la santé d’Hamilton et Centre régional de cancérologie de Grand

L’incidence et la prévalence du cancer continuent à augmenter dans l’ensemble du Canada. On s’attend à ce que un Canadiens sur deux souffrent d’un cancer à un moment de leur vie (Canadian Cancer Society/Société canadienne du cancer, 2021). Comme la complexité et la gravité des cas de cancer sont en hausse, il devient essentiel de définir le ratio idéal infirmière-patients et le nombre de patients par infirmière dans les services d’oncologie. Deux infirmières en chef chevronnées amenées à définir dans leurs secteurs respectifs le meilleur modèle à associer à celui en place pour les soins infirmiers ont décidé, après s’être concertées, de mettre en œuvre le modèle synergique. Le « modèle synergique » est un modèle de pratique professionnelle élaboré par l’American Association of Critical Care Nurses (AACN) dans lequel les soins infirmiers reflètent l’intégration des connaissances, des aptitudes, des comportements, des compétences et de l’expérience des infirmières pour répondre aux besoins des patients et de leurs familles (Curley, 2007). Il offre une structure pour harmoniser les ressources en soins infirmiers et les besoins en soins des patients et a été adapté à différents types de soins. Cependant, ce modèle n’avait pas été mis en place dans des unités hospitalières d’oncologie chirurgicale ni dans des services d’oncologie ambulatoires. Grâce à une méthodologie d’amélioration de la qualité, le modèle synergique a été testé avec succès dans ces nouveaux services. Il peut être utilisé pour établir le besoin de ressources supplémentaires en soins infirmiers assurés par des infirmières spécialisées en oncologie ainsi qu’une combinaison appropriée d’aptitudes offertes par des équipes infirmières intraprofessionnelles. Il sert à évaluer les patients adultes en oncologie qui se présentent dans une salle de traitements ambulatoires systémiques pour recevoir des soins non planifiés en raison de symptômes.

Applying the Synergy Model to inform the nursing model of care in an inpatient and an ambulatory care setting: The experience of two urban cancer institutions, Hamilton Health Sciences and Grand River Regional Cancer Centre

The incidence and prevalence of cancer continues to rise throughout Canada. Approximately one in two Canadians are expected to develop cancer at some point in their lives (Canadian Cancer Society, 2021). As the complexity and acuity of individuals with cancer increases, there is increased necessity to define the ideal nurse-to-patient ratio and patient caseload for nurses in specialized oncology settings. Two senior nurse leaders, faced with the need to determine the most appropriate model to inform the nursing model of care within their respective care areas, collaborated and decided to implement the Synergy Model. The Synergy Model is a professional practice model developed by the American Association of Critical Care Nurses (AACN). In the Synergy Model, nursing care reflects the integration of nurses' knowledge, skills, attitudes, competencies, and experience to meet the needs of patients and families (Curley, 2007). This model provides a framework for matching nursing resources based on patient care needs and has been adapted in various care settings. The model, however, has not been applied in a surgical oncology inpatient unit or in an oncology ambulatory care setting. Using a quality improvement methodology, the Synergy Model was piloted in these new areas and found to be effective. The Synergy Model can be utilized to determine the need for additional nursing resources with specialized oncology nurses and appropriate skill mix of intraprofessional nursing teams. It can also be used to assess adult oncology patients who present to the ambulatory systemic care suite for unscheduled care related to symptomatic concerns.

What Are Models of Care? A Systematic Search and Narrative Review to Guide Development of Care Models for Premature Ovarian Insufficiency

No specific model of care (MoC) is recommended for premature ovarian insufficiency (POI), despite awareness that POI is associated with comorbidities requiring multidisciplinary care. This article aims to explore the definitions and central components of MoC in health settings, so that care models for POI can be developed. A systematic search was performed on Ovid Medline and Embase, and including gray literature. Unique definitions of MoC were identified, and thematic analysis was used to summarize the key component of MoC. Of 2,477 articles identified, 8 provided unique definitions of MoC, and 11 described components of MoC. Definitions differ in scope, focusing on disease, service, or system level, but a key feature is that MoC is operational, describing how care is delivered, as well as what that care is. Thematic analysis identified 42 components of MoC, summarized into 6 themes-stakeholder engagement, supporting integrated care, evidence-based care, defined outcomes and evaluation, behavior change methodology, and adaptability. Stakeholder engagement was central to all other themes. MoCs operationalize how best practice care can be delivered at a disease, service, or systems level. Specific MoC should be developed for POI, to improve clinical and process outcomes, translate evidence into practice, and use resources more efficiently.

BeyondSilos, a Telehealth-Enhanced Integrated Care Model in the Domiciliary Setting for Older Patients: Observational Prospective Cohort Study for Effectiveness and Cost-Effectiveness Assessments

BACKGROUND

Information and communication technology may provide domiciliary care programs with continuity of care. However, evidence about the effectiveness and cost-effectiveness of information and communication technology in the context of integrated care models is relatively scarce.

OBJECTIVE

The objective of our study was to provide evidence on the clinical effectiveness and cost-effectiveness of the BeyondSilos project for patients enrolled in the Badalona city pilot site in Spain.

METHODS

A quasi-experimental study was used to assess the cost-effectiveness of information and communication technology-enhanced integration of health and social care, including the third sector (intervention), compared to basic health and social care coordination (comparator). The study was conducted in Badalona between 2015 and 2016. Participants were followed for 8 months.

RESULTS

The study included 198 patients: 98 in the intervention group and 100 in the comparator group. The mean Barthel index remained unchanged in the intervention group (mean change 0.14, 95% CI -4.51 to 4.78; P=.95) but decreased in the comparator group (mean change -3.23, 95% CI -5.34 to -1.11; P=.003). Instrumental Activities of Daily Living significantly decreased in both groups: mean changes of -0.23 (95% CI -0.44 to -0.02; P=.03) and -0.33 (95% CI -0.46 to -0.20; P<.001) in the intervention and comparator groups, respectively. No differences were found in the Geriatric Depression Scale (intervention: mean change 0.28, 95% CI -0.44 to 1.01, P=.44; comparator: mean change -0.29, 95% CI -0.59 to 0.01, P=.06). The intervention showed cost-effectiveness (incremental cost-effectiveness ratio €6505.52, approximately US $7582).

CONCLUSIONS

The information and communication technology-enhanced integrated domiciliary care program was cost-effective. The beneficial effects of this approach strongly rely upon the commitment of the professional staff involved.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03111004; http://clinicaltrials.gov/ct2/show/ NCT03111004.

Study protocol of a quasi-experimental trial to compare two models of home care for older people in the primary setting

BACKGROUND

Preventive home visits are suited for patients with reduced mobility, such as older people. Healthcare needs for older patients are expected to increase due to the extended life expectancy estimated in coming years. The implementation of low-cost, patient-centered methodologies may buffer this rise in health care costs without affecting the quality of service. In order to find the best home care model with less investment, this paper describes a study protocol comparing two models of home care for older people.

METHODS

We describe a quasi-experimental study that compares the outcome of two different home care models already implemented in two primary care centers in Badalona (Barcelona, Spain). The traditional model (control model) is integrated in the sense that is continuous, the same primary care center team looks after its assigned patients both at the center and in preventive home visits. The new functional home care model (study model), consisting of a highly trained team, is specifically designed to meet patient needs and give total attention to preventive home interventions. The study will start and end on the expected dates, June 2018 to October 2020, and include all patients over 65 years old already enrolled in the home care programs of the primary care centers selected. The primary endpoint assessed will be the difference in hospitalization days between patients included in both home care programs. Other variables regarding health status, quality of care and resource utilization will also be compared between the two models.

DISCUSSION

The study in progress will assess whether a functional and highly trained home care team will meet the ever-aging population needs in terms of cost and health outcomes better than a traditional, integrated one. Lessons learned from this pilot study will provide guidelines for a future model of home care based on the IHI Triple Aim: better care, better health, and lower costs.

TRIAL REGISTRATION

Registered in ClinicalTrials.gov (Identifier: NCT03461315; March 12, 2018).

Coping with more people with more illness. Part 1: the nature of the challenge and the implications for safety and quality

Health systems are under more pressure than ever before, and the challenges are multiplying and accelerating. Economic forces, new technology, genomics, AI in medicine, increasing demands for care-all are playing a part, or are predicted to increasingly do so. Above all, ageing populations in many parts of the world are exacerbating the disease burden on the system and intensifying the requirements to provide effective care equitably to citizens. In this first of two companion articles on behalf of the Innovation and Systems Change Working Group of the International Society for Quality in Health Care (ISQua), in consultation with representatives from over 40 countries, we assess this situation and discuss the implications for safety and quality. Health systems will need to run ahead of the coming changes and learn how to cope better with more people with more chronic and acute illnesses needing care. This will require collective ingenuity, and a deep desire to reconfigure healthcare and re-engineer services. Chief amongst the successful strategies, we argue, will be preventative approaches targeting both physical and psychological health, paying attention to the determinants of health, keeping people at home longer, experimenting with new governance and financial models, creating novel incentives, upskilling workforces to fit them for the future, redesigning care teams and transitioning from a system delivering episodic care to one that looks after people across the life cycle. There are opportunities for the international community to learn together to revitalise their health systems in a time of change and upheaval.