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Giguere A, Holroyd-Leduc JM, Straus SE, Urquhart R, Turcotte V, Durand PJ, Turgeon A. Prioritization of indicators of the quality of care provided to older adults with frailty by key stakeholders from five canadian provinces. BMC Geriatr 2022; 22:149. [PMID: 35197016 PMCID: PMC8864862 DOI: 10.1186/s12877-022-02843-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background To meet the needs of older adults with frailty better, it is essential to understand which aspects of care are important from their perspective. We therefore sought to assess the importance of a set of quality indicators (QI) for monitoring outcomes in this population. Methods In this mixed-method study, key stakeholders completed a survey on the importance of 36 QIs, and then explained their ratings in a semi-structured interview. Stakeholders included older adults with frailty and their caregivers, healthcare providers (HCPs), and healthcare administrators or policy/decision makers (DMs). We conducted descriptive statistical analyses of quantitative variables, and deductive thematic qualitative analyses of interview transcripts. Results The 42 participants (8 older adults, 18 HCPs, and 16 DMs) rated six QIs as more important: increasing the patients’ quality of life; increasing healthcare staff skills; decreasing patients’ symptoms; decreasing family caregiver burden; increasing patients’ satisfaction with care; and increasing family doctor continuity of care. Conclusions Key stakeholders prioritized QIs that focus on outcomes targeted to patients and caregivers, whereas the current healthcare systems generally focus on processes of care. Quality improvement initiatives should therefore take better account of aspects of care that are important for older adults with frailty, such as having a chance to express their individual goals of care, receiving quality communications from HCPs, or monitoring symptoms that they might not spontaneously describe. Our results point to the need for patient-centred care that is oriented toward quality of life for older adults with frailty. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02843-9.
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Affiliation(s)
- Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada. .,Quebec Excellence Centre on Aging, Quebec, Canada. .,VITAM - Research Centre on Sustainable Health (Centre de recherche en santé durable), 2480, chemin de la Canardière, QC, G1J 0A4, Québec, Canada.
| | | | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | | | - Pierre J Durand
- Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
| | - Alexis Turgeon
- Population Health and Optimal Health Practices Research Unit, Division of Critical Care Medicine, CHU de Quebec - Université Laval Research Centre, Université Laval, Quebec, Canada
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Lethin C, Giertz L, Vingare EL, Hallberg IR. Dementia care and service systems - a mapping system tested in nine Swedish municipalities. BMC Health Serv Res 2018; 18:778. [PMID: 30326900 PMCID: PMC6192069 DOI: 10.1186/s12913-018-3592-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 10/01/2018] [Indexed: 12/17/2022] Open
Abstract
Background In dementia care, it is crucial that the chain of care is adapted to the needs of people with dementia and their informal caregivers throughout the course of the disease. Assessing the existing dementia care system with regard to facilities, availability and utilization may provide useful information for ensuring that the professional dementia care and service system meets the needs of patients and their families from disease onset to end of life. Methods The aim of this study was to further develop and test a mapping system, and adapt it to a local context. In addition, the aim was to assess availability and utilization of care activities as well as professional providers’ educational level in nine municipalities under the categories of Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care. This cross-sectional study was conducted in April through May 2015. Data was derived from the health care and social service systems in nine rural and urban municipalities in two counties in Sweden. The mapping system covered seven categories with altogether 56 types of health care and social service activities. Results The mapping system was found to be reliable with minor adaptations to the context mainly in terms of activities. Availability of care activities was common with low utilization regarding Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care and dementia trained staff was rare. Availability and utilization of care activities and professionals’ educational level was higher concerning screening, the diagnostic procedures and treatment compared with outpatient care facilities, institutional care and palliative care. Conclusions The mapping system enables policy makers and professionals to assess and develop health care and social service systems, to be offered proactively and on equal terms to people with dementia and their informal caregivers throughout the course of the disease. The educational level of professionals providing care and services may reveal where, in the chain of care, dementia-specific education for professionals, needs to be developed.
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Affiliation(s)
- Connie Lethin
- Faculty of Medicine, Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden. .,Faculty of Medicine, Department of Clinical Sciences, Clinical Memory Research Unit, Lund, Sweden.
| | - Lottie Giertz
- Department of Social Work, Linnaeus University, Universitetsplatsen 1, 351 95, Växjö, Sweden
| | - Emme-Li Vingare
- Department of Social Work, Linnaeus University, Universitetsplatsen 1, 351 95, Växjö, Sweden
| | - Ingalill Rahm Hallberg
- Faculty of Medicine, Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden
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3
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Brand S, Pollock K. How is continuity of care experienced by people living with chronic kidney disease? J Clin Nurs 2017; 27:153-161. [DOI: 10.1111/jocn.13860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Sarah Brand
- Renal and Transplant Unit; Nottingham University Hospitals Trust; Nottingham UK
| | - Kristian Pollock
- School of Health Sciences; University of Nottingham; Nottingham UK
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Dwyer T, Craswell A, Rossi D, Holzberger D. Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service. BMC Health Serv Res 2017; 17:33. [PMID: 28086869 PMCID: PMC5237281 DOI: 10.1186/s12913-017-1977-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/04/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. METHODS Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. RESULTS Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. CONCLUSIONS This study provides valuable insights into the contribution of the NP model of care within an aged care, HA service and how staff manipulated the process dimensions to improve referral to the NPs. NP service in this study was dynamic, flexible and responsive to both patient and organisational demands.
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Affiliation(s)
- Trudy Dwyer
- Central Queensland University, Building 18 Rockhampton, Bruce Highway, Rockhampton, Q 4702 Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Q 4556 Australia
| | - Dolene Rossi
- Central Queensland University, Building 18 Rockhampton, Bruce Highway, Rockhampton, Q 4702 Australia
| | - Darren Holzberger
- Central Queensland Hospital and Health Service, Queensland Health, Rockhampton, Q 4770 Australia
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Lethin C, Hallberg IR, Karlsson S, Janlöv AC. Family caregivers experiences of formal care when caring for persons with dementia through the process of the disease. Scand J Caring Sci 2015; 30:526-34. [DOI: 10.1111/scs.12275] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/03/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Connie Lethin
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | | | - Staffan Karlsson
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
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Lood Q, Gustafsson S, Dahlin Ivanoff S. Bridging barriers to health promotion: a feasibility pilot study of the 'Promoting Aging Migrants' Capabilities study'. J Eval Clin Pract 2015; 21:604-13. [PMID: 25810033 DOI: 10.1111/jep.12345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2015] [Indexed: 01/27/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Improving the possibilities for ageing persons to take control over their health is an increasingly important public health issue. Health promotion has previously been visualized to succeed with this goal, but research has primarily focused on ageing persons who are native-born, leaving the generalizability to persons who are foreign-born unexplored. Therefore, as part of the development of a larger health promotion initiative for ageing persons who have experienced migration, this study aimed to assess the feasibility of an adapted protocol. The specific feasibility objectives were to assess recruitment procedure, retention rates, study questionnaire administration and variability of collected data. METHOD Forty persons who were ≥70 years, and who had migrated from Finland, Bosnia and Herzegovina, Croatia, Montenegro or Serbia to Sweden were randomly allocated to a health promotion programme or a control group. The programme was linguistically adapted with regard to translated information material, bilingual health professionals and evaluators, and a person-centred approach was applied to both programme development and provision. The data analysis was explorative and descriptive. RESULTS The results visualized structural and linguistic barriers to recruitment and study questionnaire administration, and describe strategies for how to bridge them. Retention rates and data variability were satisfying. CONCLUSIONS Calling for iterative and pragmatic programme design, the findings describe how to move towards a more inclusive health care environment. Person-centred and bilingual approaches with attention to the possibilities for building authentic relationships between participants and providers are emphasized, and a structured methodology for developing study questionnaires is suggested.
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Affiliation(s)
- Qarin Lood
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center of Ageing and Health - Agecap, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Gustafsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center of Ageing and Health - Agecap, University of Gothenburg, Gothenburg, Sweden
| | - Synneve Dahlin Ivanoff
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Ageing and Health - Agecap, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), Gothenburg, Sweden
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Gustafsson S, Lood Q, Wilhelmson K, Häggblom-Kronlöf G, Landahl S, Dahlin-Ivanoff S. A person-centred approach to health promotion for persons 70+ who have migrated to Sweden: promoting aging migrants' capabilities implementation and RCT study protocol. BMC Geriatr 2015; 15:10. [PMID: 25887506 PMCID: PMC4333269 DOI: 10.1186/s12877-015-0005-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/21/2015] [Indexed: 11/15/2022] Open
Abstract
Background There are inequities in health status associated with ethnicity, which may limit older foreign-born persons’ ability to age optimally. Health promotion for older persons who have experienced migration is thus an area of public health importance. However, since research related to this issue is very limited, the study ‘Promoting Aging Migrants’ Capabilities’ was initiated to improve our understanding. The study aims to implement and evaluate a linguistically adapted, evidence-based, health-promoting intervention with a person-centred approach for two of the largest groups of aging persons who have migrated to Sweden: persons from Finland and persons from the Balkan Peninsula. Methods/Design This study has a descriptive, analytical, and experimental design. It is both a randomised controlled trial and an implementation study, containing the collection and analysis of both qualitative and quantitative data. The setting is an urban district in a medium-sized Swedish city with a high proportion of persons who were born abroad and whose socio-economic status is low. The intervention comprises four group meetings (‘senior meetings’) and one follow-up home visit made by a multi-professional team. For the randomised controlled trial, the plan is to recruit at least 130 community-dwelling persons 70 years or older from the target group. Additional persons from involved organisations will participate in the study of the implementation. Both the intervention effects in the target group (outcome) and the results of the implementation process (output) will be evaluated. Discussion The results of this forthcoming randomised controlled trial and implementation study may be useful for optimising implementation of person-centred, health-promoting initiatives for older persons who have experienced migration. It is also hoped that this combined study will show that the capabilities for optimal aging among older persons born in Finland and the Balkan countries can be improved in the Swedish healthcare context. Trial registration The trial was registered at ClinicalTrials.gov April 10, 2013, identifier: NCT01841853.
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Affiliation(s)
- Susanne Gustafsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Section for Health and Rehabilitation, Gothenburg, Sweden. .,University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden.
| | - Qarin Lood
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Section for Health and Rehabilitation, Gothenburg, Sweden. .,University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
| | - Katarina Wilhelmson
- University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden. .,Department of Public Health and Community Medicine/Social Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Greta Häggblom-Kronlöf
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Section for Health and Rehabilitation, Gothenburg, Sweden. .,University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
| | - Sten Landahl
- University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden.
| | - Synneve Dahlin-Ivanoff
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Section for Health and Rehabilitation, Gothenburg, Sweden. .,University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
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Östman M, Ung EJ, Falk K. Health-care encounters create both discontinuity and continuity in daily life when living with chronic heart failure-A grounded theory study. Int J Qual Stud Health Well-being 2015; 10:27775. [PMID: 28229746 PMCID: PMC4490805 DOI: 10.3402/qhw.v10.27775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2015] [Indexed: 12/18/2022] Open
Abstract
Living with chronic heart failure (CHF) often involves lifelong contact with health care, more or less frequently, depending on fluctuating health-generating disruptions in everyday life. To reduce the influence on continuity in life, health-care professionals should preferably focus on supporting patients in managing their daily lives, based on their perspective. The aim of this study was to describe how the interaction in health-care encounters contributes to either continuity or discontinuity in the daily life for persons with CHF. Interviews with 18 participants were carried out, using the grounded theory method, through data collection and analysis. Two core concepts were constructed from data which reveal a model that illuminates the characteristics of the encounters, the actions of health-care professionals and the normative discourse. Patient-centred agenda consists of the categories: "Experiencing a subordinate approach," "Objectifying during the encounter" and "Expected to be compliant." This describes how health-care professionals enhance discontinuity in daily life by using a paternalistic approach in the encounter. Person-centred agenda consists of the categories: "Experiencing an empowering approach," "Person-centredness during the encounter" and "Expected to be capable." It describes how participants perceive that health-care professionals enable them to deal with everyday life which enhances continuity. The findings highlight the importance of health-care professionals' attitudes and communication in encounters with patients. Health care must be designed to support and promote patients' own strategic thinking by strengthening their self-image to enhance continuity in everyday life. The experience of discontinuity is based on the prevailing health-care culture which focuses on disease and medical treatment and regards it as superior to the illness experience in an everyday life context. We therefore strongly suggest a paradigm shift in the health-care organisation and culture in order to support the patients in their efforts to live a meaningful, rich life, in spite of the chronic illness CHF.
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Affiliation(s)
- Malin Östman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Källstorp Health Centre, Trollhättan, Sweden
| | - Eva Jakobsson Ung
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristin Falk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cameron A, Lart R, Bostock L, Coomber C. Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:225-33. [PMID: 23750908 DOI: 10.1111/hsc.12057] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2013] [Indexed: 05/12/2023]
Abstract
This article reports the results of a review of the research evidence related to joint working in the field of adult health and social care services in the UK. It explores whether recent reforms to joint working have met the objectives set by policy-makers. The review followed an established methodology: electronic databases were searched using predetermined terms, abstracts were screened against inclusion criteria, studies that met the criteria were read in full and assessed for inclusion and data were extracted systematically. The findings of the review suggest that there is some indication that recent developments, in particular the drive to greater integration of services, may have positive benefits for organisations as well as for users and carers of services. However, the evidence consistently reports a lack of understanding about the aims and objectives of integration, suggesting that more work needs to be done if the full potential of the renewed policy agenda on integration is to be realised. Additionally, while the review acknowledges that greater emphasis has been placed on evaluating the outcome of joint working, studies largely report small-scale evaluations of local initiatives and few are comparative in design and therefore differences between 'usual care' and integrated care are not assessed. This makes it difficult to draw firm conclusions about the effectiveness of UK-based integrated health and social care services.
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Affiliation(s)
- Ailsa Cameron
- School for Policy Studies, University of Bristol, Bristol, UK
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Cameron A, Bostock L, Lart R. Service user and carers perspectives of joint and integrated working between health and social care. JOURNAL OF INTEGRATED CARE 2014. [DOI: 10.1108/jica-10-2013-0042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to provide an update to a review of the joint working literature in the field of health and social care for adults, with particular emphasis given to the experiences of users and carers.
Design/methodology/approach
– The aims of the literature review remained largely the same as those of the original, they were to identify: models of joint working, evidence of effectiveness and cost-effectiveness and the factors promoting or hindering the models. However, to reflect the growing interest in the experiences of users and carers a fourth aim was added to map these experiences. Given their prominence in terms of policy debates about integration, the review focused on jointly organised services for older people and people with mental health problems in the UK only.
Findings
– The review demonstrates tentative signs that some initiatives designed to join-up or integrate services can deliver outcomes desired by government. Importantly some studies that report the experiences of users of services and carers suggest that they perceive benefits from efforts to join-up or integrate services. However it is our contention that the evidence is less than compelling and does not justify the faith invested in the strategy by current or previous governments.
Originality/value
– The study updates our knowledge of the impact of joint working in the field of health and social care for adults. Importantly the paper highlights what is known about the experiences of users and carers of joint/integrated services.
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Hartgerink JM, Cramm JM, de Vos AJBM, Bakker TJEM, Steyerberg EW, Mackenbach JP, Nieboer AP. Situational awareness, relational coordination and integrated care delivery to hospitalized elderly in the Netherlands: a comparison between hospitals. BMC Geriatr 2014; 14:3. [PMID: 24410889 PMCID: PMC3890569 DOI: 10.1186/1471-2318-14-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is known that interprofessional collaboration is crucial for integrated care delivery, yet we are still unclear about the underlying mechanisms explaining effectiveness of integrated care delivery to older patients. In addition, we lack research comparing integrated care delivery between hospitals. Therefore, this study aims to (i) provide insight into the underlying components 'relational coordination' and 'situational awareness' of integrated care delivery and the role of team and organizational context in integrated care delivery; and (ii) compare situational awareness, relational coordination, and integrated care delivery of different hospitals in the Netherlands. METHODS This cross-sectional study took place in 2012 among professionals from three different hospitals involved in the delivery of care to older patients. A total of 215 professionals filled in the questionnaire (42% response rate).Descriptive statistics and paired-sample t-tests were used to investigate the level of situational awareness, relational coordination, and integrated care delivery in the three different hospitals. Correlation and multilevel analyses were used to investigate the relationship between background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery. RESULTS No differences in background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery were found among the three hospitals. Correlational analysis revealed that situational awareness (r = 0.30; p < 0.01), relational coordination (r = 0.17; p < 0.05), team climate (r = 0.29; p < 0.01), formal internal communication (r = 0.46; p < 0.01), and informal internal communication (r = 0.36; p < 0.01) were positively associated with integrated care delivery. Stepwise multilevel analyses showed that formal internal communication (p < 0.001) and situational awareness (p < 0.01) were associated with integrated care delivery. Team climate was not significantly associated with integrated care delivery when situational awareness and relational coordination were included in the equation. Thus situational awareness acted as mediator between team climate and integrated care delivery among professionals delivering care to older hospitalized patients. CONCLUSIONS The results of this study show the importance of formal internal communication and situational awareness for quality of care delivery to hospitalized older patients.
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Affiliation(s)
- Jacqueline M Hartgerink
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
| | - Jane M Cramm
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
| | - Annemarie JBM de Vos
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
| | - Ton JEM Bakker
- Argos Zorggroep, P.O. Box 4023, Schiedam, GA 3102, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Anna P Nieboer
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
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Haggerty JL, Roberge D, Freeman GK, Beaulieu C. Experienced continuity of care when patients see multiple clinicians: a qualitative metasummary. Ann Fam Med 2013; 11:262-71. [PMID: 23690327 PMCID: PMC3659144 DOI: 10.1370/afm.1499] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Continuity of care among different clinicians refers to consistent and coherent care management and good measures are needed. We conducted a metasummary of qualitative studies of patients' experience with care to identify measurable elements that recur over a variety of contexts and health conditions as the basis for a generic measure of management continuity. METHODS From an initial list of 514 potential studies (1997-2007), 33 met our criteria of using qualitative methods and exploring patients' experiences of health care from various clinicians over time. They were coded independently. Consensus meetings minimized conceptual overlap between codes. RESULTS For patients, continuity of care is experienced as security and confidence rather than seamlessness. Coordination and information transfer between professionals are assumed until proven otherwise. Care plans help clinician coordination but are rarely discerned as such by patients. Knowing what to expect and having contingency plans provides security. Information transfer includes information given to the patient, especially to support an active role in giving and receiving information, monitoring, and self-management. Having a single trusted clinician who helps navigate the system and sees the patient as a partner undergirds the experience of continuity between clinicians. CONCLUSION Some dimensions of continuity, such as coordination and communication among clinicians, are perceived and best assessed indirectly by patients through failures and gaps (discontinuity). Patients experience continuity directly through receiving information, having confidence and security on the care pathway, and having a relationship with a trusted clinician who anchors continuity.
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13
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Hartgerink JM, Cramm JM, Bakker TJEM, van Eijsden RAM, Mackenbach JP, Nieboer AP. The importance of relational coordination for integrated care delivery to older patients in the hospital. J Nurs Manag 2012; 22:248-56. [PMID: 24576117 DOI: 10.1111/j.1365-2834.2012.01481.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2012] [Indexed: 12/29/2022]
Abstract
AIM This study investigated relational coordination among professionals providing healthcare to hospitalized older patients and assessed its impact on integrated care delivery. BACKGROUND Previous studies have shown that relational coordination is positively associated with the delivery of acute, emergency and trauma care. The effect of relational coordination in integrated care delivery to hospitalized older patients remains unknown. METHODS This cross-sectional study was part of an examination of integrated care delivery to hospitalized older patients. Data were collected using questionnaires distributed to hospital professionals (192 respondents; 44% response rate). RESULTS After controlling for demographic variables, regression analyses showed that relational coordination was positively related to integrated care delivery (β = 0.20; P ≤ 0.05). Relational coordination was lower among professionals in the same discipline, and higher between nurses and others than between medical specialists and others. Relational coordination and integrated care delivery were significantly higher in geriatrics than in other units (both P ≤ 0.001). CONCLUSIONS The enhancement of relational coordination among healthcare professionals is positively associated with integrated care delivery to older patients. IMPLICATIONS FOR NURSING MANAGEMENT Relational coordination should be improved between medical specialists and others and higher levels of relational coordination and integrated care delivery should be achieved in all hospital units.
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Waibel S, Henao D, Aller MB, Vargas I, Vázquez ML. What do we know about patients' perceptions of continuity of care? A meta-synthesis of qualitative studies. Int J Qual Health Care 2011; 24:39-48. [PMID: 22146566 DOI: 10.1093/intqhc/mzr068] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The increasing complexity in healthcare delivery might impede the achievement of continuity of care, being defined as 'one patient experiencing care over time as coherent and linked'. This article aims to improve the knowledge on patients' perceptions of relational (RC), informational (IC) and management continuity (MC) across care levels. DESIGN A descriptive, qualitative meta-synthesis was conducted based on a literature search in various electronic databases using the subject heading 'continuity of care' and linked key terms. We scanned retrieved articles for adherence to inclusion criteria: (i) relevance to research topic, (ii) original study adopting a qualitative design and (iii) investigating the patient's perspective. Content analysis was conducted by identification of themes and aggregation of findings. RESULTS The selected 25 studies most frequently investigated RC. Being attended to regularly and over time by one physician (RC) was valued by chronic ill patients, but balanced with convenient access by young patients (MC). Communication and information transfer across care settings as well as the gathering of holistic information about the patient were perceived to foster IC. Critical features for achieving MC were accessibility between care levels, individualized care and a smooth discharge process including the receipt of support. Patients further considered that their personal involvement was one facilitating element of continuity of care. CONCLUSIONS Patients identified elements that enhance or distract from continuity of care across boundaries. Variations in perceived importance seem to depend on both individual and contextual factors which should be taken into account during healthcare provision.
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Affiliation(s)
- Sina Waibel
- Health Policy and Health Services Research Group, Consortium for Healthcare and Social Services of Catalonia, Av. Tibidabo 21, 08022 Barcelona, Spain.
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McCormack B, Karlsson B, Dewing J, Lerdal A. Exploring person-centredness: a qualitative meta-synthesis of four studies. Scand J Caring Sci 2010; 24:620-34. [PMID: 21050249 DOI: 10.1111/j.1471-6712.2010.00814.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Brendan McCormack
- Person Centred Practice Research Centre, Institute of Nursing Research/School of Nursing, University of Ulster, Co Antrim, UK.
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Nurse-patient encounters in the hospital ward, from the perspectives of older persons: an analysis using the Authentic Consciousness Framework. Int J Older People Nurs 2010; 7:95-104. [DOI: 10.1111/j.1748-3743.2010.00233.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hunter S, Levett-Jones T. The practice of nurses working with older people in long term care: an Australian perspective. J Clin Nurs 2010; 19:527-36. [DOI: 10.1111/j.1365-2702.2009.02967.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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