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Yankova L, Berkwitt A, Loyal J. Low-Value Care for Hospitalized Children With Dual Medical and Behavioral Complexity. Hosp Pediatr 2024; 14:e245-e248. [PMID: 38651257 DOI: 10.1542/hpeds.2024-007766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Lyubina Yankova
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Adam Berkwitt
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Jaspreet Loyal
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
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Terwilliger IA, Johnson JK, Manojlovich M, Astik GJ, Kim JS, Williams MV, O'Leary KJ. Contextual Factors Influencing the Implementation of a Multifaceted Intervention to Improve Teamwork and Quality for Hospitalized Patients: A Multisite Qualitative Comparative Case Study. Jt Comm J Qual Patient Saf 2024; 50:193-201. [PMID: 37838603 DOI: 10.1016/j.jcjq.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Many hospitals have begun to implement models that combine interventions to redesign care for medical patients. These models include localization of physicians to specific units, nurse-physician co-leadership, and interprofessional rounds. Understanding contextual factors, the circumstances surrounding an implementation effort that influence its success, is essential to provide guidance to leaders implementing similar models of care. METHODS A multisite qualitative comparative case study was conducted with four hospitals in the REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients (RESET) study. Researchers conducted observations and semistructured interviews with 40 health care professionals and four implementation mentors. Researchers used inductive qualitative content analysis, reviewed fidelity of implementation trends, and performed cross-case analysis to identify contextual factors and their influence on implementation. RESULTS Four contextual factors were associated with implementation success: (1) senior hospital leader involvement and organizational support; (2) alignment of RESET with organizational, hospital, and professional group priorities; (3) site leaders' engagement in RESET and relationship with one another; and (4) perceptions of need and intervention benefits among professionals. Implementation was optimal when senior leadership was stable and tangibly involved; organizational, hospital, and group goals were aligned; site leaders were committed and collaborated well; and nurses and physicians perceived a need for and benefits from the interventions. CONCLUSION Four interrelated contextual factors are associated with the implementation of combined interventions to redesign care for hospitalized medical patients. Hospital leaders should consider these findings prior to implementing similar interventions and be prepared to address challenges related to these factors during implementation.
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Tops L, Coteur K, Vermandere M. Defining Vision and Mission of a Medical Psychiatry Unit (MPU) for Older Adults: A Focus Group Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241236038. [PMID: 38465594 PMCID: PMC10929058 DOI: 10.1177/00469580241236038] [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: 10/04/2023] [Revised: 01/12/2024] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Abstract
This study aims to determine the vision and mission of an academic hospital's medical psychiatry unit (MPU) that exclusively treats geriatric patients. All healthcare providers working at an academic hospital's geriatric MPU were invited to reflect on formulate the vision and mission of this ward. Twenty-two of them took part in the focus group interviews. The interviews focused on defining the MPU's functioning, its objectives, how it will reach these objectives, and where the MPU aspires to go. The interviews were transcribed verbatim and analyzed according to the QUAGOL guide. The themes from the analysis emerged from these group discussions. The participants defined the MPU's vision as to excel in integrated mental and physical geriatric inpatient healthcare, inspiring others to shed the stigma related to this vulnerable patient population. The mission that emerged from the focus group discussions is to provide patient-centered, integrated healthcare for older adults with combined mental and physical disorders. To achieve this, involving the patient's network, interdisciplinarity, shared decision-making, clear communication between all stakeholders, and reintegration of patients into their communities emerged as important themes. This study provides a vision and mission of a geriatric MPU in an academic psychiatric hospital. Since there is no consensus in the literature about the characteristics of MPUs despite the international call for integrated care for older persons with combined mental and physical disorders, these vision and mission statements can feed the discussion on how to install excellent healthcare for this vulnerable patient population.
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Affiliation(s)
- Laura Tops
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Kristien Coteur
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Mieke Vermandere
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
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Pinto C, Fabbricotti IN, van Wijngaarden J, Hoogendijk WJG, Alsma J, van Busschbach JJ, van Schijndel MA. Moving Beyond the Status Quo of Integrated Inpatient Medical and Psychiatric Care Units: The Path to Real-World Evaluation. Psychiatr Serv 2022; 73:555-560. [PMID: 34704774 DOI: 10.1176/appi.ps.202000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Integrated inpatient medical and psychiatric care units (IMPUs) are hospital wards that care for inpatients with both acute general medical and psychiatric disorders. IMPU development has stalled, and wide variation in IMPU designs may reflect the fact that IMPUs are still in an early evolutionary stage. High-quality evidence concerning the costs and effectiveness of IMPUs is sparse, because IMPUs do not lend themselves well to traditional evidence-based medicine methods. As a result, most studies of IMPUs have been only observational. Therefore, it is time for a different approach, in which goals for IMPUs are explicitly formulated and IMPU research is incorporated into evidence-based practice (EBP) instead of evidence-based medicine. EBP can be viewed as integrating best available evidence into organizational practices by using four pillars of evidence: organizational, experiential, stakeholder, and scientific. Such types of evidence require an investment in describing the field more precisely. When pragmatic reasoning, where clinical expertise and organizational needs determine IMPU designs, is replaced with EBP, researchers can more effectively perform studies that may convince health care policy makers that IMPUs represent a cost-effective way to improve patients' health and that they increase the well-being of both patients and hospital staff.
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Affiliation(s)
- C Pinto
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - I N Fabbricotti
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - J van Wijngaarden
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - W J G Hoogendijk
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - J Alsma
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - J J van Busschbach
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - M A van Schijndel
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
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