1
|
Wei YJ, Hsieh CF, Huang YT, Huang MS, Fang TJ. The influence of integrated geriatric outpatient clinics on the health care utilization of older people. BMC Geriatr 2020; 20:379. [PMID: 33008337 PMCID: PMC7531091 DOI: 10.1186/s12877-020-01782-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background The number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people. Methods This was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups. Results A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62 ± 10.85) and the number of clinic visits per year (18.18 ± 48.85) (P < 0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients. Conclusion The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.
Collapse
Affiliation(s)
- Yu-Ju Wei
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Fang Hsieh
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ting Huang
- Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Shyan Huang
- E-Da Cancer Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Tzu-Jung Fang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
2
|
Yang YT, Lin NP, Su S, Chen YM, Chang YM, Handa Y, Khan HAA, Elsa Hsu YH. Value-added strategy models to provide quality services in senior health business. Int J Qual Health Care 2017; 32:1-5. [PMID: 28637191 DOI: 10.1093/intqhc/mzx072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 06/15/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The rapid population aging is now a global issue. The increase in the elderly population will impact the health care industry and health enterprises; various senior needs will promote the growth of the senior health industry. Most senior health studies are focused on the demand side and scarcely on supply. Our study selected quality enterprises focused on aging health and analyzed different strategies to provide excellent quality services to senior health enterprises. DESIGN We selected 33 quality senior health enterprises in Taiwan and investigated their excellent quality services strategies by face-to-face semi-structured in-depth interviews with CEO and managers of each enterprise in 2013. SETTING A total of 33 senior health enterprises in Taiwan. PARTICIPANTS Overall, 65 CEOs and managers of 33 enterprises were interviewed individually. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Core values and vision, organization structure, quality services provided, strategies for quality services. RESULTS This study's results indicated four type of value-added strategy models adopted by senior enterprises to offer quality services: (i) residential care and co-residence model, (ii) home care and living in place model, (iii) community e-business experience model and (iv) virtual and physical portable device model. The common part in these four strategy models is that the services provided are elderly centered. These models offer virtual and physical integrations, and also offer total solutions for the elderly and their caregivers. Through investigation of successful strategy models for providing quality services to seniors, we identified opportunities to develop innovative service models and successful characteristics, also policy implications were summarized. CONCLUSIONS The observations from this study will serve as a primary evidenced base for enterprises developing their senior market and, also for promoting the value co-creation possibility through dialogue between customers and those that deliver service.
Collapse
Affiliation(s)
- Ya-Ting Yang
- Institute of Health Policy and Management, National Taiwan University, No. 17, Xu-Zhou Road, Taipei 100, Taiwan
- Golden Dream Think Tank and Research Center, 250 WuHsing St., Taipei 110, Taiwan
- School of Health Care Administration, College of Management, Taipei Medical University, 250 WuHsing St., Taipei 110, Taiwan
| | - Neng-Pai Lin
- Institute of Health Policy and Management, National Taiwan University, No. 17, Xu-Zhou Road, Taipei 100, Taiwan
| | - Shyi Su
- Department of Health Business, HungKuang University, No. 34 Chung-Chie Rd., Sha Lu, Taichung City 443, Taiwan (R.O.C.)
| | - Ya-Mei Chen
- Institute of Health Policy and Management, National Taiwan University, No. 17, Xu-Zhou Road, Taipei 100, Taiwan
| | - Yao-Mao Chang
- School of Health Care Administration, College of Management, Taipei Medical University, 250 WuHsing St., Taipei 110, Taiwan
| | - Yujiro Handa
- Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, 7-1 15 Yatsuyamada, Koriyama-shi, Fukushima 963-8563, Japan
| | - Hafsah Arshed Ali Khan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, 250 WuHsing St., Taipei 110, Taiwan
| | - Yi-Hsin Elsa Hsu
- Golden Dream Think Tank and Research Center, 250 WuHsing St., Taipei 110, Taiwan
- School of Health Care Administration, College of Management, Taipei Medical University, 250 WuHsing St., Taipei 110, Taiwan
- Executive Master Program of Business Administration in Biotechnology, College of Management, Taipei Medical University, 250 WuHsing St., Taipei 110, Taiwan
| |
Collapse
|
3
|
Fujita T, Iida Y, Tanaka C, Nakamura K, Yamanaka K, Ueno J, Iino Y, Chitose H, Sakamoto H, Daiko H. Development and evaluation of an "Interdisciplinary Postoperative Support Program" in outpatient clinics after thoracic esophagectomy. Int J Surg 2017; 43:58-66. [PMID: 28529190 DOI: 10.1016/j.ijsu.2017.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/13/2017] [Accepted: 05/15/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND To support patients discharged from the hospital after surgery, we launched an "Interdisciplinary Postoperative Support Program" in outpatient clinics for patients who were discharged within 1 month after thoracic esophagectomy and their families. We introduce our program and clarify the patient's physical and psychologic status by analyzing the questionnaire provided from this program. MATERIALS AND METHODS From August 2014 to January 2015, we conducted the Interdisciplinary Postoperative Support Program every month. Thus, questionnaires regarding physical and psychologic symptoms as well as the meaningfulness of the program were obtained from 59 patients and prospectively analyzed. RESULTS We obtained valid responses from 48 patients (81.4%). Frequent postoperative difficulties included dysphagia (50%) and decreased physical strength (39.5%). Oral intake decreased to half (55.3%) and one-fourth (25.5%) of that before esophagectomy. Frequent requests made by patients to medical staff included explanations of the postoperative symptoms (97.9%), further information on the treatments of esophageal cancer (93.8%), and the typical postoperative course experienced by other patients (76.6%). A higher percentage of positive comments were obtained regarding the management of symptoms (87.8%) and optimal access to the consultations (78.9%). The incidences of unscheduled outpatient visits were 4.1% and 14.0%, respectively, under conditions with and without this postoperative program (P = 0.03). CONCLUSION We found that our program could provide appropriate information with higher levels of satisfaction after thoracic esophagectomy. Further investigations regarding longer periods of physical and psychologic symptoms, as well as the needs of patients and their families should be conducted to augment our program.
Collapse
Affiliation(s)
- Takeo Fujita
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Yoko Iida
- Supportive Care Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chiharu Tanaka
- Supportive Care Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kumi Nakamura
- Supportive Care Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keiko Yamanaka
- Supportive Care Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Junya Ueno
- Division of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshie Iino
- Division of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Haruka Chitose
- Division of Nutrition, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hatoe Sakamoto
- Supportive Care Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroyuki Daiko
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
4
|
Yang YT, Iqbal U, Chen YM, Su S, Chang YM, Handa Y, Lin NP, Hsu YHE. Co-creating value through demand and supply integration in senior industry-observations on 33 senior enterprises in Taiwan. Int J Qual Health Care 2016; 28:497-501. [PMID: 27301480 DOI: 10.1093/intqhc/mzw051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2016] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE With global population aging, great business opportunities are driven by the various needs that the elderly face in everyday living. Internet development makes information spread faster, also allows elderly and their caregivers to more easily access information and actively participate in value co-creation in the services. This study aims to investigate the designs of value co-creation by the supply and demand sides of the senior industry. DESIGN This study investigated senior industry in Taiwan and analyzed bussiness models of 33 selected successful senior enterprises in 2013. We adopted series field observation, reviews of documentations, analysis of meeting records and in-depth interviews with 65 CEOs and managers. SETTING Thirty-three quality enterprises in senior industry. PARTICIPANTS Sixty-five CEOs and managers in 33 senior enterprises. INTERVENTIONS None. MAIN OUTCOME MEASURES Value co-creation design, value co-creating process. RESULTS We constructed a conceptual model that comprehensively describes essential aspects of value co-creation and categorized the value co-creation designs into four types applying for different business models: (i) interaction in experience spaces co-creation design, (ii) on-site interacting co-creation design, (iii) social networking platform co-creation design and (iv) empowering customers co-creation design. Through value co-creation platform design, the senior enterprises have converted the originally passive roles of the elderly and caregivers into active participants in the value co-creation process. CONCLUSIONS The new paradigm of value co-creation designs not only promote innovative development during the interactive process, lead enterprises reveal and meet customers' needs but also increase markets and profits.
Collapse
Affiliation(s)
- Ya-Ting Yang
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan Golden Dream Think Tank and Research Center, Taiwan School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Usman Iqbal
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan International Center for Health Information Technology (ICHIT), Taipei Medical University, Taiwan Health Informatics Department, COMSATS Institute of Information Technology (CIT), Islamabad, Pakistan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Shyi Su
- Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Yao-Mao Chang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Yujiro Handa
- Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Neng-Pai Lin
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Yi-Hsin Elsa Hsu
- Golden Dream Think Tank and Research Center, Taiwan School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
5
|
Körner M, Lippenberger C, Becker S, Reichler L, Müller C, Zimmermann L, Rundel M, Baumeister H. Knowledge integration, teamwork and performance in health care. J Health Organ Manag 2016; 30:227-43. [DOI: 10.1108/jhom-12-2014-0217] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Knowledge integration is the process of building shared mental models. The integration of the diverse knowledge of the health professions in shared mental models is a precondition for effective teamwork and team performance. As it is known that different groups of health care professionals often tend to work in isolation, the authors compared the perceptions of knowledge integration. It can be expected that based on this isolation, knowledge integration is assessed differently. The purpose of this paper is to test these differences in the perception of knowledge integration between the professional groups and to identify to what extent knowledge integration predicts perceptions of teamwork and team performance and to determine if teamwork has a mediating effect.
Design/methodology/approach
– The study is a multi-center cross-sectional study with a descriptive-explorative design. Data were collected by means of a staff questionnaire for all health care professionals working in the rehabilitation clinics.
Findings
– The results showed that there are significant differences in knowledge integration within interprofessional health care teams. Furthermore, it could be shown that knowledge integration is significantly related to patient-centered teamwork as well as to team performance. Mediation analysis revealed partial mediation of the effect of knowledge integration on team performance through teamwork.
Practical/implications
– In practice, the results of the study provide a valuable starting point for team development interventions.
Originality/value
– This is the first study that explored knowledge integration in medical rehabilitation teams and its relation to patient-centered teamwork and team performance.
Collapse
|
6
|
Measured outcomes of chronic care programs for older adults: a systematic review. BMC Geriatr 2015; 15:139. [PMID: 26503159 PMCID: PMC4621859 DOI: 10.1186/s12877-015-0136-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Wagner’s Chronic Care Model (CCM), as well as the expanded version (ECCM) developed by Barr and colleagues, have been widely adopted as frameworks for prevention and management of chronic disease. Given the high prevalence of chronic illness in older persons, these frameworks can play a valuable role in reorienting the health care system to better serve the needs of seniors. We aimed to identify and assess the measured goals of E/CCM interventions in older populations. In particular, our objective was to determine the extent to which published E/CCM initiatives were evaluated based on population, community, system and individual-level outcomes (including clinical, functional and quality of life measures). Methods We conducted a systematic search of the Science Citation Index Web of Knowledge search tool to gather articles published between January 2003 and July 2014. We included published CCM interventions that cited at least one of the fundamental papers that introduced and described the CCM and ECCM. Studies retained for review reported evaluations of senior-focused E/CCM initiatives in community-based settings, with the topic of “older adults” OR senior* OR elder* OR geriatric OR aged. The resulting 619 published articles were independently reviewed for inclusion by two researchers. We excluded the following: systematic reviews, meta-analyses, descriptions of proposed programs, and studies whose populations did not focus on seniors. Results We identified 14 articles that met inclusion criteria. Studies used a wide range of measures, with little consensus between studies. All of the included studies used the original CCM. While a range of system-level and individual patient outcomes have been used to evaluate CCM interventions, no studies employed measures of population or community health outcomes. Conclusions Future efforts to test E/CCM interventions with seniors would be aided by more consistent outcome measures, greater attention to outcomes for the caregivers of older persons with chronic illness, and a greater focus on population and community impacts.
Collapse
|
7
|
Körner M, Wirtz MA, Bengel J, Göritz AS. Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams. BMC Health Serv Res 2015; 15:243. [PMID: 26099228 PMCID: PMC4477418 DOI: 10.1186/s12913-015-0888-y] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 05/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Team effectiveness is often explained on the basis of input-process-output (IPO) models. According to these models a relationship between organizational culture (input = I), interprofessional teamwork (process = P) and job satisfaction (output = O) is postulated. The aim of this study was to examine the relationship between these three aspects using structural analysis. METHODS A multi-center cross-sectional study with a survey of 272 employees was conducted in fifteen rehabilitation clinics with different indication fields in Germany. Structural equation modeling (SEM) was carried out using AMOS software version 20.0 (maximum-likelihood method). RESULTS Of 661 questionnaires sent out to members of the health care teams in the medical rehabilitation clinics, 275 were returned (41.6%). Three questionnaires were excluded (missing data greater than 30%), yielding a total of 272 employees that could be analyzed. The confirmatory models were supported by the data. The results showed that 35% of job satisfaction is predicted by a structural equation model that includes both organizational culture and teamwork. The comparison of this predictive IPO model (organizational culture (I), interprofessional teamwork (P), job satisfaction (O)) and the predictive IO model (organizational culture (I), job satisfaction (O)) showed that the effect of organizational culture is completely mediated by interprofessional teamwork. The global fit indices are a little better for the IO model (TLI: .967, CFI: .972, RMSEA .052) than for the IPO model (TLI: .934, CFI: .943, RMSEA: .61), but the prediction of job satisfaction is better in the IPO model (R(2) = 35%) than in the IO model (R(2) = 24%). CONCLUSIONS Our study results underpin the importance of interprofessional teamwork in health care organizations. To enhance interprofessional teamwork, team interventions can be recommended and should be supported. Further studies investigating the organizational culture and its impact on interprofessional teamwork and team effectiveness in health care are important.
Collapse
Affiliation(s)
- Mirjam Körner
- Medical Psychology and Medical Sociology, University of Freiburg, Hebelstr. 29, 79104, Freiburg, Germany.
| | - Markus A Wirtz
- Department of Research Methods, Institute of Psychology, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany.
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany.
| | - Anja S Göritz
- Department of Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany.
| |
Collapse
|
8
|
Valentijn PP, Boesveld IC, van der Klauw DM, Ruwaard D, Struijs JN, Molema JJW, Bruijnzeels MA, Vrijhoef HJ. Towards a taxonomy for integrated care: a mixed-methods study. Int J Integr Care 2015; 15:e003. [PMID: 25759607 PMCID: PMC4353214 DOI: 10.5334/ijic.1513] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/09/2015] [Accepted: 01/20/2015] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Building integrated services in a primary care setting is considered an essential important strategy for establishing a high-quality and affordable health care system. The theoretical foundations of such integrated service models are described by the Rainbow Model of Integrated Care, which distinguishes six integration dimensions (clinical, professional, organisational, system, functional and normative integration). The aim of the present study is to refine the Rainbow Model of Integrated Care by developing a taxonomy that specifies the underlying key features of the six dimensions. METHODS First, a literature review was conducted to identify features for achieving integrated service delivery. Second, a thematic analysis method was used to develop a taxonomy of key features organised into the dimensions of the Rainbow Model of Integrated Care. Finally, the appropriateness of the key features was tested in a Delphi study among Dutch experts. RESULTS The taxonomy consists of 59 key features distributed across the six integration dimensions of the Rainbow Model of Integrated Care. Key features associated with the clinical, professional, organisational and normative dimensions were considered appropriate by the experts. Key features linked to the functional and system dimensions were considered less appropriate. DISCUSSION This study contributes to the ongoing debate of defining the concept and typology of integrated care. This taxonomy provides a development agenda for establishing an accepted scientific framework of integrated care from an end-user, professional, managerial and policy perspective.
Collapse
Affiliation(s)
- Pim P Valentijn
- Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands
| | - Inge C Boesveld
- The Netherlands Expert Centre Integrated Primary Care, Jan van Es Institute, Almere, The Netherlands
| | | | - Dirk Ruwaard
- Public Health and Health Care Innovation, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Marc A Bruijnzeels
- The Netherlands Expert Centre Integrated Primary Care, Jan van Es Institute, Almere, The Netherlands
| | - Hubertus Jm Vrijhoef
- Chronic Care, Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
9
|
Körner M. Patient-centered care through internal and external participation in medical rehabilitation. Health (London) 2013. [DOI: 10.4236/health.2013.56a2008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
10
|
Jacelon CS, Furman E, Rea A, Macdonald B, Donoghue LC. Creating a Professional Practice Model for Postacute Care. J Gerontol Nurs 2011; 37:53-60. [DOI: 10.3928/00989134-20100831-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Accepted: 05/06/2010] [Indexed: 11/20/2022]
|
11
|
Models for integrating rehabilitation and primary care: a scoping study. Arch Phys Med Rehabil 2009; 90:1523-31. [PMID: 19735780 DOI: 10.1016/j.apmr.2009.03.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 03/02/2009] [Accepted: 03/17/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the scope and breadth of knowledge currently available regarding the integration of rehabilitation and primary care services. DATA SOURCES Peer-reviewed journals were searched using CINAHL, MEDLINE, and EBM Reviews for the years 1995 through 2007. This process identified 172 items. STUDY SELECTION To be considered for the subsequent review, the article had to describe a service delivery program that offered primary care and rehabilitation, or services specifically designed for people with chronic conditions/disabilities. Further, it had to be available in English or French. No methodological limitations were applied to screen for levels of evidence. DATA EXTRACTION Based on these criteria, 38 articles remained that pertained to both primary care and rehabilitation. These were reviewed, sorted, and categorized to discover commonalities and differences among the approaches used to integrating rehabilitation into primary care. DATA SYNTHESIS In consultation with the team of investigators, it was determined that there were 6 different models for providing primary health care and rehabilitation services in an integrated approach: clinic, outreach, self-management, community-based rehabilitation, shared care, and case management. In addition, a number of themes were identified across models that may act as either supports or impediments to the integration of rehabilitation services into primary care settings: team approach, interprofessional trust, leadership, communication, compensation, accountability, referrals, and population-based approach. CONCLUSIONS Rehabilitation providers interested in working in the primary care sector may be assisted in conceptualizing the benefits that they bring to the setting by considering these models and issues.
Collapse
|
12
|
McAtee RE, Crandall D, Wright LD, Beverly CJ. Senior health clinics: are they financially viable? J Am Geriatr Soc 2009; 57:1293-9. [PMID: 19558482 DOI: 10.1111/j.1532-5415.2009.02314.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Are hospital-based outpatient interdisciplinary clinics a financially viable alternative for caring for our burgeoning population of older adults in America? Although highly popular, with high patient satisfaction rates among older adults and their families, senior health clinics (SHCs) can be expensive to operate, with limited quantifiable health outcomes. This study analyzed three geriatric hospital-based interdisciplinary clinics in rural Arkansas by examining their patient profiles, revenues, and expenses. It closely examined the effects of the downstream revenue using the multiplier effect and acknowledged other factors that weigh heavily on the success of SHCs and the care of older adults. The findings highlight the similarities and differences in the three clinics' operating and financial structures in addition to the clinics' and providers' productivity. The analysis presents an evidence-based illustration that SHCs can break even or lose large amounts of money.
Collapse
Affiliation(s)
- Robin E McAtee
- Donald W. Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | | | | | | |
Collapse
|
13
|
Cummings SM. Treating older persons with severe mental illness in the community: impact of an interdisciplinary geriatric mental health team. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2009; 52:17-31. [PMID: 19197627 DOI: 10.1080/01634370802561919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Little information is available concerning community-based interventions to treat the growing number older persons with severe mental illness. This study examined treatment efficacy of a specialized interdisciplinary geriatric mental health team (mental health geriatric interdisciplinary teams or MHGITs) for 69 older clients with severe mental disorders. Depression, life satisfaction, health, and psychiatric and medical hospitalization data were gathered. A decrease in depressive symptoms and in psychiatric hospitalizations, and an increase in life satisfaction at 6 months were found. No change in health nor medical hospitalizations were reported. This study provides preliminary support for the feasibility and efficacy of a MGHIT approach in treating older community-dwelling adults with severe mental illnesses. Implications for social workers are discussed.
Collapse
Affiliation(s)
- Sherry M Cummings
- College of Social Work, University of Tennessee, Nashville, Tennessee 37210, USA.
| |
Collapse
|
14
|
Stock R, Mahoney ER, Reece D, Cesario L. Developing a senior healthcare practice using the chronic care model: effect on physical function and health-related quality of life. J Am Geriatr Soc 2008; 56:1342-8. [PMID: 18503521 DOI: 10.1111/j.1532-5415.2008.01763.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An ambulatory senior health clinic was developed using the chronic care model (CCM), with emphasis on an interdisciplinary team approach. To determine the effect of this care model approach in a nonprofit healthcare system, an observational, longitudinal panel study of community-dwelling Medicare beneficiaries was performed to examine the effect on physical function and health-related quality of life (HRQL). Participants in the study were recruited from a community sample of 6,864 eligible Medicare beneficiaries. Informed consent and baseline data were obtained from 1,709 individuals (recruitment response rate=25%) and complete data across 30 months from 1,307 (completion response rate=76%). Participants receiving care in the CCM-based senior healthcare practice (n=318) were compared with patients of primary care physicians supported by care managers (n=598) and a group without care managers (n=391). Self-reported data were collected over the telephone to measure physical function and HRQL at baseline and 6, 18, and 30 months. A multiple group mixture growth model was used to analyze physical function and HRQL across the 30 months. Physical function and HRQL mean scores decreased across time in all participants and were moderately correlated at each wave (correlation coefficient=0.74-0.79). Two latent growth classes were identified. In class 1, physical function decreased, and HRQL remained stable across time. In class 2, physical function and HRQL decreased in parallel. Ninety-seven percent of intervention group patients were in class 1, and 99% of patients in comparison groups 1 and 2 were in class 2. Despite physical function decline, patients in a senior health clinic care model maintained HRQL over time, whereas patients receiving traditional care had physical function and HRQL decline. An interdisciplinary team CCM approach appears to have a positive effect on HRQL in this population.
Collapse
Affiliation(s)
- Ronald Stock
- Geriatricsand Care Coordination, PeaceHealth Oregon Region, Eugene, Oregon 97401, USA.
| | | | | | | |
Collapse
|