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Remers TEP, Jeurissen PPT, Coremans A, Olde Rikkert MGM, van Dulmen SA. Experiences and preliminary effects of the Comprehensive chrOnic caRe outpatiEnt (CORE) clinic for patients with multimorbidity in the hospital setting. J Eval Clin Pract 2024; 30:1361-1372. [PMID: 39031802 DOI: 10.1111/jep.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 05/25/2024] [Accepted: 06/03/2024] [Indexed: 07/22/2024]
Abstract
RATIONALE Healthcare systems remain disease oriented despite growing sustainability concerns caused by inadequate management of patients with multimorbidity. Comprehensive care programmes (CCPs) can play an important role in streamlining care delivery, but large differences in setup and results hinder firm conclusions on their effectiveness. Many elements for successful implementation of CCPs are identified, but strategies to overcome barriers and embed programmes within health systems remain unknown. AIMS AND OBJECTIVES To address this knowledge gap through a detailed study of implementing a CCP in a Dutch hospital setting, including patient experiences, facilitators, barriers and ways to overcome those barriers. Additionally, this study aims to explore effects on patient satisfaction and healthcare use. METHODS A qualitative study design with 39 semistructured interviews and focus groups between July 2020 and February 2023 with 16 patients and 17 involved professionals. Additionally, effects on quantitative outcomes for patient satisfaction (PACIC-20) and healthcare use were explored. RESULTS Professionals expressed a wide range of topics related to implementation and ways to overcome barriers at hospital and system level. Alterations in the design to accommodate varying care demands, focus on inclusions through referrals, and lack of long-term support and appropriate financing were key topics. Patients expressed varying experiences, stated a strong desire for comprehensive information, and emphasised the importance of trust in caregivers. Patient satisfaction showed no effects, while healthcare use showed slight decreases in trends, but patient numbers were limited. CONCLUSION The introduction of a CCP is feasible, and exploratory analysis on effectiveness shows lower hospital care use without decreasing patient satisfaction. However, this is accompanied by several challenges that show current fragmented systems still do not support implementation of integrated care initiatives. Overcoming those comes with substantial costs and may require a strong bottom-up implementation within a motivated team and actions on all levels of healthcare systems.
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Affiliation(s)
- Toine E P Remers
- Radboud University Medical Center, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- Radboud University Medical Center, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Annemiek Coremans
- Department of Internal Medicine, Bernhoven Hospital, Uden, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Radboud Alzheimer Centre, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Simone A van Dulmen
- Radboud University Medical Center, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
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Schwartz DB, Sumner S, Cardenas D, Wong T, Annetta MG, Goldman B, Barrocas A, Echeverri S, Francisco EMP, Hardy G. ASPEN international survey on ethical competencies dealing with decision-making in the use of artificially administered nutrition and hydration and competency application in clinical practice. Nutr Clin Pract 2024. [PMID: 39312472 DOI: 10.1002/ncp.11213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 08/17/2024] [Accepted: 08/23/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Ethical competencies dealing with decision-making for clinicians involved in artificially administered nutrition and hydration (AANH) have not been defined in the literature. Although clinical assessments identify nutrition needs and appropriate routes of nutrition administration, an assessment of the ethical, cultural, and spiritual implications of the medical nutrition therapy may be overlooked. METHODS Eleven competency statements were developed by members of two international sections of the American Society for Parenteral and Enteral Nutrition. This descriptive cross-sectional survey study was conducted to measure the importance of the competency statements to the membership of two sections using a five-point Likert scale of 1-5 (1-low to 5-high). RESULTS A total of 113 responses (12.5% response rate) were obtained predominantly from physicians and dietitians from 25 countries. There was a wide range of world regions of the 49% respondents outside of the United States. Means and SDs were calculated for agreement with the 11 competency statements with overall means ranging from 4.32 to 4.67. Most of the participants cared for adult/older adult patients (63.7%) exclusively, and 12.4% cared for pediatric/neonate patients exclusively; the remainder (23.9%) cared for both populations. Respondents reported they were either experienced, competent, or expert (88.6%) in dealing with ethical issues related to AANH. CONCLUSION This international interdisciplinary group agreed that the integration of ethical, cultural, and spiritual competencies into clinical decision-making regarding artificially AANH is important.
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Affiliation(s)
| | - Sarah Sumner
- Intensive Care Unit, Providence Saint Joseph Medical Center, Burbank, California, USA
| | - Diana Cardenas
- Nutrition Unit, Institu Gustave Roussy, Villejuif, France
| | - Theodoric Wong
- Birmingham Children's Hospital, Birmingham, United Kingdom
| | | | - Babak Goldman
- Providence Saint Joseph Medical Center, Burbank, California, USA
| | - Albert Barrocas
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Eliza Mei Perez Francisco
- ASPEN International Clinical Nutrition Section, Asian Hospital and Medical Center, Manila, Philippines
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
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Gheduzzi E, Savarese M, Mangini A, Mitidieri S, Paleologo M, Masella C, Graffigna G. Co-producing and co-assessing a new service solution for enhancing health and social care integration: a participatory research protocol. BMC Health Serv Res 2024; 24:1103. [PMID: 39300510 DOI: 10.1186/s12913-024-11598-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 09/17/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND This paper describes a study protocol for co-producing and co-assessing a new sustainable and scalable service solution that enhances health and social integration by involving providers and volunteers delivering services for elderly people in the province of Cremona (Italy), where the elderly population will reach 27% in 2023. METHODS This upcoming study involves mixed-method participatory research and is structured in three study phases and related objectives. First, it will co-produce a new, accessible and sustainable service solution using an iterative design and management method, Plan-Do-Check-Act by involving professionals and volunteers of a heterogeneous group of health, social and third sector organizations located in the city of Cremona (Italy). Second, the study protocol will co-assess the outcomes of the new service solution using a mixed-method approach for measuring the outcomes on: professionals and volunteers (micro level) and their health, social and third sector organizations (meso level). Third, this study will co-investigate the scalability of the new solution promoting health and social integration in other similar urban areas of the Province of Cremona via the Intervention Scalability Assessment Tool (macro level). The data will be collected through the analysis of official documents, websites, policies and participatory workshops. DISCUSSION This protocol proposes an innovative intervention, a novel participatory approach, and an unexplored scalability assessment tool in the context of health and social care integration. This study aims to support professionals from health and social care service providers and volunteers from third-sector organizations to collaborate and integrate each other's resources. In doing so, the participatory approach will facilitate the co-creation of an effective response to the need of health and social integration, and the development of trustful relationships between health and social care service providers. Moreover, the adoption of Plan-Do-Check-Act and Intervention Scalability Assessment Tool will ensure the quality, scalability and sustainability of the new service solution in other settings.
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Affiliation(s)
- Eleonora Gheduzzi
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milano, 20156, Italia.
| | - Mariarosaria Savarese
- EngageMinds HUB, Università Cattolica del Sacro Cuore, Via Bissolati, 74, Cremona, 26100, Italia
| | - Alberto Mangini
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milano, 20156, Italia
| | - Silvia Mitidieri
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milano, 20156, Italia
| | - Michele Paleologo
- EngageMinds HUB, Università Cattolica del Sacro Cuore, Via Bissolati, 74, Cremona, 26100, Italia
| | - Cristina Masella
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Via Lambruschini 4/B, Milano, 20156, Italia
| | - Guendalina Graffigna
- EngageMinds HUB, Università Cattolica del Sacro Cuore, Via Bissolati, 74, Cremona, 26100, Italia
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Daniel K, Bousfield J, Hocking L, Jackson L, Taylor B. Women's Health Hubs: a rapid mixed-methods evaluation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-138. [PMID: 39268794 DOI: 10.3310/jyft5036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Background Women's sexual and reproductive health needs are complex and vary across the life course. They are met by a range of providers, professionals and venues. Provision is not well integrated, with inequalities in access. In some areas of the United Kingdom Women's Health Hubs have been established to improve provision, experience and outcomes for women, and to address inequalities and reduce costs. These models were established prior to the national implementation of Women's Health Hubs announced in the English 2022 Women's Health Strategy. Objective To explore the 'current state of the art', mapping the United Kingdom landscape, and studying experiences of delivering and using Women's Health Hubs across England, defining key features and early markers of success to inform policy and practice. Design A mixed-methods evaluation, comprising three work packages: Mapping the Women's Health Hub landscape and context and developing a definition of Women's Health Hubs, informed by an online national survey of Women's Health Hub leaders, and interviews with regional stakeholders. In-depth evaluation in four hub sites, including interviews with staff and women, focus groups in local communities and documentary analysis. Interviews with national stakeholders and consolidation of findings from work packages 1 and 2. Fieldwork was undertaken from May 2022 to March 2023. The evaluation was initiated prior to the national scale-up of Women's Health Hubs announced in the 2022 Women's Health Strategy. Results Most areas of the United Kingdom did not have a Women's Health Hub. Seventeen active services were identified, established between 2001 and 2022. Women's Health Hubs were diverse, predominantly GP-led, with different perspectives of the role and definition of a hub. Women using hubs reported positive experiences, finding services caring and convenient. Implementation facilitators included committed, collaborative leaders working across boundaries, sufficient workforce capacity and a supportive policy context. Challenges included access to funding, commissioning, workforce issues, facilities and equipment, stakeholder engagement and wider system integration, priorities and pressures. Leaders were committed to addressing inequalities, but evidence of impact was still emerging. Limitations It was challenging to locate models; therefore, some may have been missed. Data availability limited assessment of impact, including inequalities. Some population groups were not represented in the data, and the evaluation was more provider-oriented. It was not possible to develop a typology of Women's Health Hubs as planned due to heterogeneity in models. Conclusions Existing Women's Health Hub models were providing integrated approaches to meet local needs. Many were at an early stage of development. Evidence of system-level impact and costs was still emerging. Women's Health Hubs may widen inequalities if models are more accessible to advantaged groups. The important role of committed leaders in existing 'bottom-up' models may limit scalability and sustainability. Findings suggest that national scale-up will take time and requires funding and that it is necessary to design models according to local needs and resources. In 2023, the Department of Health and Social Care announced funding to establish a Women's Health Hub in every Integrated Care System in England. Future work Future evaluation should consider system-level impact and costs, explore unintended consequences and test assumptions. Funding This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135589) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 30. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Kelly Daniel
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | | | | | - Louise Jackson
- Warwick Medical School, University of Warwick, Coventry, UK
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Beck Taylor
- Warwick Medical School, University of Warwick, Coventry, UK
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Chen TT, Su WC, Liu MI. Patient-centered care in diabetes care-concepts, relationships and practice. World J Diabetes 2024; 15:1417-1429. [PMID: 39099822 PMCID: PMC11292325 DOI: 10.4239/wjd.v15.i7.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/11/2024] [Accepted: 05/13/2024] [Indexed: 07/08/2024] Open
Abstract
We still do not have comprehensive knowledge of which framework of patient-centered care (PCC) is appropriate for diabetes care, which elements of PCC are evidence-based, and the mechanism by which PCC elements are associated with outcomes through mediators. In this review, we elaborate on these issues. We found that for diabetes care, PCC elements such as autonomy support (patient individuality), cooperation and collaboration (system-level approach), com-munication and education (behavior change techniques), emotional support (biopsychosocial approach), and family/other involvement and support are critically important. All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation. We present the practical implications of these PCC elements.
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Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan
| | - Wei-Chih Su
- Department of Gastroenterology, Taipei Tzu-Chi Hospital, New Taipei 23142, Taiwan
| | - Mei-I Liu
- Department of Pediatric Endocrinology, Mackay Children's Hospital, Taipei 10449, Taiwan
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Hyett N, Hutchinson M, Doyle D, Adem T, Coghill D, Harvey P, Lees C, O'Sullivan B. Rural community-centred co-planning for sustainable rural health systems. Aust J Rural Health 2024. [PMID: 38989766 DOI: 10.1111/ajr.13162] [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: 08/25/2023] [Revised: 06/14/2024] [Accepted: 06/22/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVE Sustaining rural healthcare services is challenging because of numerous systemic factors. Rural communities can inform the design of sustainable rural health models; however, further evidence of effective co-design is needed to guide implementation. The study aim was to co-design a series of place-based and evidence-informed rural health models, to improve local health system sustainability. SETTING A rural region (categorised as Modified Monash Model 5) defined by three adjoining Shires in Central and Northwest Victoria, Australia. PARTICIPANTS A health executive co-planning network led the co-design, with input and oversight from a broader cross-sector group. Healthcare professionals (n = 44) and consumers and carers (n = 21) participated in interviews, and an online survey was completed by healthcare professionals (n = 11) and consumers and carers (n = 7) to provide feedback on the preliminary results. DESIGN Community-based participatory action research was applied incorporating co-design methods and systems thinking. Data were collected through qualitative interviews followed by an online feedback survey. Mixed method data analysis (QUAL-quant) was conducted with qualitative directed content analysis of interview transcripts and quantitative descriptive analyses of survey responses to aid prioritisation. RESULTS Healthcare priorities, strengths and challenges, and proposed rural health models are described. A rural health system sustainability strategy was developed with three integrated pillars: 1. Workforce strengthening, 2. Integrated health services and 3. Innovative models of care. CONCLUSION Community-centred co-design with rural health stakeholders was effective for generating locally tailored ideas and potential health models that emulate community strengths and resources, and provide a foundation for further planning, implementation and evaluation.
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Affiliation(s)
- Nerida Hyett
- Murray PHN, Monash University, La Trobe University, Bendigo, Victoria, Australia
| | | | - Donna Doyle
- Boort District Health, Boort, Victoria, Australia
| | - Trevor Adem
- East Wimmera Health Service, Saint Arnaud, Victoria, Australia
| | - Dallas Coghill
- Inglewood & Districts Health Service, Inglewood, Victoria, Australia
| | - Pamela Harvey
- Monash Rural Health, Monash University, Bendigo, Victoria, Australia
| | - Catherine Lees
- Murray PHN, La Trobe University, Monash University, University of Melbourne, Melbourne, Victoria, Australia
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Whetten J, Medina L, Krabbenhoft C, Will V, Reising M, Maska BK, Phillips JK. Health Resource Utilization and Cost Impact of Integrative Medicine Services for Newly Diagnosed Chronic Pain Patients. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38976483 DOI: 10.1089/jicm.2024.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Background: Integrative medicine (IM) is the healing-oriented practice of medicine that emphasizes the relationship between practitioner and patient. It considers the whole person, their environment, lifestyle, and social and cultural factors. It is evidence based and makes use of all appropriate therapies, conventional and complimentary. Objective: To evaluate the impact of IM services on health outcomes and care costs of chronic pain management patients compared with standard care. Methods: This article uses University of New Mexico hospital billing data from 10/2016 to 09/2019 to identify patients with nervous system or musculoskeletal pain. A total of 1,304 patients were matched using propensity scores into IM services (treatment: 652) and standard care (control: 652) cohorts for difference-in-differences analysis. The patients were matched based on age, sex, race, zip code, insurance type, ICD-10s, prescriptions, health care events, and medical claim costs. Results: Patients who used IM services had better health outcomes and lower costs at 3-month, 6-month, and 12-month follow-up. At the 12-month follow-up, the IM group showed a 19% decrease in utilization of inpatient care, a 37% decrease in Emergency Department utilization, and an 11.3% reduction in claim costs compared with the control group. Conclusion: Patients who utilize IM services as part of chronic pain management have overall lower health care costs and better health outcomes. Unfortunately, in the health system studied, less than 3% of patients utilize these services. Promotion of and education about IM services should be aimed at both patients and their providers.
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Affiliation(s)
- Justin Whetten
- University of New Mexico Health System, Albuquerque, NM, USA
| | - Laura Medina
- University of New Mexico Health System, Albuquerque, NM, USA
| | | | - Vanessa Will
- University of New Mexico Health System, Albuquerque, NM, USA
| | - Mary Reising
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM USA
| | - Breanna K Maska
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM USA
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Fullaondo A, Hamu Y, Txarramendieta J, de Manuel E. Scaling-Out Digitally Enabled Integrated Care in Europe Through Good Practices Transfer: The JADECARE Study. Int J Integr Care 2024; 24:15. [PMID: 39131232 PMCID: PMC11312721 DOI: 10.5334/ijic.8605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 08/01/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction The absence of a coordinated approach to health and social care compromises the ability of health systems to provide universal, equitable, high-quality, and financially sustainable care. Transferring evidence-based practices focused on digitally-enabled integrated care to new contexts can overcome this challenge if implementation is satisfactory. This paper presents the scaling-out methodology that JADECARE has designed to spread effective innovative practices across Europe. Methodology The scaling-out methodology pretends to guide the Next Adopters in the transfer and adoption of practices, whereas increasing their implementation capacity and providing an evaluation framework to assess impact and success. Discussion JADECARE scaling-out effort is based on guiding principles found in the literature such as the balance between fidelity to the original practice and the degree of adaptation required to fit the new context, the need for capacity building in implementation to bridge the gap between research and routine practice and the focus on explaining why, for whom and in what circumstances an intervention works. Conclusion The JADECARE scaling-out methodology is theory-driven and pragmatic and aims to facilitate the transfer of complex interventions across different contexts.
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Affiliation(s)
- Ane Fullaondo
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Yhasmine Hamu
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Jon Txarramendieta
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
- Osakidetza, Gorliz Hospital, Basque Country, Spain
| | - Esteban de Manuel
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
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Ambagtsheer RC, Leach MJ, O'Brien LM, Tyndall J, Wardle J, Beilby J. Multidisciplinary, multicomponent interventions to reduce frailty among older persons in residents of residential care facilities: a scoping review. Syst Rev 2024; 13:154. [PMID: 38858798 PMCID: PMC11163739 DOI: 10.1186/s13643-024-02576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Frailty reduction and reversal have been addressed successfully among older populations within community settings. However, these findings may not be applicable to residential care settings, largely due to the complex and multidimensional nature of the condition. Relatively, few attempts at frailty prevention exist in residential settings. This review aims to identify and describe best practice models of care for addressing frailty among older populations in residential care settings. This research also sets out to explore the impact of multidisciplinary health service delivery models on health outcomes such as mortality, hospitalisations, quality of life, falls and frailty. METHODS A scoping review of the literature was conducted to address the project objectives. Reference lists of included studies, bibliographic databases and the grey literature were systematically searched for literature reporting multidisciplinary, multidimensional models of care for frailty. RESULTS The scoping review found no interventions that met the inclusion criteria. Of the 704 articles screened, 664 were excluded as not relevant. Forty articles were fully assessed, and while no eligible studies were found, relevant data were extracted from 10 near-eligible studies that reported single disciplines or single dimensions rather than a model of care. The physical, nutritional, medicinal, social and cognitive aspects of the near eligible studies have been discussed as playing a key role in frailty reduction or prevention care models. CONCLUSION This review has identified a paucity of interventions for addressing and reducing frailty in residential care settings. High-quality studies investigating novel models of care for addressing frailty in residential care facilities are required to address this knowledge gap. Similarly, there is a need to develop and validate appropriate screening and assessment tools for frailty in residential care populations. Health service providers and policy-makers should also increase their awareness of frailty as a dynamic and reversible condition. While age is a non-modifiable predictor of frailty, addressing modifiable factors through comprehensive care models may help manage and prevent the physical, social and financial impacts of frailty in the ageing population.
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Affiliation(s)
| | - M J Leach
- Faculty of Health, National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - L M O'Brien
- Torrens University Australia, Adelaide, SA, 5000, Australia.
| | - J Tyndall
- Torrens University Australia, Adelaide, SA, 5000, Australia
| | - J Wardle
- Faculty of Health, National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - J Beilby
- Torrens University Australia, Adelaide, SA, 5000, Australia
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Ferreira R, Pedrosa AR, Reis N, Sousa L, Nicolau C, Ferreira B, Rocha B, Baixinho CL. Transitional care for older persons with need of geriatric rehabilitation nursing interventions. BMC Nurs 2024; 23:376. [PMID: 38834990 DOI: 10.1186/s12912-024-02050-4] [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: 03/19/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The literature review notes that people in need of care from Rehabilitation Programs do not always see their continuity ensured. OBJECTIVE This study aim to analyze the perspective of Specialists Nurse in Rehabilitation Nursing in relation to the organization and specialized intervention of transitional care for older people in need of rehabilitation programs. METHODS This is a qualitative study within the interpretivist paradigm. A focus group with 8 nurses and 13 interviews with Portuguese nurses were carried out between April 2022 and February 2023. Content analysis was carried out. RESULTS The triangulation of the data made it possible to identify 3 categories: Coordination of a transitional care program; Empowering the person to self-manage the transitional care process and Empowering the Informal Caregiver. CONCLUSIONS It is imperative to promote the coordination of transitional care, increase the functional capacity of the person and empower the informal caregiver.
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Affiliation(s)
- Rogério Ferreira
- Polytechnic Institute of Beja, Higher School of Health, Rua Pedro Soares, 7800-295, Beja, Portugal
- Comprehensive Health Research Centre (CHRC), 7000-811, Évora, Portugal
| | - Ana Rita Pedrosa
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160, Lisbon, Portugal
| | - Neuza Reis
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160, Lisbon, Portugal
| | - Luís Sousa
- Comprehensive Health Research Centre (CHRC), 7000-811, Évora, Portugal
- Higher School of Atlantic Health, 2730-036, Barcarena, Oeiras, Portugal
| | - Célia Nicolau
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160, Lisbon, Portugal
- Alentejo Coastal Hospital (HLA), Alentejo Coastal Local Health Unit (ULSLA), 7540-230, Santiago do Cacém, Portugal
| | - Bruno Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160, Lisbon, Portugal
- Polytechnic Institute of Setúbal, Higher School of Health, 2910-761, Setúbal, Portugal
| | - Belmiro Rocha
- Associação Portuguesa de Enfermeiros de Reabilitação (APER), 4500-627, Silvalde, Portugal
| | - Cristina Lavareda Baixinho
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160, Lisbon, Portugal.
- Center for Innovative Care and Health Technology (ciTechcare), 2410-541, Leiria, Portugal.
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Middleton L, O'Loughlin C, Tenbensel T, Silwal P, Churchward M, Russell L, Cumming J. Implementing new forms of collaboration and participation in primary health care: leveraging past learnings to inform future initiatives. J Prim Health Care 2024; 16:198-205. [PMID: 38941260 DOI: 10.1071/hc24026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/18/2024] [Indexed: 06/30/2024] Open
Abstract
Introduction Within primary health care policy, there is an increasing focus on enhancing involvement with secondary health care, social care services and communities. Yet, translating these expectations into tangible changes frequently encounters significant obstacles. As part of an investigation into the progress made in achieving primary health care reform in Aotearoa New Zealand, realist research was undertaken with those charged with responsibility for national and local policies. The specific analysis in this paper probes primary health care leaders' assessments of progress towards more collaboration with other health and non-health agencies, and communities. Aim This study aimed to investigate how ideas for more integration and joinedup care have found their way into the practice of primary health care in Aotearoa New Zealand. Methods Applying a realist logic of inquiry, data from semi-structured interviews with primary health care leaders were analysed to identify key contextual characteristics and mechanisms. Explanations were developed of what influenced leaders to invest energy in joined-up and integrated care activities. Results Our findings highlight three explanatory mechanisms and their associated contexts: a willingness to share power, build trusting relationships and manage task complexity. These underpin leaders' accounts of the success (or otherwise) of collaborative arrangements. Discussion Such insights have import in the context of the current health reforms for stakeholders charged with developing local approaches to the planning and delivery of health services.
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Affiliation(s)
- Lesley Middleton
- School of Health, Faculty of Health, Te Herenga Waka - Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand
| | - Claire O'Loughlin
- Te Hikuwai Rangahau Hauora - Health Services Research Centre, Faculty of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Tim Tenbensel
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Pushkar Silwal
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Marianna Churchward
- Te Hikuwai Rangahau Hauora - Health Services Research Centre, Faculty of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Lynne Russell
- Te Hikuwai Rangahau Hauora - Health Services Research Centre, Faculty of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Jacqueline Cumming
- Te Hikuwai Rangahau Hauora - Health Services Research Centre, Faculty of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
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Rivard M, Jacques C, Hérault É, Mello C, Abouzeid N, Saulnier G, Boulé M. An innovative and collaborative method to develop a model care and service trajectory for the assessment, diagnosis, and support of children with developmental disabilities. EVALUATION AND PROGRAM PLANNING 2024; 104:102431. [PMID: 38608392 DOI: 10.1016/j.evalprogplan.2024.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
This paper documents an innovative research approach undertaken to co-develop an integrated assessment, diagnosis, and support service trajectory for children suspected of having a developmental disability. It employed data-driven practices and involved multiple stakeholders such as parents, professionals, managers, and researchers. It emphasized the importance of incorporating experiential knowledge adopting an integrated care and service trajectory perspective, and using an implementation science framework. The first part of this article presents the theoretical roots and the collaborative method used to co-construct the model trajectory. The second part of this article presents the results of a survey in which participating stakeholders shared their point of view on the value and impact of this approach Overall, this article provides a step-by-step operationalization of participative research in the context of public health and social services. This may help guide future initiatives to improve services for developmental disabilities in partnership with those directly concerned by these services.
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Affiliation(s)
- Mélina Rivard
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke West, Montréal, QC H2X 3P2, Canada.
| | - Claudine Jacques
- Department of Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Élodie Hérault
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke West, Montréal, QC H2X 3P2, Canada
| | - Catherine Mello
- Department of Psychology, Penn State University - Berks, Reading, PA, Canada
| | - Nadia Abouzeid
- Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, QC, Canada
| | - Geneviève Saulnier
- Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, QC, Canada
| | - Mélina Boulé
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke West, Montréal, QC H2X 3P2, Canada
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Hedqvist AT, Praetorius G, Ekstedt M, Lindberg C. Entangled in complexity: An ethnographic study of organizational adaptability and safe care transitions for patients with complex care needs. J Adv Nurs 2024. [PMID: 38641975 DOI: 10.1111/jan.16203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
AIM The aim of this study was to visualize vulnerabilities and explore the dynamics of inter-professional collaboration and organizational adaptability in the context of care transitions for patients with complex care needs. DESIGN An ethnographic design using multiple convergent data collection techniques. METHODS Data collection involved document review, participant observations and interviews with healthcare and social care professionals (HSCPs). Narrative analysis was employed to construct two illustrative patient scenarios, which were then examined using the Functional Resonance Analysis Method (FRAM). Thematic analysis was subsequently applied to synthesize the findings. RESULTS Inconsistencies in timing and precision during care transitions pose risks for patients with complex care needs as they force healthcare systems to prioritize structural constraints over individualized care, especially during unforeseen events outside regular hours. Such systemic inflexibility can compromise patient safety, increase the workload for HSCPs and strain resources. Organizational adaptability is crucial to managing the inherent variability of patient needs. Our proposed 'safe care transition pathway' addresses these issues, providing proactive strategies such as sharing knowledge and increasing patient participation, and strengthening the capacity of professionals to meet dynamic care needs, promoting safer care transitions. CONCLUSION To promote patient safety in care transitions, strategies must go beyond inter-professional collaboration, incorporating adaptability and flexible resource planning. The implementation of standardized safe care transition pathways, coupled with the active participation of patients and families, is crucial. These measures aim to create a resilient, person-centred approach that may effectively manage the complexities in care transitions. IMPLICATIONS The recommendations of this study span the spectrum from policy-level changes aimed at strategic resource allocation and fostering inter-professional collaboration to practical measures like effective communication, information technology integration, patient participation and family involvement. Together, the recommendations offer a holistic approach to enhance care transitions and, ultimately, patient outcomes. REPORTING METHOD Findings are reported per the Consolidated Criteria for Reporting Qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Ann-Therese Hedqvist
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
- Ambulance Service, Region Kalmar County, Västervik, Sweden
| | - Gesa Praetorius
- Swedish National Road and Transport Research Institute, Linköping, Sweden
- Department of Maritime Operations, University of South-Eastern Norway, Norway
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
- Department of Learning, Informatics, Management and Ethics, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Lindberg
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
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Gear C, Ting C, Manuel C, Eppel E, Koziol-McLain J. Integrated System Responses for Families Impacted by Violence: A Scoping Review. Int J Integr Care 2024; 24:17. [PMID: 38798719 PMCID: PMC11122700 DOI: 10.5334/ijic.7542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Violence within families is a complex problem which significantly impacts health and wellbeing. Despite the ubiquitous call for integrated family violence service delivery, integrated approaches vary significantly and challenges to implementation remain. This scoping review explored how integrated approaches to family violence service delivery are conceptualised within international and Aotearoa New Zealand literature. Methods Following a documented scoping review process identified from literature, dynamic interplay between system agents within integrated family violence service delivery were mapped with the assistance of a complexity theory lens. We analysed characteristics of included studies, agents involved, how they interacted and the methods and mechanisms of integration among them. Results Seventy-two published reports were included. The most common interactions occurred between statutory agencies such as police and child protection. While health care service providers were included within 55 studies, their engagement was often peripheral. Qualitative analysis elucidated three broad pathways to service delivery impact underpinned by systems-centred, person-centred, or Indigenous-centred worldviews. Discussion and Conclusion Integrated approaches to family violence service delivery are highly variable. Despite a strong assumption that integration leads to improved safety, health, and wellbeing for care-seekers, most studies did not include evidence of such impact. Consideration of how worldviews characterise service provision provides insight into why integration has proven challenging over time.
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Affiliation(s)
- Claire Gear
- Centre for Interdisciplinary Trauma Research, School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Chien Ting
- Centre for Interdisciplinary Trauma Research, School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Carey Manuel
- Āio Consulting Limited, Tauranga Moana, New Zealand
| | - Elizabeth Eppel
- School of Government, Victoria University of Wellington, Wellington, New Zealand
| | - Jane Koziol-McLain
- Centre for Interdisciplinary Trauma Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Claessens F, Seys D, Van der Auwera C, Castro EM, Jans A, Schoenmakers B, De Ridder D, Bruyneel L, Van Wilder A, Vanhaecht K. The FlaQuM-Quickscan: A starting point to include primary care professionals' perspectives in the evaluation of hospital quality priorities. J Healthc Qual Res 2024; 39:89-99. [PMID: 38195377 DOI: 10.1016/j.jhqr.2023.12.002] [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: 07/26/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Today, primary care professionals' (PCPs) perspectives on hospital quality are unknown when evaluating hospital quality priorities. The aims of the present study were to identify key healthcare quality attributes from PCPs' perspective, to validate an instrument that measures PCPs' experiences of healthcare quality multidimensionally and to define hospital quality priorities based on PCPs' experiences. MATERIAL AND METHODS Focus groups with PCPs were conducted to identify quality attributes through a qualitative in-depth analysis. A multicentre study of 18 hospitals was used to quantitatively assess construct, discriminant and criterion validity of the FlaQuM-Quickscan, an instrument that measures 'Healthcare quality for patients and kin' (part 1) and 'Healthcare quality for professionals' (part 2). To set quality priorities, scores on quality domains were analyzed descriptively and between-hospital variation was examined by evaluating differences in hospitals' mean scores on the quality domains using one-way Analysis of Variance (ANOVA). RESULTS Identified key attributes largely corresponded with Lachman's multidimensional quality model. Including 'Communication' as a new quality domain was recommended. The FlaQuM-Quickscan was completed by 550 PCPs. Confirmatory factor analyses showed reasonable to good fit, except for the Root Mean Square Error of Approximation (RMSEA) in part 2. The 'Equity' domain scored the highest in parts 1 and 2. Domains 'Kin-centred care' and 'Accessibility and timeliness' scored the lowest in part 1 and 'Resilience' and 'Partnership and co-production' in part 2. Significant variation in hospitals' mean scores was observed for eleven domains in part 1 and sixteen domains in part 2. CONCLUSIONS The results gained a better understanding of PCPs' perspective on quality. The FlaQuM-Quickscan is a valid instrument to measure PCPs' experiences of hospital quality. Identified priorities indicate that hospital management should focus on multifaceted quality strategies, including technical domains, person-and kin-centredness, core values and catalysts.
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Affiliation(s)
- F Claessens
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium.
| | - D Seys
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - C Van der Auwera
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - E M Castro
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - A Jans
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - B Schoenmakers
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - D De Ridder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - L Bruyneel
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - A Van Wilder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Chong F, Jianping Z, Zhenjie L, Wenxing L, Li Y. Does competition support integrated care to improve quality? Heliyon 2024; 10:e24836. [PMID: 38333801 PMCID: PMC10850910 DOI: 10.1016/j.heliyon.2024.e24836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 01/01/2024] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction This work investigates the compatibility of integrated care and competition in China and analyses the impact of integrated care on regional care quality (DeptQ) within a competitive framework. Method The study was built on multivariate correspondence analysis and a two-way fixed-effects model. The data were collected from Xiamen's Big Data Application Open Platform and represent nine specialised departments that regularly performed inter-institutional referrals between 2016 and 2019. Results First, care quality for referred patients (ReferQ) and the relative scale of referred patients (ReferScale) and competition have an antagonistic but not completely mutually exclusive relationship. Second, ReferQ and competition both have a significant effect on DeptQ, but only when competition is weak can ReferQ and competition act synergistically on DeptQ. When competition is fierce, competition will weaken the impact of ReferQ on DeptQ. Conclusion Changes in the intensity of integrated care and competition ultimately affect care quality.
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Affiliation(s)
- Feng Chong
- School of Mathematics and Statistics, Xiamen University of Technology, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
| | - Zhu Jianping
- School of Management, Xiamen University, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Fujian, Xiamen, China
| | - Liang Zhenjie
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- College of Economics and Management, Minjiang University, Fujian, Fuzhou, China
| | - Lin Wenxing
- Xiamen Health and Medical Big Data Center, Fujian, Xiamen, China
| | - Yumin Li
- School of Economics and Management, Nanjing University of Science and Technology, Jiangsu, Nanjing, China
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Poksinska B, Wiger M. From hospital-centered care to home-centered care of older people: propositions for research and development. J Health Organ Manag 2024; 38:1-18. [PMID: 38296820 PMCID: PMC10879925 DOI: 10.1108/jhom-03-2023-0077] [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: 03/15/2023] [Revised: 12/06/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE Providing high-quality and cost-efficient care of older people is an important development priority for many health and social care systems in the world. This paper suggests a shift from acute, episodic and reactive hospital-centered care toward longitudinal, person-centered and proactive home-centered care. The purpose of this paper is to contribute to the knowledge of a comprehensive development strategy for designing and providing home-centered care of older people. DESIGN/METHODOLOGY/APPROACH The study design is based on qualitative research with an inductive approach. The authors study development initiatives at the national, regional and local levels of the Swedish health and social care system. The data collection methods included interviews (n = 54), meeting observations (n = 25) and document studies (n = 59). FINDINGS The authors describe findings related to policy actions and system changes, attempts to achieve collaboration, integration and coordination, new forms of care offerings, characteristics of work settings at home and differences in patients' roles and participation at home and in the hospital. PRACTICAL IMPLICATIONS The authors suggest home-centered care as a solution for providing person-centered and integrated care of older people and give examples of how this can be achieved. ORIGINALITY/VALUE The authors outline five propositions for research and development related to national policies, service modularity as a solution for customized and coordinated care, developing human resources and infrastructure for home settings, expanding services that enable older people living at home and patient co-creation.
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Affiliation(s)
- Bonnie Poksinska
- Department of Management and Engineering, Linkopings
Universitet, Linkoping, Sweden
- Production Development Unit, Region
Ostergotland, Linkoping, Sweden
| | - Malin Wiger
- Department of Management and Engineering, Linkopings
Universitet, Linkoping, Sweden
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18
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van Ede AFTM, Stein KV, Bruijnzeels MA. Assembling a population health management maturity index using a Delphi method. BMC Health Serv Res 2024; 24:110. [PMID: 38243278 PMCID: PMC10799527 DOI: 10.1186/s12913-024-10572-5] [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: 02/20/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Although local initiatives commonly express a wish to improve population health and wellbeing using a population health management (PHM) approach, implementation is challenging and existing tools have either a narrow focus or lack transparency. This has created demand for practice-oriented guidance concerning the introduction and requirements of PHM. METHODS Existing knowledge from scientific literature was combined with expert opinion obtained using an adjusted RAND UCLA appropriateness method, which consisted of six Dutch panels in three Delphi rounds, followed by two rounds of validation by an international panel. RESULTS The Dutch panels identified 36 items relevant to PHM, in addition to the 97 items across six elements of PHM derived from scientific literature. Of these 133 items, 101 were considered important and 32 ambiguous. The international panel awarded similar scores for 128 of 133 items, with only 5 items remaining unvalidated. Combining literature and expert opinion gave extra weight and validity to the items. DISCUSSION In developing a maturity index to help assess the use and progress of PHM in health regions, input from experts counterbalanced a previous skewedness of item distribution across the PHM elements and the Rainbow Model of Integrated Care (RMIC). Participant expertise also improved our understanding of successful PHM implementation, as well as how the six PHM elements are best constituted in a first iteration of a maturity index. Limitations included the number of participants in some panels and ambiguity of language. Further development should focus on item clarity, adoption in practice and item interconnectedness. CONCLUSION By employing scientific literature enriched with expert opinion, this study provides new insight for both science and practice concerning the composition of PHM elements that influence PHM implementation. This will help guide practices in their quest to implement PHM.
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Affiliation(s)
- A F T M van Ede
- Health Campus The Hague / Department of Public Health and Primary Care, Leiden University Medical Centre, The Hague, The Netherlands.
| | - K V Stein
- Health Campus The Hague / Department of Public Health and Primary Care, Leiden University Medical Centre, The Hague, The Netherlands
| | - M A Bruijnzeels
- Health Campus The Hague / Department of Public Health and Primary Care, Leiden University Medical Centre, The Hague, The Netherlands
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Mirza M, Verma M, Aggarwal A, Satpathy S, Sahoo SS, Kakkar R. Indian Model of Integrated Healthcare (IMIH): a conceptual framework for a coordinated referral system in resource-constrained settings. BMC Health Serv Res 2024; 24:42. [PMID: 38195544 PMCID: PMC10777560 DOI: 10.1186/s12913-023-10454-2] [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: 05/19/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION With the escalating burden of chronic disease and multimorbidity in India, owing to its ageing population and overwhelming health needs, the Indian Health care delivery System (HDS) is under constant pressure due to rising public expectations and ambitious new health goals. The three tired HDS should work in coherence to ensure continuity of care, which needs a coordinated referral system. This calls for optimising health care through Integrated care (IC). The existing IC models have been primarily developed and adopted in High-Income Countries. The present study attempts to review the applicability of existing IC models and frame a customised model for resource-constrained settings. METHODS A two-stage methodology was used. Firstly, a narrative literature review was done to identify gaps in existing IC models, as per the World Health Organization framework approach. The literature search was done from electronic journal article databases, and relevant literature that reported conceptual and theoretical concepts of IC. Secondly, we conceptualised an IC concept according to India's existing HDS, validated by multiple rounds of brainstorming among co-authors. Further senior co-authors independently reviewed the conceptualised IC model as per national relevance. RESULTS Existing IC models were categorised as individual, group and disease-specific, and population-based models. The limitations of having prolonged delivery time, focusing only on chronic diseases and being economically expensive to implement, along with requirement of completely restructuring and reorganising the existing HDS makes the adoption of existing IC models not feasible for India. The Indian Model of Integrated Healthcare (IMIH) model proposes three levels of integration: Macro, Meso, and Micro levels, using the existing HDS. The core components include a Central Gateway Control Room, using existing digital platforms at macro levels, a bucket overflow model at the meso level, a Triple-layered Concentric Circle outpatient department (OPD) design, and a three-door OPD concept at the micro level. CONCLUSION IMIH offers features that consider resource constraints and local context of LMICs while being economically viable. It envisages a step toward UHC by optimising existing resources and ensuring a continuum of care. However, health being a state subject, various socio-political and legal/administrative issues warrant further discussion before implementation.
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Affiliation(s)
- Moonis Mirza
- Department of Hospital Administration, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Arun Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sidhartha Satpathy
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Swaroop Sahoo
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Rakesh Kakkar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
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Thomson LJM, Chatterjee HJ. Barriers and enablers of integrated care in the UK: a rapid evidence review of review articles and grey literature 2018-2022. Front Public Health 2024; 11:1286479. [PMID: 38239795 PMCID: PMC10794528 DOI: 10.3389/fpubh.2023.1286479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Integrated care refers to person-centered and coordinated, health and social care, and community services. Integrated care systems are partnerships of organizations that deliver health and care services which were placed on a statutory footing in England, April 2022. Due to the need for fast, accessible, and relevant evidence, a rapid review was conducted according to World Health Organization methods to determine barriers and enablers of integrated care across the United Kingdom, 2018-2022. Nine databases were searched for review articles reporting evaluation of integrated care interventions involving medical (clinical and diagnostic) and nonmedical (public health services and community-based or social care/person-centred care) approaches, quality checked with the Critical Appraisal Skills Program qualitative checklist. OpenGrey and hand searches were used to identify grey literature, quality checked with the Authority, Accuracy, Coverage, Objectivity, Date, and Significance checklist. Thirty-four reviews and 21 grey literature reports fitted inclusion criteria of adult physical/mental health outcomes/multiple morbidities. Thematic analysis revealed six themes (collaborative approach; costs; evidence and evaluation; integration of care; professional roles; service user factors) with 20 subthemes including key barriers (cost effectiveness; effectiveness of integrated care; evaluation methods; focus of evidence; future research; impact of integration) and enablers (accessing care; collaboration and partnership; concept of integration; inter-professional relationships; person-centered ethos). Findings indicated a paucity of robust research to evaluate such interventions and lack of standardized methodology to assess cost effectiveness, although there is growing interest in co-production that has engendered information sharing and reduced duplication, and inter-professional collaborations that have bridged task-related gaps and overlaps. The importance of identifying elements of integrated care associated with successful outcomes and determining sustainability of interventions meeting joined-up care and preventive population health objectives was highlighted.
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Affiliation(s)
- Linda J. M. Thomson
- Department of Biosciences and Arts & Sciences, University College London, London, United Kingdom
| | - Helen J. Chatterjee
- Department of Biosciences and Arts & Sciences, University College London, London, United Kingdom
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Anand V. Team-Based Approach in Hypertension Management: A Quality Improvement Project. J Nurs Care Qual 2024; 39:76-83. [PMID: 37267122 PMCID: PMC10655909 DOI: 10.1097/ncq.0000000000000726] [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] [Accepted: 05/15/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND/LOCAL PROBLEM Hypertension is a major risk factor for heart diseases and stroke among Americans; only 25% have this under control nationwide. METHODS This quality improvement project evaluated the outcomes of team-based care in hypertension control by registered nurses and certified nurse practitioners in a primary care setting. Pre/post-data analysis of blood pressure (BP) control, and BP knowledge, was done. INTERVENTION The team provided education and counseling based on knowledge assessment during visits and used unattended automated blood pressure measurement (uAOBPM) techniques to measure BP. RESULTS There was a significant reduction in systolic and diastolic BP control ( P < .001). There was a statistically significant increase in disease knowledge score pre- and postintervention ( P < .001). CONCLUSION The team-based care approach improved patients' BP control and knowledge of the disease. The uAOBPM technique could be incorporated into clinical settings for accurate BP measurements.
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Wong Chung R, Willemen A, Bakker A, Maaskant J, Voorman J, Becher J, Schuengel C, Alsem M. The development and validation of the S-scan-parental self-management support (S-scan - PS): A self-reflection tool for child healthcare professionals. Child Care Health Dev 2024; 50:e13223. [PMID: 38265134 DOI: 10.1111/cch.13223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/18/2023] [Accepted: 12/07/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Professionals providing self-management support to parents regarding the care for their child with a chronic condition nowadays is an important aspect of child healthcare. This requires professionals to orient themselves towards partnership and collaboration with parents. The aims of the current study were the development and validation of the S-Scan-Parental self-management Support (S-scan - PS) as a tool for healthcare professionals to reflect on their attitude and practices regarding the support for parental self-management. METHODS An existing instrument was adapted together with field experts for professionals to self-evaluate their support for self-management of parents. The resulting 36-item self-report questionnaire was filled in by healthcare professionals in the Netherlands working with children and their parents. Cognitive interviews, exploratory and confirmatory factor analysis (CFA), and test-retest reliability analysis were part of the development and validation process. RESULTS In total, 434 professionals, including physicians, physiotherapists, occupational therapists, and nurses, from 13 rehabilitation institutes and 5 medical centres participated. The cognitive interviews with child healthcare professionals indicated adequate face and content validity. The S-scan - PS scale had acceptable internal consistency (0.71 ≤ α ≤ 0.91) for the total score as well as the domain scores. CFA showed acceptable root mean square error of approximation (RMSEA) model fit (0.066), though not on other tested goodness-of-fit indices. Test-retest reliability of the instrument was moderate with an average intraclass correlation coefficient (ICC) = 0.61. CONCLUSIONS The S-scan - PS fulfils important psychometric criteria for use by child healthcare professionals to reflect on parental self-management support. Such self-reflection might help to improve their approach towards supporting self-management of parents in the care for their child with a chronic condition. Further research is needed into the construct validity and test-retest reliability of the instrument.
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Affiliation(s)
- Ruud Wong Chung
- Merem Medical Rehabilitation, Almere, The Netherlands
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Agnes Willemen
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amber Bakker
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jolanda Maaskant
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Jeanine Voorman
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and De Hoogstraat Rehabilitation Utrecht, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jules Becher
- Amsterdam Movement Sciences and Department of Rehabilitation Medicine, Amsterdam UMC - VU Medical Centre, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Carlo Schuengel
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mattijs Alsem
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Mujirishvili T, Cabrero-Garćıa J, Fló rez-Revuelta F, Richart-Mart´ınez M. Navigating the crossroads of aging, caregiving and technology: Insights from a southern Spain about video-based technology in the care context. Digit Health 2024; 10:20552076241271856. [PMID: 39221088 PMCID: PMC11363029 DOI: 10.1177/20552076241271856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/31/2024] [Indexed: 09/04/2024] Open
Abstract
Objective As the world faces an aging population, the complexities of care management become increasingly pronounced. While technological solutions hold promise in addressing the dynamic demands of care, many nuances are to be considered in the design and implementation of active and assisted living technologies (AAL) for older adult care. This qualitative study, set in southern Spain, is positioned at the crossroads of healthcare challenges, as seen by the different actors involved in the care process and the technological solutions developed in response to these challenges. By investigating the complex landscape of caregiving and by examining the experiences and challenges faced by caregivers, healthcare professionals, and older adults, we aim to guide the development of vision-based AAL technologies that are responsive to the genuine needs of older adults and those requiring care. Methods A qualitative research methodology was used in the study. In total15 in-depth interviews and five focus groups were conducted with a diverse group of stakeholders involved in the process of care provision and reception. Results While the results demonstrate that there is a readiness for technological solutions, concerns over privacy and trust highlight the need for a carefully integrated, human-centric approach to technology in caregiving. Conclusion This research serves as a compass, guiding future discussions on the intersection of aging, technology, and care, with the ultimate goal of transforming caregiving into a collaborative and enriching journey for all stakeholders involved.
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Affiliation(s)
- Tamara Mujirishvili
- Department of Nursing, University of Alicante, San Vicente del Raspeig, Spain
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Ibadi MH, Majeed S, Ghafil FA, Hadi NR. Effects of CDDO-EA in sepsis-induced acute lung injury: mouse model of endotoxaemia. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:497-505. [PMID: 38691792 DOI: 10.36740/wlek202403119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Aim: The aim of this research is to clarify the potential effect of CDDO-EA against experimentally sepsis induced lung injury in mice. PATIENTS AND METHODS Materials and Methods: Mice have divided into four groups: Sham group CLP group, Vehicle-treatment group, CDDO-EA-treated group: mice in this group received CDDO-EA 2mg/kg intraperitoneally, 1hr before CLP, then the animals were sacrificed 24hr after CLP. After exsAngpuinations, tissue samples of lung were collected, followed by markers measurement including, TNF-α, IL-1β, VEGF, MPO, caspase11, Angp-1and Angp-2 by ELISA, gene expression of TIE2 and VE-cadherin by qRT-PCR, in addition to histopathological study. RESULTS Results: A significant elevation (p<0.05) in TNF-α, IL-1β, MPO, ANGP-2, VEGF, CASPASE 11 in CLP and vehicle groups when compared with sham group. CDDO-EA group showed significantly lower levels p<0.05, level of ANGP-1 was significantly lower p<0.05 in the CLP and vehicle groups as compared with the sham group. Quantitative real-time PCR demonstrated a significant decrement in mRNA expression of TIE2&ve-cadherin genes p<0.05 in sepsis & vehicle. CONCLUSION Conclusions: CDDO-EA has lung protective effects due to its anti-inflammatory and antiAngpiogenic activity, additionally, CDDO-EA showes a lung protective effect as they affect tissue mRNA expression of TIE2 and cadherin gene. Furthermore, CDDO-EA attenuate the histopathological changes that occur during polymicrobial sepsis thereby lung protection effect.
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Affiliation(s)
| | - Sahar Majeed
- DEPARTMENT OF PHARMACOLOGY AND THERAPEUTIC, FACULTY OF MEDICINE, UNIVERSITY OF KUFA, KUFA, IRAQ
| | | | - Najah R Hadi
- DEPARTMENT OF PHARMACOLOGY AND THERAPEUTIC, FACULTY OF MEDICINE, UNIVERSITY OF KUFA, KUFA, IRAQ
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Beard JR. Beyond integrated care for older adults. NATURE AGING 2024; 4:1-4. [PMID: 38177328 DOI: 10.1038/s43587-023-00542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- John R Beard
- International Longevity Center - USA, Columbia University, New York, NY, USA.
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26
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Oostra DL, Nieuwboer MS, Melis RJF, Remers TEP, Olde Rikkert MGM, Perry M. DementiaNet facilitates a sustainable transition toward integrated primary dementia care: A long-term evaluation. Alzheimers Dement 2023; 19:5498-5505. [PMID: 37218358 DOI: 10.1002/alz.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Care integration is a promising strategy to achieve sustainable health-care systems. With DementiaNet, a 2-year program, we facilitated collaboration between primary health-care professionals. We studied changes in primary dementia care integration during and after DementiaNet participation. METHODS A longitudinal follow-up study was performed. Networks started between 2015 and 2020; follow-up ended in 2021. Quantitative and quantitative data were collected annually to assess quality of care, network collaboration, and number of crisis admissions. Growth modeling was used to identify changes over time. RESULTS Thirty-five primary care networks participated. Network collaboration and quality of care of newly formed networks increased significantly in the first 2 years (respectively, 0.35/year, P < .001; 0.29/year, P < .001) and thereafter stabilized. CONCLUSION Primary care networks improved their collaboration and quality of care during DementiaNet participation, which persisted after the program ended. This indicates that DementiaNet facilitated a sustainable transition toward integrated primary dementia care.
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Affiliation(s)
- Dorien L Oostra
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
| | - Minke S Nieuwboer
- Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, Academy of Health and Vitality, Nijmegen, The Netherlands
| | - René J F Melis
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
| | - Toine E P Remers
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Radboud university medical center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Marieke Perry
- Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Radboud university medical center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboud university medical center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
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Tingvold L, Melby L. Three ways of organising general practitioner's medical services in sheltered housing. A qualitative study. Scand J Prim Health Care 2023; 41:400-410. [PMID: 37706637 PMCID: PMC11001341 DOI: 10.1080/02813432.2023.2256381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE Explore care providers' experiences with the organisation of the medical services for residents in round-the-clock staffed sheltered housing. DESIGN Qualitative study and thematic analysis of individual interviews after strategic sampling of participants. SETTING Round-the-clock staffed sheltered housing in seven municipalities, inhabited by various user groups, and GPs in various locations in Norway. SUBJECTS In-depth interviews with 18 participants: 11 managers or employees in sheltered housing and seven GPs. MAIN OUTCOME MEASURES Main themes and subthemes reporting participants' experiences of medical provision to sheltered housing residents. RESULTS Three main models of organizing medical services for round-the-clock staffed sheltered housing were identified: (i) the 'multiple GP' model, where each resident has their own individual GP; (ii) the 'single GP' model, where all residents in the sheltered housing have one common GP; (iii) the 'hybrid' model, where a few dedicated GPs follow up the residents. CONCLUSION Residents in round-the-clock staffed sheltered housing constitute a varied group that generally has substantial medical assistance needs. Given that many residents lack autonomy to manage their own care needs and make decisions, models with fewer GPs like models ii and iii seem to provide a better medical professional offer. Moving towards such an organising of the medical services for sheltered housing residents could have implications for GPs' workload and competence needs. Future studies are needed to test models and assess implications.
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Affiliation(s)
- Laila Tingvold
- Centre for Care Research East, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Line Melby
- Centre for Care Research East, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Khatri RB, Wolka E, Nigatu F, Zewdie A, Erku D, Endalamaw A, Assefa Y. People-centred primary health care: a scoping review. BMC PRIMARY CARE 2023; 24:236. [PMID: 37946115 PMCID: PMC10633931 DOI: 10.1186/s12875-023-02194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Integrated people-centred health services (IPCHS) are vital for ensuring comprehensive care towards achieving universal health coverage (UHC). The World Health Organisation (WHO) envisions IPCHS in delivery and access to health services. This scoping review aimed to synthesize available evidence on people-centred primary health care (PHC) and primary care. METHODS We conducted a scoping review of published literature on people-centred PHC. We searched eight databases (PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science, and Google Scholar) using search terms related to people-centred and integrated PHC/primary care services. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to select studies. We analyzed data and generated themes using Gale's framework thematic analysis method. Themes were explained under five components of the WHO IPCHS framework. RESULTS A total of fifty-two studies were included in the review; most were from high-income countries (HICs), primarily focusing on patient-centred primary care. Themes under each component of the framework included: engaging and empowering people and communities (engagement of community, empowerment and empathy); strengthening governance and accountability (organizational leadership, and mutual accountability); reorienting the model of care (residential care, care for multimorbidity, participatory care); coordinating services within and across sectors (partnership with stakeholders and sectors, and coordination of care); creating an enabling environment and funding support (flexible management for change; and enabling environment). CONCLUSIONS Several people-centred PHC and primary care approaches are implemented in HICs but have little priority in low-income countries. Potential strategies for people-centred PHC could be engaging end users in delivering integrated care, ensuring accountability, and implementing a residential model of care in coordination with communities. Flexible management options could create an enabling environment for strengthening health systems to deliver people-centred PHC services.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia.
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Eskinder Wolka
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Southport, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Aklilu Endalamaw
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
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Neiva ER, Abbad G, Conceição MIG, Pinho DLM, Xyrichis A. How is Integration Defined and Measured, and what Factors Drive Success in Brazil? An Integrative Review. Int J Integr Care 2023; 23:9. [PMID: 37928206 PMCID: PMC10624152 DOI: 10.5334/ijic.7002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/26/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Integration in health and care can improve quality and outcomes, but it is challenged by expansion of medical knowledge, social pressures on patient needs, and demands to deliver critical information. In Latin American and in other lower and middle-income countries integrated care remains in development. This paper examined the available literature on integrated care to understand how Latin American countries identify and measure integration, and what factors influence success. Methods This integrative literature review included systematic searches in Global Health, PubMed, SciELO and BVSPsi databases for articles on integrated care in Spanish, Portuguese, and English in the period from January of 1999 to December 2020. The articles were screened for selection and assessed independently by five reviewers that used the inclusion criteria of papers about integration in health care systems. The sample excluded articles that did not deal with the integration of health care, which addressed issues related to public health campaigns, programs to control endemics and epidemics, reports on the experience of implementing health services, health promotion guidelines, food safety, oral health, and books evaluation. Results 24 articles were included: qualitative (75%), quantitative (12,5%), and mixed-method research (4%) published between 2000 and 2017. All studies were undertaken in Brazil, and two of them were also conducted in Latin American countries. In 15 articles there was an interchangeable use between concepts of integration of services and integrated care, while nine studies did not define integration. Barriers to integration included absence of shared understanding of knowledge among members of interprofessional teams, lack of clarity on professional roles, missing consensus on a definition and measurement of integrated care, power struggles between professionals, poor institutional support, insufficient team preparation and training and unequal valuation of professions by society. Conclusion Several types of integration and factors contributing to the success of implementation of integrated care in various contexts in Brazil were identified. The concept of integration reflected the varied local and regional realities including different health settings and levels of health and care, suggesting a need for further clarifications on its objective and components especially in LMIC contexts.
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Wankah P, Gordon D, Shahid S, Chandra S, Abejirinde IO, Yoon R, Wodchis WP, O’Campo P, Gray CS, Clark N, Shaw J. Equity Promoting Integrated Care: Definition and Future Development. Int J Integr Care 2023; 23:6. [PMID: 37867579 PMCID: PMC10588500 DOI: 10.5334/ijic.7614] [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: 03/22/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023] Open
Abstract
Over the last three decades, integrated care has emerged as an important health system strategy to improve population health while addressing the unique needs of structurally marginalised communities. However, less attention has been given to the role of integrated care in addressing issues related to inequities in health and health care. In this commentary we introduce the concept of Equity Promoting Integrated Care (EPIC) that situates integrated care in a social justice context to frame the actions necessary to center equity as a priority for integrated care. We suggest that efforts to advance the design and implementation of integrated care should focus on three avenues for future research and practice, namely, the collaborative mobilization of a global network of integrated care stakeholders to advocate for social justice and health equity, investing in equity-focused approaches to implementation science that highlight the importance of social concepts such as colonialism and intersectionality to advance the theory and practice of implementing EPIC models of care, and leveraging innovative approaches to measuring equity-related aspects of integrated care to inform continuous improvement of health systems.
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Affiliation(s)
- Paul Wankah
- University of Toronto, CA
- Women’s College Hospital, CA
| | - Dara Gordon
- University of Toronto, CA
- Women’s College Hospital, CA
| | | | | | | | | | - Walter P. Wodchis
- University of Toronto, CA
- Institute for Better Health, Trillium Health Partners, CA
| | | | - Carolyn Steele Gray
- University of Toronto, CA
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, CA
| | | | - James Shaw
- University of Toronto, Women’s College Hospital, CA
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Godinho MA, Ashraf MM, Narasimhan P, Liaw ST. Understanding the convergence of social enterprise, digital health, and citizen engagement for co-producing integrated Person-Centred health services: A critical review and theoretical framework. Int J Med Inform 2023; 178:105174. [PMID: 37573637 DOI: 10.1016/j.ijmedinf.2023.105174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION To achieve Universal Health Coverage and the United Nations' (UN) Sustainable Development Goals (SDGs) agenda for 2030, the World Health Organisation (WHO) recommended the use of social enterprise, digital technology, and citizen engagement in the delivery of Integrated People-Centred Health Services (IPCHS) as part of its strategic vision for 21st century primary care. METHODS We conducted a hermeneutic review of frameworks, models and theories on social enterprise, digital health, citizen engagement and IPCHS. This involved multiple iterative cycles of (i) searching and acquisition, followed by (ii) critical analysis and interpretation of literature to assemble arguments and evidence for conceptual relationships until information saturation was reached. This process identified a set of constructs which we synthesised into a testable framework. RESULTS Several interdisciplinary frameworks, models and theories explain how social enterprises could use digital technology, and citizen engagement to enable the technical and social integration required to facilitate people-centred primary care. Innovative approaches can be used to maintain financial sustainability while delivering IPCHS at lower cost to vulnerable and marginalised populations in both developed and developing countries. CONCLUSION This framework provides a theoretical grounding to guide empirical inquiry into how social enterprises use digital technology to engage citizens in co-producing IPCHS.
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Affiliation(s)
- Myron Anthony Godinho
- WHO Collaborating Centre for eHealth, School of Population Health, UNSW Sydney, Australia; Yunus Social Business Health Hub, School of Population Health, UNSW Sydney, Australia
| | - Md Mahfuz Ashraf
- Entrepreneurship and Innovation, Crown Institute of Higher Education, Sydney, Australia
| | - Padmanesan Narasimhan
- WHO Collaborating Centre for eHealth, School of Population Health, UNSW Sydney, Australia; Yunus Social Business Health Hub, School of Population Health, UNSW Sydney, Australia
| | - Siaw-Teng Liaw
- WHO Collaborating Centre for eHealth, School of Population Health, UNSW Sydney, Australia; Yunus Social Business Health Hub, School of Population Health, UNSW Sydney, Australia.
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Noort BAC, Buijs P, Roemeling O. Outsourcing the Management of Reusable Medical Devices in a Chain-Wide Care Setting: Mixed Methods Feasibility Study. Interact J Med Res 2023; 12:e41409. [PMID: 37725420 PMCID: PMC10548324 DOI: 10.2196/41409] [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: 07/28/2022] [Revised: 01/18/2023] [Accepted: 08/11/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Managing reusable medical devices incurs substantial health care costs and complexity, particularly in integrated care settings. This complexity hampers care quality, safety, and costs. Studying logistical innovations within integrated care can provide insights to medical devices use among staff effectively. OBJECTIVE This study aimed to establish the feasibility of a logistical intervention through outsourcing and a web portal. The goal was to provide insights into users' acceptability of the intervention, on whether the intervention was successfully implemented, and on the intervention's preliminary efficacy, thus benefiting practitioners and researchers. METHODS This paper presents a mixed methods feasibility study at a large chain-wide health care provider in the Netherlands. The intervention entailed outsourcing noncritical reusable medical devices and introducing a web portal for device management. A questionnaire gauged perceived ordering and delivery times, satisfaction with the ordering and delivery process, compliance with safety and hygiene certification, and effects on the care delivery process. Qualitative data in the form of observations, documentation, and interviews were used to identify implementing challenges. Using on-site stocktaking and data from information systems, we analyzed the utilization, costs, and rental time of medical devices before and after the intervention for wheelchairs and anti-pressure ulcer mattresses. RESULTS Looking at the acceptability of the intervention, a high user satisfaction with the ordering and delivery process was reported (rated on a 5-point Likert scale). With respect to preliminary efficacy, we noted a reduction in the utilization of wheelchairs (on average, 1106, SD 106 fewer utilization d/mo), and a halted increase in the utilization of anti-pressure ulcer mattresses. In addition, nurses who used the web portal reported shorter ordering times for wheelchairs (-2.7 min) and anti-pressure ulcer mattresses (-3.1 min), as well as shorter delivery times for wheelchairs (-0.5 d). Moreover, an increase in device certification was reported (average score of 1.9, SD 1.0), indicating higher levels of safety and hygiene standards. In theory, these improvements should translate into better outcomes in terms of costs and the quality of care. However, we were unable to establish a reduction in total care costs or a reduced rental time per device. Furthermore, respondents did not identify improvements in safety or the quality of care. Although implementation challenges related to the diverse supply base and complexities with different care financers were observed, the overall implementation of the intervention was considered successful. CONCLUSIONS This study confirms the feasibility of our intervention, in terms of acceptability, implementation success, and preliminary efficacy. The integrated management of medical devices should enable a reduction in costs, required devices, and material waste, as well as higher quality care. However, several challenges remain related to the implementation of such interventions.
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Affiliation(s)
- Bart A C Noort
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Paul Buijs
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Oskar Roemeling
- Department of Innovation Management & Strategy, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
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Guo D, Zhou C, Li H, Su D, Gong G, Chen X, Chen X, Chen Y. Mapping the scientific research on integrated care: a bibliometric and social network analysis. Front Psychol 2023; 14:1095616. [PMID: 37786479 PMCID: PMC10541993 DOI: 10.3389/fpsyg.2023.1095616] [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: 11/11/2022] [Accepted: 08/25/2023] [Indexed: 10/04/2023] Open
Abstract
Background Integrated care (IC) is the cornerstone of the sustainable development of the medical and health system. A thorough examination of the existing scientific literature on IC is essential for assessing the present state of knowledge on this subject. This review seeks to offer an overview of evidence-based knowledge, pinpoint existing knowledge gaps related to IC, and identify areas requiring further research. Methods Data were retrieved from the Web of Science Core Collection, from 2010 to 2020. Bibliometrics and social network analysis were used to explore and map the knowledge structure, research hotspots, development status, academic groups and future development trends of IC. Results A total of 7,501 articles were obtained. The number of publications on IC was rising in general. Healthcare science services were the most common topics. The United States contributed the highest number of articles. The level of collaboration between countries and between authors was found to be relatively low. The keywords were stratified into four clusters: IC, depression, integrative medicine, and primary health care. In recent years, complementary medicine has become a hotspot and will continue to be a focus. Conclusion The study provides a comprehensive analysis of global research hotspots and trends in IC, and highlights the characteristics, challenges, and potential solutions of IC. To address resource fragmentation, collaboration difficulties, insufficient financial incentives, and poor information sharing, international collaboration needs to be strengthened to promote value co-creation and model innovation in IC. The contribution of this study lies in enhancing people's understanding of the current state of IC research, guiding scholars to discover new research perspectives, and providing valuable references for researchers and policymakers in designing and implementing effective IC strategies.
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Affiliation(s)
- Dandan Guo
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaofeng Zhou
- Wuhan Library, Chinese Academy of Sciences, Wuhan, China
- Department of Library, Information and Archives Management, School of Economic and Management, UCAS, Beijing, China
| | - Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Dai Su
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Guangwen Gong
- Guangwen Gong, School of Management, Hubei University of Chinese Medicine, Wuhan, China
| | - Xinlin Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinlan Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingchun Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Centre for Rural Health Service, Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, China
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Dufour E, Bolduc J, Leclerc-Loiselle J, Charette M, Dufour I, Roy D, Poirier AA, Duhoux A. Examining nursing processes in primary care settings using the Chronic Care Model: an umbrella review. BMC PRIMARY CARE 2023; 24:176. [PMID: 37661248 PMCID: PMC10476383 DOI: 10.1186/s12875-023-02089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 06/22/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND While there is clear evidence that nurses can play a significant role in responding to the needs of populations with chronic conditions, there is a lack of consistency between and within primary care settings in the implementation of nursing processes for chronic disease management. Previous reviews have focused either on a specific model of care, populations with a single health condition, or a specific type of nurses. Since primary care nurses are involved in a wide range of services, a comprehensive perspective of effective nursing processes across primary care settings and chronic health conditions could allow for a better understanding of how to support them in a broader way across the primary care continuum. This systematic overview aims to provide a picture of the nursing processes and their characteristics in chronic disease management as reported in empirical studies, using the Chronic Care Model (CCM) conceptual approach. METHODS We conducted an umbrella review of systematic reviews published between 2005 and 2021 based on the recommendations of the Joanna Briggs Institute. The methodological quality was assessed independently by two reviewers using the AMSTAR 2 tool. RESULTS Twenty-six systematic reviews and meta-analyses were included, covering 394 primary studies. The methodological quality of most reviews was moderate. Self-care support processes show the most consistent positive outcomes across different conditions and primary care settings. Case management and nurse-led care show inconsistent outcomes. Most reviews report on the clinical components of the Chronic Care Model, with little mention of the decision support and clinical information systems components. CONCLUSIONS Placing greater emphasis on decision support and clinical information systems could improve the implementation of nursing processes. While the need for an interdisciplinary approach to primary care is widely promoted, it is important that this approach not be viewed solely from a clinical perspective. The organization of care and resources need to be designed to support contributions from all providers to optimize the full range of services available to patients with chronic conditions. PROSPERO REGISTRATION CRD42021220004.
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Affiliation(s)
- Emilie Dufour
- Faculty of Nursing, Université de Montréal, Montréal, Canada.
| | - Jolianne Bolduc
- École de santé publique, Université de Montréal, Montréal, Canada
| | | | - Martin Charette
- School of Nursing, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Dufour
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
| | - Denis Roy
- Commissaire à la santé et au bien-être, Gouvernement du Québec, Montréal, Canada
| | | | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, Canada
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Lugo‐Palacios DG, Clarke JM, Kristensen SR. Back to basics: A mediation analysis approach to addressing the fundamental questions of integrated care evaluations. HEALTH ECONOMICS 2023; 32:2080-2097. [PMID: 37232044 PMCID: PMC10947178 DOI: 10.1002/hec.4713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 03/23/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
Health systems around the world are aiming to improve the integration of health and social care services to deliver better care for patients. Existing evaluations have focused exclusively on the impact of care integration on health outcomes and found little effect. That suggests the need to take a step back and ask whether integrated care programmes actually lead to greater clinical integration of care and indeed whether greater integration is associated with improved health outcomes. We propose a mediation analysis approach to address these two fundamental questions when evaluating integrated care programmes. We illustrate our approach by re-examining the impact of an English integrated care program on clinical integration and assessing whether greater integration is causally associated with fewer admissions for ambulatory care sensitive conditions. We measure clinical integration using a concentration index of outpatient referrals at the general practice level. While we find that the scheme increased integration of primary and secondary care, clinical integration did not mediate a decrease in unplanned hospital admissions. Our analysis emphasizes the need to better understand the hypothesized causal impact of integration on health outcomes and demonstrates how mediation analysis can inform future evaluations and program design.
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Affiliation(s)
- David G. Lugo‐Palacios
- Centre for Health PolicyInstitute of Global Health InnovationImperial College LondonLondonUK
- Department of Health Services Research & PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Jonathan M. Clarke
- Centre for Health PolicyInstitute of Global Health InnovationImperial College LondonLondonUK
- EPSRC Centre for Mathematics of Precision HealthcareImperial College LondonLondonUK
| | - Søren Rud Kristensen
- Centre for Health PolicyInstitute of Global Health InnovationImperial College LondonLondonUK
- Danish Centre for Health Economics (DaCHE)University of Southern DenmarkOdenseDenmark
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Macq J. Integrated Care Policies and Politics in Belgium: Conceptual, Contextual and Governance Linkages for More Effective Integrated Care Policy Management Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study". Int J Health Policy Manag 2023; 12:7009. [PMID: 37579354 PMCID: PMC10702372 DOI: 10.34172/ijhpm.2023.7009] [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: 12/14/2021] [Accepted: 07/12/2023] [Indexed: 08/16/2023] Open
Abstract
The study on the management of integrated care (IC) policies in Belgium from Martens et al illustrates the complex process of the political and stakeholder game in a country whose governance is changing as a result of successive state reforms. We argue that the way forward for putting health back at the centre of IC policy design and management is to improve three types of connections. First, the conceptual connections should help to articulate the different IC policies into a coherent overall picture. Second, contextual connections should allow for the adaptation of policies to different country contexts. This requires a new form of governance, ie, a place-based and adaptive form of governance. This can be developed, provided that a third connection, between the different levels of governance, is fully revised.
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Affiliation(s)
- Jean Macq
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
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Leslie M, Fadaak R, Pinto N. Doing primary care integration: a qualitative study of meso-level collaborative practices. BMC PRIMARY CARE 2023; 24:149. [PMID: 37460971 PMCID: PMC10353261 DOI: 10.1186/s12875-023-02104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a 'pro-integration culture' amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems. METHODS 11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants' experiences and efforts to 'do' integration as they responded to Alberta's first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities. RESULTS As Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels. CONCLUSIONS Achieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system.
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Affiliation(s)
- Myles Leslie
- School of Public Policy, University of Calgary, 906 8 Ave SW 5th floor T2P 1H9, Calgary, AB, Canada.
- Cumming School of Medicine, Department of Community Health Sciences. 3D10, University of Calgary, 3280 Hospital Drive NW Calgary, Calgary, Alberta, Alberta, T2N 4Z6, Canada.
| | - Raad Fadaak
- School of Public Policy, University of Calgary, 906 8 Ave SW 5th floor T2P 1H9, Calgary, AB, Canada
| | - Nicole Pinto
- School of Public Policy, University of Calgary, 906 8 Ave SW 5th floor T2P 1H9, Calgary, AB, Canada
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Noor F, Gulis G, Karlsson LE. Exploration of understanding of integrated care from a public health perspective: A scoping review. J Public Health Res 2023; 12:22799036231181210. [PMID: 37435440 PMCID: PMC10331197 DOI: 10.1177/22799036231181210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/28/2023] [Indexed: 07/13/2023] Open
Abstract
Background Many health care systems attempt to develop an integrated care approach that is a whole population health-oriented system. However, knowledge of strategies to support this effort are scarce and fragmented. The aim of the current paper is to investigate existing concepts of integrated care and their elements from a public health perspective and to propose an elaborated approach that could be applied to explore the public health orientation of integrated care. Design and methods We applied a scoping review approach. A literature search was conducted in Embase, Medline, CINAHL, Scopus and Web of Science for the period 2000-2020 yielding 16 studies for inclusion. Results Across the papers, 14 frameworks were identified. Nine of these referred to the Chronic Care Model (CCM). Service delivery, person-centeredness, IT systems design and utilization and decision support were identified as the core elements of most of the included frameworks. The descriptions of these elements were mainly clinical-oriented focusing particularly on clinical care processes and treatment of diseases instead of wider determinants of population health. Conclusions A synthesized model is proposed that emphasizes the importance of mapping the unique needs and characteristics of the population it aims to serve, leans on the social determinants approach with a commitment to individual and community empowerment, health literacy and suggests reorienting services to meet the expressed needs of the population.
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Affiliation(s)
- Fadumo Noor
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Campus Esbjerg, Esbjerg Ø, Denmark
| | - Gabriel Gulis
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Campus Esbjerg, Esbjerg Ø, Denmark
| | - Leena Eklund Karlsson
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Campus Esbjerg, Esbjerg Ø, Denmark
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McKeown A. Ethical challenges and principles in integrated care. Br Med Bull 2023; 146:4-18. [PMID: 37100423 PMCID: PMC10286793 DOI: 10.1093/bmb/ldac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Integrated care is an established approach to delivery in parts of the healthcare infrastructure, and an ideal which, it is claimed, should be realized system-wide. Its ethical weight derives from its defence of a view about how healthcare ought to operate. Although the goal of integration is laudable, it is ethically and practically complex, involving trade-offs. SOURCES OF DATA Considerable evidence attests to widespread enthusiasm for integration, given the need to prevent harm and extend the reach of scarce resources. Equally, evidence increasingly highlights the obstacles to successfully translating this ideal into practice. AREAS OF AGREEMENT The principle that healthcare should be seamless, ensuring that patients do not come to harm through gaps in care enjoys broad agreement. There is a similar consensus that placing the patient's perspective at the centre of decision-making is vital, since this enables identification of these gaps. AREAS OF CONTROVERSY Integrating care by making it seamless entails blurring boundaries of care domains. This risks undermining the locus of responsibility for care decisions via confusion about who has ownership of specialist knowledge where domains overlap. There is a lack of consensus about how successful integration should be measured. GROWING POINTS More research into the relative cost-effectiveness of upstream public health investment in preventing chronic ill-health caused by modifiable lifestyle factors vs integrating care for people already ill; further research into ethical implications of integration in practice, which can be obscured by the simplicity of the fundamental normative principle guiding integration in theory.
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Affiliation(s)
- Alex McKeown
- Department of Psychiatry, Wellcome Centre for Ethics and Humanities, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, Oxfordshire, OX3 7JX, UK
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Sadler E, Khadjesari Z, Ziemann A, Sheehan KJ, Whitney J, Wilson D, Bakolis I, Sevdalis N, Sandall J, Soukup T, Corbett T, Gonçalves-Bradley DC, Walker DM. Case management for integrated care of older people with frailty in community settings. Cochrane Database Syst Rev 2023; 5:CD013088. [PMID: 37218645 PMCID: PMC10204122 DOI: 10.1002/14651858.cd013088.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Ageing populations globally have contributed to increasing numbers of people living with frailty, which has significant implications for use of health and care services and costs. The British Geriatrics Society defines frailty as "a distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves". This leads to an increased susceptibility to adverse outcomes, such as reduced physical function, poorer quality of life, hospital admissions, and mortality. Case management interventions delivered in community settings are led by a health or social care professional, supported by a multidisciplinary team, and focus on the planning, provision, and co-ordination of care to meet the needs of the individual. Case management is one model of integrated care that has gained traction with policymakers to improve outcomes for populations at high risk of decline in health and well-being. These populations include older people living with frailty, who commonly have complex healthcare and social care needs but can experience poorly co-ordinated care due to fragmented care systems. OBJECTIVES To assess the effects of case management for integrated care of older people living with frailty compared with usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Health Systems Evidence, and PDQ Evidence and databases from inception to 23 September 2022. We also searched clinical registries and relevant grey literature databases, checked references of included trials and relevant systematic reviews, conducted citation searching of included trials, and contacted topic experts. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared case management with standard care in community-dwelling people aged 65 years and older living with frailty. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures recommended by Cochrane and the Effective Practice and Organisation of Care Group. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 20 trials (11,860 participants), all of which took place in high-income countries. Case management interventions in the included trials varied in terms of organisation, delivery, setting, and care providers involved. Most trials included a variety of healthcare and social care professionals, including nurse practitioners, allied healthcare professionals, social workers, geriatricians, physicians, psychologists, and clinical pharmacists. In nine trials, the case management intervention was delivered by nurses only. Follow-up ranged from three to 36 months. We judged most trials at unclear risk of selection and performance bias; this consideration, together with indirectness, justified downgrading the certainty of the evidence to low or moderate. Case management compared to standard care may result in little or no difference in the following outcomes. • Mortality at 12 months' follow-up (7.0% in the intervention group versus 7.5% in the control group; risk ratio (RR) 0.98, 95% confidence interval (CI) 0.84 to 1.15; I2 = 11%; 14 trials, 9924 participants; low-certainty evidence) • Change in place of residence to a nursing home at 12 months' follow-up (9.9% in the intervention group versus 13.4% in the control group; RR 0.73, 95% CI 0.53 to 1.01; I2 = 0%; 4 trials, 1108 participants; low-certainty evidence) • Quality of life at three to 24 months' follow-up (results not pooled; mean differences (MDs) ranged from -6.32 points (95% CI -11.04 to -1.59) to 6.1 points (95% CI -3.92 to 16.12) when reported; 11 trials, 9284 participants; low-certainty evidence) • Serious adverse effects at 12 to 24 months' follow-up (results not pooled; 2 trials, 592 participants; low-certainty evidence) • Change in physical function at three to 24 months' follow-up (results not pooled; MDs ranged from -0.12 points (95% CI -0.93 to 0.68) to 3.4 points (95% CI -2.35 to 9.15) when reported; 16 trials, 10,652 participants; low-certainty evidence) Case management compared to standard care probably results in little or no difference in the following outcomes. • Healthcare utilisation in terms of hospital admission at 12 months' follow-up (32.7% in the intervention group versus 36.0% in the control group; RR 0.91, 95% CI 0.79 to 1.05; I2 = 43%; 6 trials, 2424 participants; moderate-certainty evidence) • Change in costs at six to 36 months' follow-up (results not pooled; 14 trials, 8486 participants; moderate-certainty evidence), which usually included healthcare service costs, intervention costs, and other costs such as informal care. AUTHORS' CONCLUSIONS We found uncertain evidence regarding whether case management for integrated care of older people with frailty in community settings, compared to standard care, improved patient and service outcomes or reduced costs. There is a need for further research to develop a clear taxonomy of intervention components, to determine the active ingredients that work in case management interventions, and identify how such interventions benefit some people and not others.
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Affiliation(s)
- Euan Sadler
- School of Health Sciences, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | | | - Alexandra Ziemann
- Department of Social & Policy Sciences, University of Bath, Bath, UK
| | - Katie J Sheehan
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Julie Whitney
- School of Life Course & Population Sciences, King's College London, London, UK
- Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, London, UK
| | - Dan Wilson
- Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Health Service & Population Research Department, King's College London, London, UK
| | - Nick Sevdalis
- Centre for Behavioural & Implementation Science Interventions (BISI), National University of Singapore, Singapore, Singapore
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, London, UK
| | - Tayana Soukup
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Teresa Corbett
- Faculty of Sport, Health and Social Sciences, Solent University, Southampton, UK
| | | | - Dawn-Marie Walker
- School of Health Sciences, University of Southampton, Southampton, UK
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Pot AM, Rabheru K, Chew M. Person-centred long-term care for older persons: a new Lancet Commission. Lancet 2023; 401:1754-1755. [PMID: 37207685 DOI: 10.1016/s0140-6736(23)00920-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Anne Margriet Pot
- Health Care Governance, Erasmus School of Health Policy and Management, Erasmus University, 3000 DR Rotterdam, Netherlands; Optentia Research Unit, North-West University, Vanderbijlpark, South Africa.
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Indar A, Wright J, Nelson M. Exploring how Professional Associations Influence Health System Transformation: The Case of Ontario Health Teams. Int J Integr Care 2023; 23:19. [PMID: 37250764 PMCID: PMC10215991 DOI: 10.5334/ijic.7017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Health care system transformations that align with the principles of integrated care require the collaborative efforts of various macro-, meso- and micro-level stakeholders. Understanding the roles of various system actors can improve collaboration in ways that support purposeful health system change. Professional associations (PAs) have considerable influence, but little is known about the strategies they use to influence health system transformation. Methods Using a qualitative descriptive approach, eight interviews with 11 senior level leaders from local PAs were conducted to learn about the strategies used to influence the province-wide reorganization of health care into Ontario Health Teams. Results During times of health system transformation, PAs balance: (1) supporting members, (2) negotiating with government, (3) collaborating with stakeholders, and (4) reflecting on their role. The enactment of these various functions demonstrates the strategic nature of PAs, and showcases their ability to evolve in ways that align with the dynamic nature of healthcare. Discussion PAs are highly connected groups, deeply engaged with their members and regularly engaged with other key stakeholders and decision-makers. PAs play a critical role in influencing health system transformations, by bringing forward practical solutions to government that reflect the needs of their members, often frontline clinicians. PAs strategically seek opportunities for collaboration with stakeholders that can amplify their message. Conclusion Insights from this work could support health system leaders, policymakers, and researchers in leveraging the role of PAs in health system transformations via strategic collaboration.
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Affiliation(s)
- Alyssa Indar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - James Wright
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Economics, Policy and Research Division, Ontario Medical Association, Toronto, Canada
| | - Michelle Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute/Sinai Health System, Toronto, Canada
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van Wijngaarden MT(M, van Asselt DZB(D, Grol SM(, Scherpbier-de Haan ND(N, Fluit CRMG(L. Components and Outcomes in Under- and Postgraduate Medical Education to Prepare for the Delivery of Integrated Care for the Elderly: A Scoping Review. Int J Integr Care 2023; 23:7. [PMID: 37091493 PMCID: PMC10120600 DOI: 10.5334/ijic.6959] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction The ageing society requires physicians who can deliver integrated care, but it is unclear how they should be prepared for doing so. This scoping review aims to create an overview of educational programmes that prepare (future) physicians to deliver integrated care while addressing components and outcomes of the interventions. Method We included papers from five databases that contained: (1) integrated care (2) education programme (3) medical students (4) elderly, or synonyms. We divided the WHO definition of integrated care into ten components for the concept of 'integrated care'. Data were collected with a charting template, and template analysis was used to formulate themes. Results We found 17 educational programmes in different learning settings. All programmes addressed several components of the WHO definition. The programmes primarily focused on care for individual patients (micro-level), and the outcomes suggested that experiencing the complexity of care is key. Conclusion This review revealed the limited evidence on educational programmes about integrated care for the elderly. Our findings suggest that educational programmes on integrated care should not be limited to the micro-level, and that students should obtain adaptive expertise by experiencing complexity. Future research should contain an explicit description and definition of integrated care.
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Affiliation(s)
| | | | - S. M. (sietske) Grol
- Radboud University Medical Center, Corporate Staff Strategy Development, Nijmegen, the Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
| | | | - C. R. M. G. (Lia) Fluit
- Radboud University Medical Center, Radboudumc Health Academy, Research on Learning and Education, Nijmegen, the Netherlands
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MacLeod MLP, McCaffrey G, Wilson E, Zimmer LV, Snadden D, Zimmer P, Jónatansdóttir S, Fyfe TM, Koopmans E, Ulrich C, Graham ID. Exploring the intersection of hermeneutics and implementation: a scoping review. Syst Rev 2023; 12:30. [PMID: 36864488 PMCID: PMC9979573 DOI: 10.1186/s13643-023-02176-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 01/24/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND An enduring challenge remains about how to effectively implement programs, services, or practices. Too often, implementation does not achieve its intended effectiveness, fidelity, and sustainability, even when frameworks or theories determine implementation strategies and actions. A different approach is needed. This scoping review joined two markedly different bodies of literature: implementation and hermeneutics. Implementation is usually depicted as focused, direct, and somewhat linear, while hermeneutics attends to the messiness of everyday experience and human interaction. Both, however, are concerned with practical solutions to real-life problems. The purpose of the scoping review was to summarize existing knowledge on how a hermeneutic approach has informed the process of implementing health programs, services, or practices. METHODS We completed a scoping review by taking a Gadamerian hermeneutic approach to the JBI scoping review method. Following a pilot search, we searched eight health-related electronic databases using broadly stated terms such as implementation and hermeneutics. A diverse research team that included a patient and healthcare leader, working in pairs, independently screened titles/abstracts and full-text articles. Through the use of inclusion criteria and full-team dialogue, we selected the final articles and identified their characteristics, hermeneutic features, and implementation components. RESULTS Electronic searches resulted in 2871 unique studies. After full-text screening, we retained six articles that addressed both hermeneutics and implementing a program, service, or practice. The studies varied widely in location, topic, implementation strategies, and hermeneutic approach. All addressed assumptions underpinning implementation, the human dimensions of implementing, power differentials, and knowledge creation during implementation. All studies addressed issues foundational to implementing such as cross-cultural communication and surfacing and addressing tensions during processes of change. The studies showed how creating conceptual knowledge was a precursor to concrete, instrumental knowledge for action and behavioral change. Finally, each study demonstrated how the hermeneutic process of the fusion of horizons created new understandings needed for implementation. CONCLUSIONS Hermeneutics and implementation have rarely been combined. The studies reveal important features that can contribute to implementation success. Implementers and implementation research may benefit from understanding, articulating, and communicating hermeneutic approaches that foster the relational and contextual foundations necessary for successful implementation. TRIAL REGISTRATION The protocol was registered at the Centre for Open Science on September 10, 2019. MacLeod M, Snadden D, McCaffrey G, Zimmer L, Wilson E, Graham I, et al. A hermeneutic approach to advancing implementation science: a scoping review protocol 2019. Accessed at osf.io/eac37.
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Affiliation(s)
- Martha L P MacLeod
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada. .,Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada.
| | - Graham McCaffrey
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Erin Wilson
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Lela V Zimmer
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - David Snadden
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Prince George, British Columbia, Canada.,Northern Medical Program, Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Peter Zimmer
- University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Steinunn Jónatansdóttir
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Trina M Fyfe
- Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada.,Geoffrey R. Weller Library, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Erica Koopmans
- Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Cathy Ulrich
- Northern Health Authority, Prince George, British Columbia, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Fleming MD, Safaeinili N, Knox M, Hernandez E, Brewster AL. Between health care and social services: Boundary objects and cross-sector collaboration. Soc Sci Med 2023; 320:115758. [PMID: 36753994 DOI: 10.1016/j.socscimed.2023.115758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Health care systems throughout the United States are initiating collaborations with social services agencies. These cross-sector collaborations aim to address patients' social needs-such as housing, food, income, and transportation-in health care settings. However, such collaborations can be challenging as health care and social service sectors are composed of distinct missions, institutions, professional roles, and modes of distributing resources. This paper examines how the "high-risk" patient with both medical and social needs is constructed as a shared object of intervention across sectors. Using the concept of boundary object, we illustrate how the high-risk patient category aggregates and represents multiple types of information-medical, social, service utilization, and cost-in ways that facilitate its use across sectors. The high-risk patient category works as a boundary object, in part, by the differing interpretations of "risk" available to collaborators. During 2019-2021, we conducted 75 semi-structured interviews and 31 field observations to investigate a relatively large-scale, cross-sector collaboration effort in California known as CommunityConnect. This program uses a predictive algorithm and big data sets to assign risk scores to the population and directs integrated health care and social services to patients identified as high risk. While the high-risk patient category worked well to foster collaboration in administrative and policy contexts, we find that it was less useful for patient-level interactions, where frontline case managers were often hesitant or unable to communicate information about the risk-based eligibility process. We suggest that the predominance of health care utilization (and its impacts on costs) in constructing the high-risk patient category may be medicalizing social services, with the potential to deepen inequities.
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Affiliation(s)
- Mark D Fleming
- University of California, Berkeley, School of Public Health, Berkeley, California, USA.
| | - Nadia Safaeinili
- University of California, Berkeley, School of Public Health, Berkeley, California, USA
| | - Margae Knox
- University of California, Berkeley, School of Public Health, Berkeley, California, USA
| | | | - Amanda L Brewster
- University of California, Berkeley, School of Public Health, Berkeley, California, USA
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Mazur A, Tetzlaff B, Mallon T, Hesjedal-Streller B, Wei V, Scherer M, Köpke S, Balzer K, Steyer L, Friede T, Pfeiffer S, Hummers E, Müller C. Cluster randomised trial of a complex interprofessional intervention (interprof ACT) to reduce hospital admission of nursing home residents. Age Ageing 2023; 52:7078345. [PMID: 36934341 PMCID: PMC10024891 DOI: 10.1093/ageing/afad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Some hospital admissions of nursing home residents (NHRs) might be attributed to inadequate interprofessional collaboration. To improve general practitioner-nurse collaboration in nursing homes (NHs), we developed an intervention package (interprof ACT) in a previous study. OBJECTIVE To assess the impact of interprof ACT on the proportion of hospitalisation and other clinical parameters within 12 months from randomisation among NHRs. METHODS Multicentre, cluster randomised controlled trial in 34 German NHs. NHRs of the control group received usual care, whereas NHRs in the intervention group received interprof ACT. Eligible NHs had at least 40 long-term care residents. NHs were randomised 1:1 pairwise. Blinded assessors collected primary outcome data. RESULTS Seventeen NHs (320 NHRs) were assigned to interprof ACT and 17 NHs (323 NHRs) to usual care. In the intervention group, 136 (42.5%) NHRs were hospitalised at least once within 12 months from randomisation and 151 (46.7%) in the control group (odds ratio (OR): 0.82, 95% confidence interval (CI): [0.55; 1.22], P = 0.33). No differences were found for the average number of hospitalisations: 0.8 hospitalisations per NHR (rate ratio (RR) 0.90, 95% CI: [0.66, 1.25], P = 0.54). Average length of stay was 5.7 days for NHRs in the intervention group and 6.5 days in the control group (RR: 0.70, 95% CI: [0.45, 1.11], P = 0.13). Falls were the most common adverse event, but none was related to the study intervention. CONCLUSIONS The implementation of interprof ACT did not show a statistically significant and clinically relevant effect on hospital admission of NHRs.
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Affiliation(s)
| | - Britta Tetzlaff
- Address correspondence to: Britta Tetzlaff, Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany. Tel: +49 (40) 7410-57158; +49 (40) 7410-53681.
| | - Tina Mallon
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Berit Hesjedal-Streller
- Department of General Practice, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Vivien Wei
- Department of General Practice, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne and University Hospital Cologne, Cologne D-50935, Germany
| | - Katrin Balzer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck D-23538, Germany
| | - Linda Steyer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck D-23538, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Sebastian Pfeiffer
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Christiane Müller
- Department of General Practice, University Medical Center Göttingen, Göttingen D-37073, Germany
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Køberl S, Schrøder K, Dall-Hansen D, Abrahamsen C. From hospital to home following a lower limb amputation: A focus group study of healthcare professionals' views and experiences with transitioning. Int J Orthop Trauma Nurs 2023; 49:101003. [PMID: 36805883 DOI: 10.1016/j.ijotn.2023.101003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/03/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Patients undergoing major lower limb amputation often have multiple comorbidities, requiring care from numerous healthcare professionals (HCPs). Furthermore, they may experience physical, medical and practical challenges post-amputation. Patients with complex needs are particularly vulnerable during care transitions and may benefit from integrated care models. AIM This study aimed to explore HCPs' views and experiences regarding the transition process after implementing an integrated care model for patients with lower limb amputation. METHODS We conducted two focus groups with 13 HCPs from a Danish hospital and three surrounding districts; all working in the Safe Journey programme. The interviews were analysed using thematic analysis. RESULTS Three themes were created: 1) becoming a team across sectors, 2) continuity of care as a driver for patient safety and 3) challenges in achieving safe transitions. The Safe Journey programme facilitated the construction of an interdisciplinary team, cross-sectoral communication and professional relations, increasing HCPs' sense of improved patient safety and care continuity. However, HCPs experienced an increased workload, including coordination and at-home patient visits. CONCLUSIONS HCPs found the Safe Journey programme to be valuable for patients undergoing major lower limb amputation and promotive of cross-sectoral professional relations, communication, continuity and patient safety. However, the programme was time- and resource-consuming compared to conventional models.
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Affiliation(s)
- Sarah Køberl
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Katja Schrøder
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorte Dall-Hansen
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding Hospital, Denmark
| | - Charlotte Abrahamsen
- Department of Public Health, University of Southern Denmark, Odense, Denmark; Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding Hospital, Denmark.
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Cheetham A, Arunogiri S, Lubman D. Integrated care – panacea or white elephant? A review of integrated care approaches in Australia over the past two decades. ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-10-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose
Integrated care is widely supported as a means of improving treatment outcomes for people with co-occurring mental health and substance use disorders. Over the past two decades, Australian state and federal governments have identified integrated care as a policy priority and invested in a number of research and capacity building initiatives. This study aims to examine Australian research evaluating the effectiveness of integrated treatment approaches to provide insight into implications for future research and practice in integrated treatment.
Design/methodology/approach
This narrative review examines Australian research evaluating empirical evidence of the effectiveness of integrated treatment approaches within specific populations and evidence from initiatives aimed at integrating care at the service or system level.
Findings
Research conducted within the Australian context provides considerable evidence to support the effectiveness of integrated approaches to treatment, particularly for people with high prevalence co-occurring disorders or symptoms of these (i.e. anxiety and depression). These have been delivered through various modalities (including online and telephone-based services) to improve health outcomes in a range of populations. However, there is less evidence regarding the effectiveness of specific models or systems of integrated care, including for more severe mental disorders. Despite ongoing efforts on behalf of the Australian government, attempts to sustain system-level initiatives have remained hampered by structural barriers.
Originality/value
Effective integrated interventions can be delivered by trained clinicians without requiring integration at an organisational or structural level. While there is still considerable work to be done in terms of building sustainable models at a system level, this evidence provides a potential foundation for the development of integrated care models that can be delivered as part of routine practice.
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Leung T, Anderson S, Mozaffar H, Elizondo A, Geiger M, Williams R. Socio-Organizational Dimensions: The Key to Advancing the Shared Care Record Agenda in Health and Social Care. J Med Internet Res 2023; 25:e38310. [PMID: 36701190 PMCID: PMC9912150 DOI: 10.2196/38310] [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: 03/30/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 02/02/2023] Open
Abstract
Integrating health and social care delivery with the help of digital technologies is a grand challenge. We argue that previous attempts have largely failed to achieve their objectives because implementers and decision makers disregard the complex socio-organizational dimensions of change associated with initiatives. These include structural and organizational complexity inhibiting the development of shared care pathways; professional jurisdictions, interests, and expertise; and existing data and governance structures. We provide an overview of those dimensions that can inform strategic decisions going forward, thereby contributing to the chances of success of shared care initiatives.
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Affiliation(s)
| | - Stuart Anderson
- School of Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Hajar Mozaffar
- Business School, The University of Edinburgh, Edinburgh, United Kingdom
| | - Andrey Elizondo
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, United Kingdom
| | - Marcia Geiger
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, United Kingdom
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, United Kingdom
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Chrifou R, Stalenhoef H, Grit K, Braspenning J. Struggling with the governance of interprofessional elderly care in mandated collaboratives: a qualitative study. BMC Health Serv Res 2023; 23:26. [PMID: 36627619 PMCID: PMC9832249 DOI: 10.1186/s12913-023-09026-1] [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: 06/03/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Governing interprofessional elderly care requires the commitment of many different organisations connected in mandated collaboratives. Research over a decade ago showed that the governance relied on clan-based mechanisms, while lacking formal rules and incentives for collaborations. Awareness and reflection were seen as first steps towards progression. We aim to identify critical governance features of contemporary mandated collaboratives by discussing cases introduced by the healthcare professionals and managers themselves. METHODS Semi-structured interviews (n = 24) with two regional mandated collaboratives took place from November 2019 to November 2020 in the Netherlands to learn more about critical governance features. The interviews were thematically analysed by the project team (authors) to synthesise the results and were subsequently validated during a focus group. RESULTS Critical governance features of interorganisational activities in mandated collaboratives include the gradual formulation of shared vision and clear client-centred goals, building trust and acquaintanceship for the advancement of an open collaborative culture, establishing a non-extreme formalised governance structure through leadership, mutual trust and innovation support and facilitating information exchange and formalisation tools for optimal elderly care. CONCLUSION Trust and leadership form the backbone of interorganisational functioning. Interorganisational functioning should be seen in light of their national embedment and resources that are (being made) available, which makes them susceptible to constant change as they struggle with balancing between critical features in a fluid and intermingled governance context. The identified critical features of (contemporary) mandated collaboratives may aid in assessing and improving interprofessional functioning within integrated elderly care. International debate on governance expectations of mandated collaboratives may further contribute to sharpening the roles of both managers and healthcare professionals.
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Affiliation(s)
- Rabab Chrifou
- grid.10417.330000 0004 0444 9382Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands ,grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Hanna Stalenhoef
- grid.6906.90000000092621349Erasmus School of Health Policy & Management (ESHPM), Erasmus University, Rotterdam, The Netherlands
| | - Kor Grit
- grid.6906.90000000092621349Erasmus School of Health Policy & Management (ESHPM), Erasmus University, Rotterdam, The Netherlands
| | - Jozé Braspenning
- grid.10417.330000 0004 0444 9382Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
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