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Sipma WS, de Jong MFC, Ahaus KCTB. "It's My Life and It's Now or Never"-Transplant Recipients Empowered From a Service-Dominant Logic Perspective. Transpl Int 2023; 36:12011. [PMID: 38188696 PMCID: PMC10766819 DOI: 10.3389/ti.2023.12011] [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: 09/05/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
Patient well-being after an organ transplant is a major outcome determinant and survival of the graft is crucial. Before surgery, patients are already informed about how they can influence their prognosis, for example by adhering to treatment advice and remaining active. Overall, effective selfmanagement of health-related issues is a major factor in successful long-term graft survival. As such, organ transplant recipients can be considered as co-producers of their own health status. However, although keeping the graft in good condition is an important factor in the patient's well-being, it is not enough. To have a meaningful life after a solid organ transplant, patients can use their improved health status to once again enjoy time with family and friends, to travel and to return to work -in short to get back on track. Our assertion in this article is twofold. First, healthcare providers should look beyond medical support in enhancing long-term well-being. Second, organ recipients should see themselves as creators of their own well-being. To justify our argument, we use the theoretical perspective of service-dominant logic that states that patients are the true creators of real value-in-use. Or as Bon Jovi sings, "It's my life and it's now or never."
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Affiliation(s)
- Wim S. Sipma
- Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | | | - Kees C. T. B. Ahaus
- Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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2
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Mathias H, Rohatinsky N, Murthy SK, Novak K, Kuenzig ME, Nguyen GC, Fowler S, Benchimol EI, Coward S, Kaplan GG, Windsor JW, Bernstein CN, Targownik LE, Peña-Sánchez JN, Lee K, Ghandeharian S, Jannati N, Weinstein J, Khan R, Im JHB, Matthews P, Davis T, Goddard Q, Gorospe J, Latos K, Louis M, Balche N, Dobranowski P, Patel A, Porter LJ, Porter RM, Bitton A, Jones JL. The 2023 Impact of Inflammatory Bowel Disease in Canada: Access to and Models of Care. J Can Assoc Gastroenterol 2023; 6:S111-S121. [PMID: 37674496 PMCID: PMC10478809 DOI: 10.1093/jcag/gwad007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Rising compounding prevalence of inflammatory bowel disease (IBD) (Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18:56-66.) and pandemic-exacerbated health system resource limitations have resulted in significant variability in access to high-quality, evidence-based, person-centered specialty care for Canadians living with IBD. Individuals with IBD have identified long wait times, gaps in biopsychosocial care, treatment and travel expenses, and geographic and provider variation in IBD specialty care and knowledge as some of the key barriers to access. Care delivered within integrated models of care (IMC) has shown promise related to impact on disease-related outcomes and quality of life. However, access to these models is limited within the Canadian healthcare systems and much remains to be learned about the most appropriate IMC team composition and roles. Although eHealth technologies have been leveraged to overcome some access challenges since COVID-19, more research is needed to understand how best to integrate eHealth modalities (i.e., video or telephone visits) into routine IBD care. Many individuals with IBD are satisfied with these eHealth modalities. However, not all disease assessment and monitoring can be achieved through virtual modalities. The need for access to person-centered, objective disease monitoring strategies, inclusive of point of care intestinal ultrasound, is more pressing than ever given pandemic-exacerbated restrictions in access to endoscopy and cross-sectional imaging. Supporting learning healthcare systems for IBD and research relating to the strategic use of innovative and integrative implementation strategies for evidence-based IBD care interventions are greatly needed. Data derived from this research will be essential to appropriately allocating scarce resources aimed at improving person-centred access to cost-effective IBD care.
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Affiliation(s)
- Holly Mathias
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Kerri Novak
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Geoffrey C Nguyen
- Mount Sinai IBD Centre of Excellence, Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sharyle Fowler
- Department of Gastroenterology and Hepatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Coward
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Nazanin Jannati
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rabia Khan
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quinn Goddard
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kate Latos
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Naji Balche
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Ashley Patel
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | | | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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3
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Parmaksiz K, Bal R, van de Bovenkamp H, Kok MO. From promise to practice: a guide to developing pooled procurement mechanisms for medicines and vaccines. J Pharm Policy Pract 2023; 16:73. [PMID: 37316927 DOI: 10.1186/s40545-023-00574-9] [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: 02/23/2023] [Accepted: 06/03/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Buyers of medicines and vaccines are increasingly interested in pooling their procurement to improve access to affordable and quality-assured health commodities. However, the academic literature has provided no detailed description of how pooled procurement mechanisms are set up and develop over time. These insights are valuable as it increases our understanding of implementing and operating pooled procurement mechanisms successfully. Therefore, the aim of this paper is twofold. First, to explore how such mechanisms evolve over time. Second, to clarify the work that is needed to set up and sustain a pooled procurement mechanism. These findings have been translated into our Pooled Procurement Guidance document. METHODS This qualitative study draws upon theoretical insights from organizational life cycles, collaborative and network governance, semi-structured interviews with procurement experts and academic and grey literature documents on pooled procurement of medicines and vaccines. RESULTS We identified four general developmental stages of pooled procurement mechanisms: promise, creation, early operational and mature. The promise stage is characterized by initiating engagement between participating actors, while they try to convert their perceived problem(s) or opportunities into a shared vision. The creation stage is where the participating actors formalize and design the mechanism through consensus-building, articulation of a shared plan, and mobilize resources to put the shared plan into action. The early operational stage is where the shared plan is being executed. The newly established or appointed procurement organization is required to learn fast from experience while showing flexibility to the changing needs of buyers and suppliers. Once operations are routinized, the mechanism enters the mature stage. During this stage, the pooled procurement organization develops into a trusted player that provides sufficient incentives for all actors involved. Importantly, pooled procurement mechanisms can stagnate or turn inactive at any time during the developmental process when alignment between actors is threatened. CONCLUSIONS Pooled procurement mechanisms evolve over time. Setting up such mechanisms is a collaborative process that relies on intentional efforts by key actors involved. To increase the lifespan of pooled procurement mechanisms, key actors need to sustain a relative alignment of goals, needs, motivations and purpose of the mechanism throughout its entire life cycle.
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Affiliation(s)
- Koray Parmaksiz
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Oudlaan 50, 3062 PA, Rotterdam, The Netherlands.
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Oudlaan 50, 3062 PA, Rotterdam, The Netherlands
| | - Hester van de Bovenkamp
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Oudlaan 50, 3062 PA, Rotterdam, The Netherlands
| | - Maarten Olivier Kok
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Oudlaan 50, 3062 PA, Rotterdam, The Netherlands
- Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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4
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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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5
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Hall JN, Chartier LB. Learning From a Regional Approach: Integration to Scale, Spread, and Sustain Virtual Urgent Care. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580221143273. [PMID: 36624685 PMCID: PMC9834925 DOI: 10.1177/00469580221143273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
While new offerings of virtual urgent care services from peer hospitals faltered after initial provincial pilot funding lapsed, our 3 regional academic health sciences centers decided to partner to enhance patient access, achieve efficiencies, and support long-term sustainability. Utilizing the Development Model for Integrated Care framework, we progressed through the 4 phases to ensure joint success and high-quality care: (1) initiative and design phase-individual parallel projects but with strong collaborations and broad stakeholder engagement; (2) experimental and execution phase-continuous quality improvement approach for governance, policies, and processes; (3) expansion and monitoring phase-weekly leadership touchpoints on key performance indicators; and (4) consolidation and transformation phase-sustainability through ongoing funding.
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Affiliation(s)
- Justin N. Hall
- Sunnybrook Health Sciences Centre,
Toronto, ON, Canada,University of Toronto, Toronto, ON,
Canada,Justin N. Hall, Department of Emergency
Services, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, C753, Toronto,
ON, M4N 3M5, Canada.
| | - Lucas B. Chartier
- University of Toronto, Toronto, ON,
Canada,University Health Network, Toronto, ON,
Canada
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6
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Sari P, Herawati DMD, Dhamayanti M, Hilmanto D. Fundamental Aspects of the Development of a Model of an Integrated Health Care System for the Prevention of Iron Deficiency Anemia among Adolescent Girls: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13811. [PMID: 36360691 PMCID: PMC9657908 DOI: 10.3390/ijerph192113811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Iron deficiency anemia (IDA) in adolescent girls is a problem that has not been resolved. This study aimed to explore the critical aspects of an integrated health care system model for preventing IDA in adolescent girls in a rural area of Indonesia. This qualitative research employed a grounded theory approach in order to build a substantive theory. This study used in-depth interviews with adolescents, parents, teachers, health workers, and persons in charge of adolescent programs at the health office, education office, and ministry of religion. Purposive sampling was performed until data saturation was achieved. Codes, categories, and themes were generated through thematic data analysis to develop a substantive theory. Data analysis was performed using MAXQDA 2022 software. A total of 41 people participated in this study. This investigation generated twenty-two categories and seven themes. These themes relate to policymaker commitments, stakeholder governance, quality, adolescents' lifestyles, adolescents' self-factors, adolescents' access to health services, and social support. The themes identified become fundamental aspects of the integrated health care system model for preventing IDA in adolescent girls. The model of the integrated health care system consists of several essential points, which include awareness and efforts from policymakers and adolescent girls, supported by parents, teachers, and the community.
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Affiliation(s)
- Puspa Sari
- Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
| | | | - Meita Dhamayanti
- Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Dany Hilmanto
- Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
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Boertien S, Franx A, Jansen DEMC, Akkermans H, de Kroon MLA. Connecting Obstetric, Maternity, Pediatric and Preventive Child Health Care: A Comparative Prospective Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6774. [PMID: 35682355 PMCID: PMC9180713 DOI: 10.3390/ijerph19116774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/16/2022] [Accepted: 05/25/2022] [Indexed: 12/04/2022]
Abstract
Collaboration between birth care and Preventive Child Health Care (PCHC) in the Netherlands is so far insufficient. The aim of the Connecting Obstetric; Maternity; Pediatric and PCHC (COMPLETE) study is to: (1) better understand the collaboration between birth care and PCHC and its underlying mechanisms (including barriers and facilitators); (2) investigate whether a new multidisciplinary strategy that is developed as part of the project will result in improved collaboration. To realize the first aim, a mixed-method study composed of a (focus group) interview study, a multiple case study and a survey study will be conducted. To realize the second aim, the new strategy will be piloted in two regions in an iterative process to evaluate and refine it, following the Participatory Action Research (PAR) approach. A prospective study will be conducted to compare outcomes related to child health, patient reported outcomes and experiences and quality of care between three different cohorts (i.e., those that were recruited before, during and after the implementation of the strategy). With our study we wish to contribute to a better understanding of collaboration in care and develop knowledge on how the integration of birth care and PCHC is envisioned by stakeholders, as well as how it can be translated into practice.
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Affiliation(s)
- Silke Boertien
- Department of Obstetrics and Gynecology, Erasmus MC—Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
| | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus MC—Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
| | - Danielle E. M. C. Jansen
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands;
| | - Henk Akkermans
- Department of Management, Tilburg University, 5037 AB Tilburg, The Netherlands;
| | - Marlou L. A. de Kroon
- Department of Obstetrics and Gynecology, Erasmus MC—Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
- Department of Public Health and Primary Care, Centre for Environment and Health, Catholic University Leuven, 3000 Leuven, Belgium
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8
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Shaw J, Gutberg J, Wankah P, Kadu M, Gray CS, McKillop A, Baker GR, Breton M, Wodchis WP. Shifting paradigms: Developmental milestones for integrated care. Soc Sci Med 2022; 301:114975. [PMID: 35461081 DOI: 10.1016/j.socscimed.2022.114975] [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: 01/11/2022] [Revised: 03/21/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
Frameworks for understanding integrated care risk underemphasizing the complexities of the development of integrated care in a local context. The objectives of this article are to (1) present a novel strategy for conceptualizing integrated care as developing through a series of milestones at the organizational level, and (2) present a typology of milestones empirically generated through the analysis of four cases of integrated community-based primary health care (ICBPHC) in Canada and New Zealand. Our paper reports on an analysis of 4 specific organizational case studies within a large dataset generated for an international multiple case study project of exemplar models of ICBPHC. Drawing on earlier analyses of 359 qualitative interviews with patients, caregivers, health care providers, managers, and policymakers, in this article we present a detailed analysis of 28 interviews with managers and leaders of local models of integrated care. We generated a detailed timeline of the development of integrated care as expressed by each participant, and synthesized themes across timelines within each case to identify specific milestone events. We then synthesized across cases to generate the broader milestone categories to which each event belongs. We generated 5 milestone categories containing 12 more specific milestone events. The milestone categories include (1) strategic relational, (2) strategic process change, (3) internal structural, (4) inter-organizational structural, and (5) external milestones. We propose a comprehensive framework of developmental milestones for integrated care. Milestones represent a compelling strategy for conceptualizing the development of integrated care. Practically, policymakers and health care leaders can support the implementation of integrated care by examining the history and context of a given model of care and identifying strategies to achieve milestones that will accelerate integrated care. Further research should document additional milestone events and advance the development of dynamic frameworks for integrated care.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada.
| | - Jennifer Gutberg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Paul Wankah
- Department of Community Health, University of Sherbrooke, Canada
| | - Mudathira Kadu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Canada
| | - Ann McKillop
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Mylaine Breton
- Department of Community Health, University of Sherbrooke, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Research Chair Implementation and Evaluation Science, Institute for Better Health, Trillium Health Partners, Canada
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Abstract
Background: Integrated care is a promising approach to improve transitions from hospital for older adults. Measures of integrated care tend to be survey-based or outcomes focused. This study determined the feasibility of using hospital chart data to measure integrated processes of care. Methods: This paper reports on two objectives: 1) the development of an integrated care transition framework and associated features of care; 2) a pilot study to test if the features could be applied to 214 hospital patient charts. Results: Twenty-four features were tested, and fifteen features could be reliably measured using chart review. Of these, the percent of patients classified as receiving integrated care varied widely across the items, from 0.05% to 84.1%. Discussion: The framework presented in this paper can guide measurement of system and clinical delivery of integrated care transitions. In combination with other tools, chart review can provide perspective on day-to-day care delivery not otherwise accessible, and highlight areas requiring practice change. Conclusion: Multiple measurement perspectives are needed to improve our understanding of how integrated care is being implemented. While chart review cannot address the full breadth of integrated care, it can help understand how processes of care are being implemented in routine daily care.
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10
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van de Warrenburg BP, Tiemessen M, Munneke M, Bloem BR. The Architecture of Contemporary Care Networks for Rare Movement Disorders: Leveraging the ParkinsonNet Experience. Front Neurol 2021; 12:638853. [PMID: 33859608 PMCID: PMC8042326 DOI: 10.3389/fneur.2021.638853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
In this paper, we present a universal model for implementing network care for persons living with chronic diseases, specifically those with rare movement disorders. Building on our longstanding experience with ParkinsonNet, an integrated care network for persons living with Parkinson's disease or a form of atypical parkinsonism, we provide a series of generic, supportive building blocks to (re)design comparable care networks. We discuss the specific challenges related to rare movement disorders and how these challenges can inform a tailored implementation strategy, using the basic building blocks to offer practical guidance. Lastly, we identify three main priorities to facilitate network development for these rare diseases. These include the clustering of different types of rare movement disorders at the network level, the implementation of supportive technology, and the development of interdisciplinary guidelines.
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Affiliation(s)
- Bart P van de Warrenburg
- Department of Neurology, Radboud University Medical Centre, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Mark Tiemessen
- Department of Neurology, Radboud University Medical Centre, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Centre, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
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11
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The development of a tool to monitor integrated care for childhood overweight and obesity in the Netherlands. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-05-2020-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe development of a national model has led municipalities in the Netherlands to implement integrated care for childhood overweight and obesity. To monitor how this approach is being implemented locally, an appropriate tool is required. This study presents a “Tool to monitor the local implementation of Integrated Care for Childhood Overweight and obesity” (TICCO).Design/methodology/approachA three-step study was conducted in order to adapt and refine a generic integrated care questionnaire into a tool that suits the specific characteristics and context of integrated care for childhood overweight and obesity. The three consecutive steps comprised the following: a focus group session that assessed the relevance and comprehensiveness of the original integrated care instrument; a pilot questionnaire for end users that evaluated the feasibility of the preliminary tool and a pilot questionnaire that determined the feasibility and potential limitations of this adapted tool.FindingsThe adaptation process resulted in a 47-element digital tool for professionals actively involved in providing integrated care for childhood overweight and obesity. The results highlighted differences pertaining to how individual respondents judged each of the elements. These variations were found across both municipalities and different domains of integrated care.Originality/valueThis article presents an adapted tool that seeks to both support local discussion in the interpretation of individual TICCO scores and identify potential areas for improvement in local integrated care for childhood overweight and obesity.
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Malik B, Wells J, Hughes J, Clarkson P, Keady J, Young A, Challis D. Complex care needs and devolution in Greater Manchester: a pilot study to explore social care innovation in newly integrated service arrangements for older people. AUST HEALTH REV 2020; 44:838-846. [PMID: 32788034 DOI: 10.1071/ah19168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/03/2020] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to describe emergent approaches to integrated care for older people with complex care needs and investigate the viability of measuring integrated care. Methods A case study approach was used. Sites were recruited following discussion with senior staff in health and social care agencies. Service arrangements were categorised using a framework developed by the researchers. To investigate joint working within the sites, the development model for integrated care was adapted and administered to the manager of each service. Data were collected in 2018. Results Six case study sites were recruited illustrating adult social care services partnerships in services for older people with home care providers, mental health and community nursing services. Most were established in 2018. Service arrangements were characterised by joint assessment and informal face-to-face discussions between staff. The development of an infrastructure to promote partnership working was evident between adult social care and each of the other services and most developed with home care providers. There was little evidence of a sequential approach to the development of integrated working practices. Conclusion Components of partnerships promoting integrated care have been highlighted and understanding of the complexity of measuring integrated care enhanced. Means of information sharing and work force development require further consideration. What is known about the topic? The devolution of health and social care arrangements in Greater Manchester has aroused considerable interest in much wider arenas. Necessarily much of the focus in available material has been upon strategic development, analysis of broader trends and mechanisms and a concern with changes in the healthcare system. What does this paper add? The findings from this study will enable emerging approaches to be described and codified, and permit the specific social care contribution to the new arrangements to be discerned. The findings are relevant beyond the immediate context of Greater Manchester to wider integrated care. The evidence can be used by commissioners and services, providing a sound basis for further work as service systems develop. What are the implications for practitioners? This research is important because it is one of the first pieces of work to examine the new integrated care arrangements in Greater Manchester. By providing guidance to promote evidence-based practice, this study contributes to service development in Greater Manchester and the achievement of the broad national service objectives of improving user and carer experiences and ensuring value for money.
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Affiliation(s)
- Baber Malik
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, 4th Floor, Ellen Wilkinson Building, University of Manchester, Manchester M13 9PL, UK. ; ; and Corresponding author.
| | - Jude Wells
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, 4th Floor, Ellen Wilkinson Building, University of Manchester, Manchester M13 9PL, UK. ;
| | - Jane Hughes
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, 4th Floor, Ellen Wilkinson Building, University of Manchester, Manchester M13 9PL, UK. ; ; and University of Nottingham, Institute of Mental Health, Jubilee Campus, Innovation Park, Triumph Road, Nottingham NG7 2TU, UK. ;
| | - Paul Clarkson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, 4th Floor, Ellen Wilkinson Building, University of Manchester, Manchester M13 9PL, UK. ;
| | - John Keady
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL, UK; and University of Manchester, Division of Nursing, Midwifery & Social Work, Manchester Institute for Collaborative Research on Ageing, School of Social Sciences, Oxford Road, Manchester M13 9PL, UK. ;
| | - Alys Young
- University of Manchester, Division of Nursing, Midwifery & Social Work, Manchester Institute for Collaborative Research on Ageing, School of Social Sciences, Oxford Road, Manchester M13 9PL, UK. ;
| | - David Challis
- University of Nottingham, Institute of Mental Health, Jubilee Campus, Innovation Park, Triumph Road, Nottingham NG7 2TU, UK. ;
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Exploiting Inter-Organizational Relationships in Health Care: A Bibliometric Analysis and Literature Review. ADMINISTRATIVE SCIENCES 2020. [DOI: 10.3390/admsci10030057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inter-organizational relationships are high on the health policy agenda. Scholars and practitioners have provided heterogeneous views about the triggers of collaborative practices and the success factors that underpin the sustainability of inter-organizational relationships in the health care domain. The article proposes a literature review aimed at systematizing current scientific research that contextualizes inter-organizational relationships to health care. A mixed approach was undertaken, which consisted of a bibliometric analysis followed by a narrative literature review. A tailored search strategy on Elsevier’s Scopus yielded 411 relevant records, which were carefully screened for inclusion in this study. After screening, 105 papers were found to be consistent with the study purposes and included in this literature review. The findings emphasize that the establishment and implementation of inter-organizational relationships in health care are affected by several ambiguities, which concern both the governance and the structuring of collaborative relationships. The viability and the success of inter-organizational relationships depend on the ability of both central and peripheral partners to acknowledge and address such ambiguities. Failure to do so involves an opportunistic participation to inter-organizational relationships. This endangers conflicting behaviors rather than collaboration among partners.
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Verver D, Stoopendaal A, Merten H, Robben P, Wagner C. What are the perceived added values and barriers of regulating long-term care in the home environment using a care network perspective: a qualitative study. BMC Health Serv Res 2018; 18:946. [PMID: 30522469 PMCID: PMC6282343 DOI: 10.1186/s12913-018-3770-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Changes in Dutch policy towards long-term care led to the Dutch Health and Youth Care Inspectorate testing a regulatory framework focusing on care networks around older adults living independently. This regulatory activity involved all care providers and the older adults themselves. METHODS Semi-structured interviews with the older adults, and focus groups with care providers and inspectors were used to assess the perceived added value of, and barriers to the framework. RESULTS The positive elements of this framework were the involvement of the older adults in the regulatory activity, the focus of the framework on care networks and the open character of the conversations with the inspectors. However, applying the framework requires a substantial investment of time. Care providers often did not perceive themselves as being part of a care network around one person and they expressed concerns about financial and privacy issues when thinking in terms of care networks. CONCLUSIONS The experiences of the client were seen as important in regulating long-term care. Regulating care networks as a whole puts cooperation between care providers involved around one person on the agenda. However, barriers for this form of regulation were also perceived and, therefore, careful consideration when and how to regulate care networks is recommended.
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Affiliation(s)
- Didi Verver
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL, 1081 Amsterdam, BT Netherlands
| | - Annemiek Stoopendaal
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 Rotterdam, PA Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL, 1081 Amsterdam, BT Netherlands
| | - Paul Robben
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 Rotterdam, PA Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL, 1081 Amsterdam, BT Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, the Netherlands
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Menichetti J, Pitacco G, Graffigna G. Exploring the early-stage implementation of a patient engagement support intervention in an integrated-care context-A qualitative study of a participatory process. J Clin Nurs 2018; 28:997-1009. [PMID: 30362643 DOI: 10.1111/jocn.14706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/27/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore: (a) the usual patient education in different care services of an integrated-care organisation, (b) the healthcare professionals' experiences with adding a patient engagement support intervention called PHEinAction in the patient education practice and (c) the co-designed activities to assist the implementation. BACKGROUND Including individual support for engaging patients in care into patient education practice is a key effort of integrated-care organisations. However, there is a paucity of studies exploring the implementation of similar efforts. DESIGN AND METHODS We conducted a qualitative study of a participatory process with 26 healthcare professionals-mostly nurses (n = 22) with leading roles (n = 12)-of different care services in one Italian integrated-care organisation. Data were collected through multiple sources (observations and shadowing; interviews; documents/artefacts; workshops) during the first 6 months of the implementation of PHEinAction. A thematic analysis using a hybrid approach was performed. COREQ guidelines were followed. RESULTS The existing patient education practice of hospital, ambulatory and community healthcare services of the organisation differed in contents, perceived responsibility and focus area. These key aspects of patient education influenced the healthcare professionals' experiences with the implementation. The experiences informed the activities enacted during the participatory process to assist the implementation, from the co-creation of artefacts to the deployment of peer group supervision. CONCLUSION The implementation of a brief intervention for patient engagement support required a process of adjustment to the single settings and a continuous support to healthcare professionals. It also required performing complementary activities to assist the implementation and its adoption in new care services. RELEVANCE TO CLINICAL PRACTICE This qualitative study contributes to the understanding of the pitfalls and strategies that may surround embedding patient engagement support in the educational practice of complex organisations, potentially facilitating the deployment to other care settings.
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Affiliation(s)
- Julia Menichetti
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Giuliana Pitacco
- Nursing Direction, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
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Pincus HA, Li M, Scharf DM, Spaeth-Rublee B, Goldman ML, Ramanuj PP, Ferenchick EK. Prioritizing quality measure concepts at the interface of behavioral and physical healthcare. Int J Qual Health Care 2018. [PMID: 28651345 DOI: 10.1093/intqhc/mzx071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective Integrated healthcare models can increase access to care, improve healthcare quality, and reduce cost for individuals with behavioral and general medical healthcare needs, yet there are few instruments for measuring the quality of integrated care. In this study, we identified and prioritized concepts that can represent the quality of integrated behavioral health and general medical care. Design We conducted a literature review to identify candidate measure concepts. Experts then participated in a modified Delphi process to prioritize the concepts for development into specific quality measures. Setting United States. Participants Expert behavioral health and general medical clinicians, decision-makers (policy, regulatory and administrative professionals) and patient advocates. Main outcome measures Panelists rated measure concepts on importance, validity and feasibility. Results The literature review identified 734 measures of behavioral or general medical care, which were then distilled into 43 measure concepts. Thirty-three measure concepts (including a segmentation strategy) reached a predetermined consensus threshold of importance, while 11 concepts did not. Two measure concepts were 'ready for further development' ('General medical screening and follow-up in behavioral health settings' and 'Mental health screening at general medical healthcare settings'). Among the 31 additional measure concepts that were rated as important, 7 were rated as valid (but not feasible), while the remaining 24 concepts were rated as neither valid nor feasible. Conclusions This study identified quality measure concepts that capture important aspects of integrated care. Researchers can use the prioritization process described in this study to guide healthcare quality measures development work.
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Affiliation(s)
- Harold Alan Pincus
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit 09, New York, NY 10032, USA.,New York-Presbyterian Hospital, 630 West 168th Street, New York, NY 10032, USA
| | - Mingjie Li
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 9, New York, NY 10032, USA
| | - Deborah M Scharf
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay Ontario, P7B 5E1, Canada
| | - Brigitta Spaeth-Rublee
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 9, New York, NY 10032, USA
| | - Matthew L Goldman
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 9, New York, NY 10032, USA.,Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Box 99, New York, NY 10032, USA
| | - Parashar P Ramanuj
- Royal National Orthopaedic Hospital, 45 Bolsover Street, London, W1W 5AQ, UK
| | - Erin K Ferenchick
- Center for Family and Community Medicine, Columbia University Medical Center, 610 West 158th Street, New York, NY 10032, USA
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Halvorsrud K, Flynn D, Ford GA, McMeekin P, Bhalla A, Balami J, Craig D, White P. A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England. BMC Health Serv Res 2018; 18:135. [PMID: 29471828 PMCID: PMC5824465 DOI: 10.1186/s12913-018-2922-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/06/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intra-arterial thrombectomy is the gold standard treatment for large artery occlusive stroke. However, the evidence of its benefits is almost entirely based on trials delivered by experienced neurointerventionists working in established teams in neuroscience centres. Those responsible for the design and prospective reconfiguration of services need access to a comprehensive and complementary array of information on which to base their decisions. This will help to ensure the demonstrated effects from trials may be realised in practice and account for regional/local variations in resources and skill-sets. One approach to elucidate the implementation preferences and considerations of key experts is a Delphi survey. In order to support commissioning decisions, we aimed using an electronic Delphi survey to establish consensus on the options for future organisation of thrombectomy services among physicians with clinical experience in managing large artery occlusive stroke. METHODS A Delphi survey was developed with 12 options for future organisation of thrombectomy services in England. A purposive sampling strategy established an expert panel of stroke physicians from the British Association of Stroke Physicians (BASP) Clinical Standards and/or Executive Membership that deliver 24/7 intravenous thrombolysis. Options with aggregate scores falling within the lowest quartile were removed from the subsequent Delphi round. Options reaching consensus following the two Delphi rounds were then ranked in a final exercise by both the wider BASP membership and the British Society of Neuroradiologists (BSNR). RESULTS Eleven stroke physicians from BASP completed the initial two Delphi rounds. Three options achieved consensus, with subsequently wider BASP (97%, n = 43) and BSNR members (86%, n = 21) assigning the highest approval rankings in the final exercise for transferring large artery occlusive stroke patients to nearest neuroscience centre for thrombectomy based on local CT/CT Angiography. CONCLUSIONS The initial Delphi rounds ensured optimal reduction of options by an expert panel of stroke physicians, while subsequent ranking exercises allowed remaining options to be ranked by a wider group of experts within stroke to reach consensus. The preferred implementation option for thrombectomy is investigating suspected acute stroke patients by CT/CT Angiography and secondary transfer of large artery occlusive stroke patients to the nearest neuroscience (thrombectomy) centre.
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Affiliation(s)
- Kristoffer Halvorsrud
- Institute of Health and Society Newcastle University, Newcastle Upon Tyne, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Darren Flynn
- Institute of Health and Society Newcastle University, Newcastle Upon Tyne, UK
| | - Gary A. Ford
- Institute of Neuroscience, Newcastle University, 3-4, Claremont Terrace, Newcastle upon Tyne, NE2 4AX UK
- Oxford University Hospitals NHS Trust and Oxford University, Oxford, UK
| | - Peter McMeekin
- School of Health, Community and Education Studies, Northumbria University, Newcastle Upon Tyne, UK
| | - Ajay Bhalla
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Joyce Balami
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Dawn Craig
- Institute of Health and Society Newcastle University, Newcastle Upon Tyne, UK
| | - Phil White
- Institute of Neuroscience, Newcastle University, 3-4, Claremont Terrace, Newcastle upon Tyne, NE2 4AX UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Leijten FR, Struckmann V, van Ginneken E, Czypionka T, Kraus M, Reiss M, Tsiachristas A, Boland M, de Bont A, Bal R, Busse R, Rutten-van Mölken M. The SELFIE framework for integrated care for multi-morbidity: Development and description. Health Policy 2018; 122:12-22. [DOI: 10.1016/j.healthpol.2017.06.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 12/17/2022]
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Peña-Sánchez JN, Lix LM, Teare GF, Li W, Fowler SA, Jones JL. Impact of an Integrated Model of Care on Outcomes of Patients With Inflammatory Bowel Diseases: Evidence From a Population-Based Study. J Crohns Colitis 2017; 11:1471-1479. [PMID: 28981633 DOI: 10.1093/ecco-jcc/jjx106] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/30/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Studies evaluating the impact of integrated models of care [IMC] for inflammatory bowel disease [IBD] on disease-related outcomes are needed. We compared the risk of IBD-related outcomes and prescription medication claims between patients exposed and non-exposed to an IMC. METHODS A retrospective population-based matched cohort study was conducted between 2009 and 2015, using administrative health data of Saskatchewan, Canada. Patients aged 18+ years with a diagnosis of IBD were identified with a validated administrative definition. Cases were classified as exposed and non-exposed to the IMC for IBD and matched based on propensity scores and disease duration. IBD-related hospitalisations, surgeries, prescription medication claims, and corticosteroid dependency [CsDep] were measured. Cox and logistic regression models evaluated differences between the groups, estimating hazard [HRs] and odds [ORs] ratios with corresponding confidence intervals [CIs]. RESULTS In total, 2312 matched patients were included; 24.3% were exposed individuals. Compared with non-exposed, exposed patients had a lower risk of IBD-related surgeries [HR = 0.78, 95% CI 0.61-0.99], higher risk of prescriptions of immune modulators [HR = 1.68, 95% CI 1.42-1.99], and biologics [HR = 1.85, 95% CI 1.52-2.27], and a lower risk of 5-aminosalicylic acid prescriptions [HR = 0.81, 95% CI 0.69-0.95]. A lower risk of IBD-related hospitalisations among exposed ulcerative colitis [UC] patients [HR = 0.66, 95% CI 0.49-0.89] was identified in stratified analyses. The odds of CsDep among exposed UC patients was 0.39 [95% CI 0.15-0.98]. CONCLUSIONS The observed differences in disease-related outcomes and use of steroid-sparing maintenance therapies between exposed and non-exposed individuals support the concept that enhanced quality of care can be achieved within IMC for IBD.
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Affiliation(s)
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Canada
| | | | - Wenbin Li
- Saskatchewan Health Quality Council, Canada
| | | | - Jennifer L Jones
- Departments of Medicine and Community Health and Epidemiology, Dalhousie University, Canada
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Hardin L, Kilian A, Spykerman K. Competing health care systems and complex patients: An inter-professional collaboration to improve outcomes and reduce health care costs. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.xjep.2017.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider. Int J Integr Care 2017; 17:9. [PMID: 29042851 PMCID: PMC5630080 DOI: 10.5334/ijic.2437] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. OBJECTIVES We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. METHODS Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. RESULTS Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. CONCLUSIONS There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.
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Zonneveld N, Vat LE, Vlek H, Minkman MMN. The development of integrated diabetes care in the Netherlands: a multiplayer self-assessment analysis. BMC Health Serv Res 2017; 17:219. [PMID: 28320415 PMCID: PMC5359897 DOI: 10.1186/s12913-017-2167-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 03/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since recent years Dutch diabetes care has increasingly focused on improving the quality of care by introducing the concept of care groups (in Dutch: 'zorggroepen'), care pathways and improving cooperation with involved care professionals and patients. This study examined how participating actors in care groups assess the development of their diabetes services and the differences and similarities between different stakeholder groups. METHODS A self-evaluation study was performed within 36 diabetes care groups in the Netherlands. A web-based self-assessment instrument, based on the Development Model for Integrated Care (DMIC), was used to collect data among stakeholders of each care group. The DMIC defines nine clusters of integrated care and four phases of development. Statistical analysis was used to analyze the data. RESULTS Respondents indicated that the diabetes care groups work together in well-organized multidisciplinary teams and there is clarity about one another's expertise, roles and tasks. The care groups can still develop on elements related to the management and monitoring of performance, quality of care and patient-centeredness. The results show differences (p < 0.01) between three stakeholders groups in how they assess their integrated care services; (1) core players, (2) managers/directors/coordinators and (3) players at a distance. Managers, directors and coordinators assessed more implemented integrated care activities than the other two stakeholder groups. This stakeholder group also placed their care groups in a further phase of development. Players at a distance assessed significantly less present elements and assessed their care group as less developed. CONCLUSIONS The results show a significant difference between stakeholder groups in the assessment of diabetes care practices. This reflects that the professional disciplines and the roles of stakeholders influence the way they asses the development of their integrated care setting, or that certain stakeholder groups could be less involved or informed.
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Affiliation(s)
- Nick Zonneveld
- Vilans, National Center of Excellence in Long-term Care, Catharijnesingel 47, PO Box 8228, 3503 RE, Utrecht, The Netherlands.
| | - Lidewij E Vat
- Memorial University Newfoundland, St. John's, Canada
| | - Hans Vlek
- Vilans, National Center of Excellence in Long-term Care, Catharijnesingel 47, PO Box 8228, 3503 RE, Utrecht, The Netherlands
| | - Mirella M N Minkman
- Vilans, National Center of Excellence in Long-term Care, Catharijnesingel 47, PO Box 8228, 3503 RE, Utrecht, The Netherlands.,University of Tilburg/TIAS, Tilburg, The Netherlands
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Abstract
INTRODUCTION Integrated stroke care in the Netherlands is constantly changing to strive to better care for stroke patients. The aim of this study was to explore if and on what topics integrated stroke care has been improved in the past three years and if stroke services were further developed. METHODS A web based self-assessment instrument, based on the validated Development Model for Integrated Care, was used to collect data. In total 53 coordinators of stroke services completed the questionnaire with 98 elements and four phases of development concerning the organisation of the stroke service. Data were collected in 2012 and 2015. Descriptive-comparative statistics were used to analyse the data. RESULTS In 2012, stroke services on average had implemented 56 of the 89 elements of integrated care (range 15-88). In 2015 this was increased up to 70 elements on average (range 37-89). In total, stroke services showed development on all clusters of integrated care. In 2015, more stroke services were in further phases of development like in the consolidation and transformation phase and less were in the initiative and design phase. The results show large differences between individual stroke services. Priorities to further develop stroke services changed over the three years of data collection. CONCLUSIONS Based on the assessment instrument, it was shown that stroke services in the Netherlands were further developed in terms of implemented elements of integrated care and their phase of development. This three year comparison showed unique first analyses over time of integrated stroke care in the Netherlands on a large scale. Interesting further questions are to research the outcomes of stroke care in relation to this development, and if benefits on patient level can be assessed.
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de Lange J, Deusing E, van Asch IFM, Peeters J, Zwaanswijk M, Pot AM, Francke AL. Factors facilitating dementia case management: Results of online focus groups. DEMENTIA 2016; 17:110-125. [DOI: 10.1177/1471301216634959] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
To obtain insight into facilitating factors for case management in dementia care, we conducted a qualitative study with 13 online focus groups (OFGs). Participants were professionals involved in dementia case management ( N = 99). We used mind-maps and the method of constant comparison for analysis. Participants perceived OFGs as a useful tool to explore their perspectives. The perceived advantage of OFGs was the flexibility and convenience of logging in at any time or place preferred. Five facilitating factors for case management were identified in the OFGs: 1. Good cooperation between partners; 2. Organisational embedding with an independent position of case managers; 3. Structural funding; 4. Competent case managers; 5. Familiarity with case management in the region. Good cooperation was essential for successful dementia case management and should thus be a primary concern for care providers.
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Affiliation(s)
- Jacomine de Lange
- Program on Aging, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands; Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Eline Deusing
- Program on Aging, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Iris FM van Asch
- Program on Aging, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - José Peeters
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Marieke Zwaanswijk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Anne Margriet Pot
- Program on Aging, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands; Department of Clinical Psychology, EMGO+, VU University Amsterdam, the Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands; Department of Public and Occupational Health, EMGO+, VU University Medical Center Amsterdam, the Netherlands
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Minkman M. The Development Model for Integrated Care: a validated tool for evaluation and development. JOURNAL OF INTEGRATED CARE 2016. [DOI: 10.1108/jica-01-2016-0005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Integrating health, social and informal care and seeking for new effective collaborations is a major topic in many countries, and requires innovation and improvement in current practices. Conceptual quality management models can facilitate practice improvement. However, a generic quality management model for integrated care was lacking. The purpose of this paper is to describe the results of multiple studies that resulted in a validated generic quality management model for integrated care. The Development Model for Integrated Care (DMIC) is the basis for a digital tool for self-evaluation and is being used in multiple ways in a large number of integrated care settings.
Design/methodology/approach
– A literature review, a Delphi study and concept mapping study were executed to identify the essential ingredients of integrated care. A next step was an expert study on the development process of integrated care over time. Lastly, a survey study in 84 integrated care networks was performed to empirically validate the model. Based on the model, a digital self-assessment tool was created to apply the model in practice.
Findings
– The studies showed that integrated care is a complex and multi-component concept but generic elements can be assessed. The literature and expert study resulted in a set of 89 elements of integrated care. The elements were grouped in nine clusters; “quality care”, “performance management”, “inter-professional teamwork”, “delivery system”, “roles and tasks”, “patient-centredness”, “commitment”, “transparent entrepreneurship” and “result-focused learning”. Four developmental phases named “the initiative and design phase”, “the experimental and execution phase”, “the expansion and monitoring phase” and “the consolidation and transformation phase” were found. The findings showed that the model is applicable for multiple integrated care settings.
Research limitations/implications
– The DMIC has the potential to serve as a research framework for integrated care, and the use as an evaluation tool on multiple levels. Further research is suggested about more explicitly involving the perspectives of clients, research on the involvement of multiple stakeholders and their professional backgrounds and the use of the model in other countries.
Practical implications
– The DMIC is the basis of a digital web-based assessment tool, which is being used in the Netherlands in multiple integrated care settings. Applying the tool helps in assessing the current state of integrated care practice and defining suggestions for further improvement and development. It is also being used to benchmark multiple settings and is adopted in guidelines or care standards for integrated care.
Originality/value
– A generic conceptual and validated model that can be supportive for integrated care practices, policy and research was lacking. The results of the summarized studies in this paper present such a conceptual model for integrated care and gives suggestions for further use in an international audience. Results in a Canadian study showed that the model can also be used in other settings and countries. This contributes to the opportunities for use of the model in integrated care practice, policy and research also in other countries.
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Verver D, Merten H, Robben P, Wagner C. Supervision of care networks for frail community dwelling adults aged 75 years and older: protocol of a mixed methods study. BMJ Open 2015; 5:e008632. [PMID: 26307619 PMCID: PMC4550721 DOI: 10.1136/bmjopen-2015-008632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/06/2015] [Accepted: 06/13/2015] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The Dutch healthcare inspectorate (IGZ) supervises the quality and safety of healthcare in the Netherlands. Owing to the growing population of (community dwelling) older adults and changes in the Dutch healthcare system, the IGZ is exploring new methods to effectively supervise care networks that exist around frail older adults. The composition of these networks, where formal and informal care takes place, and the lack of guidelines and quality and risk indicators make supervision complicated in the current situation. METHODS AND ANALYSIS This study consists of four phases. The first phase identifies risks for community dwelling frail older adults in the existing literature. In the second phase, a qualitative pilot study will be conducted to assess the needs and wishes of the frail older adults concerning care and well-being, perception of risks, and the composition of their networks, collaboration and coordination between care providers involved in the network. In the third phase, questionnaires based on the results of phase II will be sent to a larger group of frail older adults (n=200) and their care providers. The results will describe the composition of their care networks and prioritise risks concerning community dwelling older adults. Also, it will provide input for the development of a new supervision framework by the IGZ. During phase IV, a second questionnaire will be sent to the participants of phase III to establish changes of perception in risks and possible changes in the care networks. The framework will be tested by the IGZ in pilots, and the researchers will evaluate these pilots and provide feedback to the IGZ. ETHICS AND DISSEMINATION The study protocol was approved by the Scientific Committee of the EMGO+institute and the Medical Ethical review committee of the VU University Medical Centre. Results will be presented in scientific articles and reports and at meetings.
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Affiliation(s)
- Didi Verver
- Department of Public and Occupational health, EMGO+Institute/VU University Medical Centre, Amsterdam, The Netherlands
| | - Hanneke Merten
- Department of Public and Occupational health, EMGO+Institute/VU University Medical Centre, Amsterdam, The Netherlands
| | - Paul Robben
- Dutch Healthcare Inspectorate (IGZ), Utrecht, The Netherlands
- Institute of Health Policy and Management (iBMG), Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational health, EMGO+Institute/VU University Medical Centre, Amsterdam, The Netherlands
- The Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Longpré C, Dubois CA. Implementation of integrated services networks in Quebec and nursing practice transformation: convergence or divergence? BMC Health Serv Res 2015; 15:84. [PMID: 25884845 PMCID: PMC4359500 DOI: 10.1186/s12913-015-0720-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 01/30/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Even though nurses are expected to play a key role in implementing integrated services networks, up to now their practice in this regard has received very little research attention. The aim of this study is to describe the extent to which the evolution of nursing practice in Quebec in recent years has converged with the requirements and efforts involved in services integration. METHODS This descriptive study was carried out with 107 nurses working an integrated network of healthcare services in Quebec in four different care pathways: chronic obstructive pulmonary disease, autonomy support for the elderly, palliative oncology care, and mental health. Development model for integrated care (DMIC) was used, first, to examine the prevalence in each pathway of integrative activities, grouped into nine practice dimensions, and then to position each pathway in relation to the four phases of development for any integration process, as defined by the DMIC. RESULTS Only one pathway had reached Phase 3, which involves expansion and monitoring of integration, whereas the others were still in the preliminary Phases 1 and 2 characterized by initiative and experimentation. Only two dimensions out of nine ('quality of care' and 'interprofessional teamwork') were prevalent in all the pathways; two others ('transparent entrepreneurship' and 'performance management') were in none of the pathways, and the remaining five ('patient-family centered care', 'result-focused learning', 'delivery system', 'commitment', 'roles and tasks') were present to varying degrees. CONCLUSIONS These results suggest that particular efforts should be made to bridge the significant gap between the pace of nursing practice transformation and the objectives of service integration. These efforts should focus, among other things, on the deployment of organizational, clinical, human, and material resources to support practice renewal and continuing education for nurses to prepare them for the requirements of integration.
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Affiliation(s)
- Caroline Longpré
- Centre for Training and Expertise in Nursing Administration Research (FERASI), University of Montreal, Montreal, Quebec, Canada.
- Department of Nursing, Université du Québec en Outaouais, 5 Saint-Joseph Street, Room 3212, Saint-Jérôme, Québec, Canada.
| | - Carl-Ardy Dubois
- Centre for Training and Expertise in Nursing Administration Research (FERASI), University of Montreal, Montreal, Quebec, Canada.
- Department of Nursing, University of Montreal, Montreal, Quebec, Canada.
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Silver SA, Thomas A, Rathe A, Robinson P, Wald R, Harel Z, Bell CM. Development of a hemodialysis safety checklist using a structured panel process. Can J Kidney Health Dis 2015; 2:5. [PMID: 25780628 PMCID: PMC4349476 DOI: 10.1186/s40697-015-0039-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The World Health Organization created a Surgical Safety Checklist with a pause or "time out" to help reduce preventable adverse events and improve communication. A similar tool might improve patient safety and reduce treatment-associated morbidity in the hemodialysis unit. OBJECTIVE To develop a Hemodialysis Safety Checklist (Hemo Pause) for daily use by nurses and patients. DESIGN A modified Delphi consensus technique based on the RAND method was used to evaluate and revise the checklist. SETTING University-affiliated in-center hemodialysis unit. PARTICIPANTS A multidisciplinary team of physicians, nurses, and administrators developed the initial version of the Hemo Pause Checklist. The evaluation team consisted of 20 registered hemodialysis nurses. MEASUREMENTS The top 5 hemodialysis safety measures according to hemodialysis nurses. A 75% agreement threshold was required for consensus. METHODS The structured panel process was iterative, consisting of a literature review to identify safety parameters, individual rating of each parameter by the panel of hemodialysis nurses, an in-person consensus meeting wherein the panel refined the parameters, and a final anonymous survey that assessed panel consensus. RESULTS The literature review produced 31 patient safety parameters. Individual review by panelists reduced the list to 25 parameters, followed by further reduction to 19 at the in-person consensus meeting. The final round of scoring yielded the following top 5 safety measures: 1) confirmation of patient identity, 2) measurement of pre-dialysis weight, 3) recognition and transcription of new medical orders, 4) confirmation of dialysate composition based on prescription, and 5) measurement of pre-dialysis blood pressure. Revision using human factors principles incorporated the 19 patient safety parameters with greater than or equal to 75% consensus into a final checklist of 17-items. LIMITATIONS The literature review was not systematic. This was a single-center study, and the panel lacked patient and family representation. CONCLUSIONS A novel 17-item Hemodialysis Safety Checklist (Hemo Pause) for use by nurses and patients has been developed to standardize the hemodialysis procedure. Further quality improvement efforts are underway to explore the feasibility of using this checklist to reduce adverse events and strengthen the safety culture in the hemodialysis unit.
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Affiliation(s)
- Samuel A Silver
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Alison Thomas
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Andrea Rathe
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Pamela Robinson
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Ron Wald
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- />Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Ziv Harel
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- />Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Chaim M Bell
- />Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- />Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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Longpré C, Dubois CA, Nguemeleu ET. Associations between level of services integration and nurses' workplace well-being. BMC Nurs 2015; 13:50. [PMID: 25598705 PMCID: PMC4297384 DOI: 10.1186/s12912-014-0050-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To respond better to population needs, in recent years Quebec has invested in improving the integration of services and care pathways. Nurses are on the front lines of these transformation processes, which require them to adopt new clinical practices. This updating of practices can be a source of both satisfaction and stress. The aim of this study was to gain a better understanding of the relationship between the transformation processes underlying services integration and nurses' workplace well-being. METHOD This study was based on a descriptive cross-sectional correlational design. The target population included all nurses working in four care pathways in a Quebec healthcare establishment: palliative oncology services, mental health services, autonomy support for the elderly, and chronic obstructive pulmonary disease. In all, 107 nurses took part in the study and completed a questionnaire sent to them. Hierarchical linear regression analyses were used to examine the relationship between level of integration, measured using the Development Model for Integrated Care; nurses' perceptions of organizational change, measured on four dimensions (challenge, responsibility, threat, control); and nurses' workplace well-being, measured on three dimensions (negative stress, positive stress, satisfaction), as defined by the Flexihealth model. RESULTS Nurses in the palliative oncology care pathway, which was at a more advanced level of integration, presented a lower negative stress level and a higher positive stress level than did nurses in other care pathways. Their mean satisfaction score was also higher. More advanced integration was associated with nurses' feeling less threatened, as well as improved workplace well-being. The perception of threat appeared to be a significant mediating variable in the relationship between level of integration and well-being. CONCLUSION The association observed between level of services integration and workplace well-being contributes to a better understanding of nurses' experiences in such situations. These results provide new perspectives on interventions that could be implemented to remedy the potential negative consequences of these types of transformations.
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Affiliation(s)
- Caroline Longpré
- Department of Nursing, University of Montreal. Centre for Training and Expertise in Nursing Administration Research (FERASI), Université du Québec en Outaouais, St-Jérôme Campus, 5 Saint-Joseph Street, Room 3212, Saint-Jérôme, Québec, J7Z 0B7 Canada
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Malakouti SK, Nojomi M, Poshtmashadi M, Hakim Shooshtari M, Mansouri Moghadam F, Rahimi-Movaghar A, Afghah S, Bolhari J, Bazargan-Hejazi S. Integrating a suicide prevention program into the primary health care network: a field trial study in Iran. BIOMED RESEARCH INTERNATIONAL 2015; 2015:193729. [PMID: 25648221 PMCID: PMC4306260 DOI: 10.1155/2015/193729] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe and evaluate the feasibility of integrating a suicide prevention program with Primary Health Care services and evaluate if such system can improve screening and identification of depressive disorder, reduce number of suicide attempters, and lower rate of suicide completion. METHODOLOGY This was a quasi-experimental trial in which one community was exposed to the intervention versus the control community with no such exposure. The study sites were two counties in Western Iran. The intervention protocol called for primary care and suicide prevention collaboration at different levels of care. The outcome variables were the number of suicides committed, the number of documented suicide attempts, and the number of identified depressed cases. RESULTS We identified a higher prevalence of depressive disorders in the intervention site versus the control site (χ (2) = 14.8, P < 0.001). We also found a reduction in the rate of suicide completion in the intervention region compared to the control, but a higher prevalence of suicide attempts in both the intervention and the control sites. CONCLUSION Integrating a suicide prevention program with the Primary Health Care network enhanced depression and suicide surveillance capacity and subsequently reduced the number of suicides, especially in rural areas.
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Affiliation(s)
- Seyed Kazem Malakouti
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nojomi
- Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, P.O. Box 14155-5988, Iran
| | - Marjan Poshtmashadi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mitra Hakim Shooshtari
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Susan Afghah
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jafar Bolhari
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA 90059, USA
- David Geffen School of Medicine at UCLA, CA, USA
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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.
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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
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Lyngsø AM, Godtfredsen NS, Høst D, Frølich A. Instruments to assess integrated care: a systematic review. Int J Integr Care 2014; 14:e027. [PMID: 25337064 PMCID: PMC4203116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/04/2014] [Accepted: 09/09/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how to measure the level of integration across health-care sectors and to assess and evaluate the organisational elements within the instruments identified. METHODS An extensive, systematic literature review in PubMed, CINAHL, PsycINFO, Cochrane Library, Web of Science for the years 1980-2011. Selected abstracts were independently reviewed by two investigators. RESULTS We identified 23 measurement instruments and, within these, eight organisational elements were found. No measurement instrument covered all organisational elements, but almost all studies include well-defined structural and process aspects and six include cultural aspects; 14 explicitly stated using a theoretical framework. CONCLUSION AND DISCUSSION This review did not identify any measurement instrument covering all aspects of integrated care. Further, a lack of uniform use of the eight organisational elements across the studies was prevalent. It is uncertain whether development of a single 'all-inclusive' model for assessing integrated care is desirable. We emphasise the continuing need for validated instruments embedded in theoretical contexts.
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Affiliation(s)
- Anne Marie Lyngsø
- Department of Integrated Healthcare, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark
| | - Nina Skavlan Godtfredsen
- Department of Respiratory Medicine, Hvidovre University Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark
| | - Dorte Høst
- Department of Integrated Healthcare, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark
| | - Anne Frølich
- Department of Integrated Healthcare, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark
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Sun X, Tang W, Ye T, Zhang Y, Wen B, Zhang L. Integrated care: a comprehensive bibliometric analysis and literature review. Int J Integr Care 2014; 14:e017. [PMID: 24987322 PMCID: PMC4059213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 04/20/2014] [Accepted: 05/13/2014] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Integrated care could not only fix up fragmented health care but also improve the continuity of care and the quality of life. Despite the volume and variety of publications, little is known about how 'integrated care' has developed. There is a need for a systematic bibliometric analysis on studying the important features of the integrated care literature. AIM To investigate the growth pattern, core journals and jurisdictions and identify the key research domains of integrated care. METHODS We searched Medline/PubMed using the search strategy '(delivery of health care, integrated [MeSH Terms]) OR integrated care [Title/Abstract]' without time and language limits. Second, we extracted the publishing year, journals, jurisdictions and keywords of the retrieved articles. Finally, descriptive statistical analysis by the Bibliographic Item Co-occurrence Matrix Builder and hierarchical clustering by SPSS were used. RESULTS As many as 9090 articles were retrieved. Results included: (1) the cumulative numbers of the publications on integrated care rose perpendicularly after 1993; (2) all documents were recorded by 1646 kinds of journals. There were 28 core journals; (3) the USA is the predominant publishing country; and (4) there are six key domains including: the definition/models of integrated care, interdisciplinary patient care team, disease management for chronically ill patients, types of health care organizations and policy, information system integration and legislation/jurisprudence. DISCUSSION AND CONCLUSION Integrated care literature has been most evident in developed countries. International Journal of Integrated Care is highly recommended in this research area. The bibliometric analysis and identification of publication hotspots provides researchers and practitioners with core target journals, as well as an overview of the field for further research in integrated care.
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Affiliation(s)
- Xiaowei Sun
- Research Centre of Rural Healthcare Services, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Wenxi Tang
- Research Centre of Rural Healthcare Services, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Ting Ye
- Research Centre of Rural Healthcare Services, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yan Zhang
- Research Centre of Rural Healthcare Services, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Bo Wen
- Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Liang Zhang
- Research Centre of Rural Healthcare Services, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Jeffs L, Law MP, Straus S, Cardoso R, Lyons RF, Bell C. Defining quality outcomes for complex-care patients transitioning across the continuum using a structured panel process. BMJ Qual Saf 2013; 22:1014-24. [PMID: 23852937 PMCID: PMC3962028 DOI: 10.1136/bmjqs-2012-001473] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 05/25/2013] [Accepted: 06/09/2013] [Indexed: 11/03/2022]
Abstract
BACKGROUND No standardised set of quality measures associated with transitioning complex-care patients across the various healthcare settings and home exists. In this context, a structured panel process was used to define quality measures for care transitions involving complex-care patients across healthcare settings. METHODS A modified Delphi consensus technique based on the RAND method was used to develop measures of quality care transitions across the continuum of care. Specific stages included a literature review, individual rating of each measure by each of the panelists (n=11), a face-to-face consensus meeting, and final ranking by the panelists. RESULTS The literature review produced an initial set of 119 measures. To advance to rounds 1 and 2, an aggregate rating of >75% of the measure was required. This analysis yielded 30/119 measures in round 1 and 11/30 measures in round 2. The final round of scoring yielded the following top five measures: (1) readmission rates within 30 days, (2) primary care visit within 7 days postdischarge for high-risk patients, (3) medication reconciliation completed at admission and prior to discharge, (4) readmission rates within 72 h and (5) time from discharge to homecare nursing visit for high-risk patients. CONCLUSIONS The five measures identified through this research may be useful as indicators of overall care quality related to care transitions involving complex-care patients across different healthcare settings. Further research efforts are called for to explore the applicability and feasibility of using the quality measures to drive quality improvement across the healthcare system.
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Affiliation(s)
- Lianne Jeffs
- St. Michael's Hospital, Toronto, Ontario, Canada
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Madelyn P Law
- Department of Community Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Sharon Straus
- Knowledge Translation Program, Li Ka Shing Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Calgary
- Department of Medicine, University of Toronto,Toronto, Ontario, Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Renee F Lyons
- Complex Chronic Disease Research, Bridgepoint Collaboratory for Research and Innovation, Toronto, Ontario, Canada
- Professor Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Bridgepoint Health, Toronto, Ontario, Canada
| | - Chaim Bell
- Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES) of Ontario, Toronto, Ontario, Canada
- Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
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Learning to Learn: towards a Relational and Transformational Model of Learning for Improved Integrated Care Delivery. ADMINISTRATIVE SCIENCES 2013. [DOI: 10.3390/admsci3020009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Minkman MMN, Vermeulen RP, Ahaus KTB, Huijsman R. A survey study to validate a four phases development model for integrated care in the Netherlands. BMC Health Serv Res 2013; 13:214. [PMID: 23758963 PMCID: PMC3733829 DOI: 10.1186/1472-6963-13-214] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 06/06/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The development of integrated care is a complex and long term process. Previous research shows that this development process can be characterised by four phases: the initiative and design phase; the experimental and execution phase; the expansion and monitoring phase and the consolidation and transformation phase. In this article these four phases of the Development Model for Integrated Care (DMIC) are validated in practice for stroke services, acute myocardial infarct (AMI) services and dementia services in the Netherlands. METHODS Based on the pre-study about the DMIC, a survey was developed for integrated care coordinators. In total 32 stroke, 9 AMI and 43 dementia services in the Netherlands participated (response 83%). Data were collected on integrated care characteristics, planned and implemented integrated care elements, recognition of the DMIC phases and factors that influence development. Data analysis was done by descriptive statistics, Kappa tests and Pearson's correlation tests. RESULTS All services positioned their practice in one of the four phases and confirmed the phase descriptions. Of them 93% confirmed to have completed the previous phase. The percentage of implemented elements increased for every further development phase; the percentage of planned elements decreased for every further development phase. Pearson's correlation was .394 between implemented relevant elements and self-assessed phase, and up to .923 with the calculated phases (p < .001). Elements corresponding to the earlier phases of the model were on average older. Although the integrated care services differed on multiple characteristics, the DMIC phases were confirmed. CONCLUSIONS Integrated care development is characterised by a changing focus over time, often starting with a large amount of plans which decrease over time when progress on implementation has been made. More awareness of this phase-wise development of integrated care, could facilitate integrated care coordinators and others to evaluate their integrated care practices and guide further development. The four phases model has the potential to serve as a generic quality management tool for multiple integrated care practices.
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Affiliation(s)
- Mirella MN Minkman
- Vilans, National Center of Excellence for Long-term care, PO Box 8228, 3503, RE Utrecht, The Netherlands
| | - Robbert P Vermeulen
- Thorax Center, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700, RB Groningen, The Netherlands
| | - Kees TB Ahaus
- Faculty of Economics and Business, Research Center on Healthcare Organization & Innovation. University Medical Center Groningen, University of Groningen, Landleven 5, 9747, AD Groningen, The Netherlands
| | - Robbert Huijsman
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000, DR Rotterdam, The Netherlands
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Gaboury I, Corriveau H, Boire G, Cabana F, Beaulieu MC, Dagenais P, Gosselin S, Bogoch E, Rochette M, Filiatrault J, Laforest S, Jean S, Fansi A, Theriault D, Burnand B. Partnership for fragility bone fracture care provision and prevention program (P4Bones): study protocol for a secondary fracture prevention pragmatic controlled trial. Implement Sci 2013; 8:10. [PMID: 23343392 PMCID: PMC3564742 DOI: 10.1186/1748-5908-8-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/16/2013] [Indexed: 01/07/2023] Open
Abstract
Background Fractures associated with bone fragility in older adults signal the potential for secondary fracture. Fragility fractures often precipitate further decline in health and loss of mobility, with high associated costs for patients, families, society and the healthcare system. Promptly initiating a coordinated, comprehensive pharmacological bone health and falls prevention program post-fracture may improve osteoporosis treatment compliance; and reduce rates of falls and secondary fractures, and associated morbidity, mortality and costs. Methods/design This pragmatic, controlled trial at 11 hospital sites in eight regions in Quebec, Canada, will recruit community-dwelling patients over age 50 who have sustained a fragility fracture to an intervention coordinated program or to standard care, according to the site. Site study coordinators will identify and recruit 1,596 participants for each study arm. Coordinators at intervention sites will facilitate continuity of care for bone health, and arrange fall prevention programs including physical exercise. The intervention teams include medical bone specialists, primary care physicians, pharmacists, nurses, rehabilitation clinicians, and community program organizers. The primary outcome of this study is the incidence of secondary fragility fractures within an 18-month follow-up period. Secondary outcomes include initiation and compliance with bone health medication; time to first fall and number of clinically significant falls; fall-related hospitalization and mortality; physical activity; quality of life; fragility fracture-related costs; admission to a long term care facility; participants’ perceptions of care integration, expectations and satisfaction with the program; and participants’ compliance with the fall prevention program. Finally, professionals at intervention sites will participate in focus groups to identify barriers and facilitating factors for the integrated fragility fracture prevention program. This integrated program will facilitate knowledge translation and dissemination via the following: involvement of various collaborators during the development and set-up of the integrated program; distribution of pamphlets about osteoporosis and fall prevention strategies to primary care physicians in the intervention group and patients in the control group; participation in evaluation activities; and eventual dissemination of study results. Study/trial registration Clinical Trial.Gov NCT01745068 Study ID number CIHR grant # 267395
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Affiliation(s)
- Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, QC, Canada.
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Evans JM, Baker GR. Shared mental models of integrated care: aligning multiple stakeholder perspectives. J Health Organ Manag 2013; 26:713-36. [PMID: 23252323 DOI: 10.1108/14777261211276989] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across inter-organizational and inter-professional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration. DESIGN/METHODOLOGY/APPROACH The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care (MMIC), which consists of three types of mental models, i.e. integration-task, system-role, and integration-belief. FINDINGS The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theory-based framework of psychological factors that may influence inter-organizational and inter-professional relations. While the existing literature on integration focuses on optimizing structures and processes, the MMIC construct emphasizes the convergence and divergence of stakeholders' knowledge and beliefs, and how these underlying cognitions influence interactions (or lack thereof) across the continuum of care. PRACTICAL IMPLICATIONS MMIC may help to: explain what differentiates effective from ineffective integration initiatives; determine system readiness to integrate; diagnose integration problems; and develop interventions for enhancing integrative processes and ultimately the delivery of integrated care. ORIGINALITY/VALUE Global interest and ongoing challenges in integrating care underline the need for research on the mental models that characterize the behaviors of actors within health systems; the proposed framework offers a starting point for applying a cognitive perspective to health systems integration.
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Affiliation(s)
- Jenna M Evans
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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Goodwin N. Understanding integrated care: a complex process, a fundamental principle. Int J Integr Care 2013; 13:e011. [PMID: 23687483 PMCID: PMC3653279 DOI: 10.5334/ijic.1144] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Nick Goodwin
- Editor-in-Chief, International Journal of Integrated Care
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Bell CM, Brener SS, Comrie R, Anderson GM, Bronskill SE. Quality measures for medication continuity in long-term care facilities, using a structured panel process. Drugs Aging 2012; 29:319-27. [PMID: 22462630 DOI: 10.2165/11599150-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Patient transitions, such as transfers between acute and long-term care (LTC), aposare times when the likelihood of communication failure between healthcare providers is increased. Employing appropriate health quality indicators helps support improvement efforts. To date, few quality indicators that evaluate the continuity of medication use between acute and LTC facilities have been described. OBJECTIVE The aim of the study was to develop quality indicators signalling the potential discontinuation of previously prescribed medications for chronic diseases when residents return to LTC following an acute-care hospitalization. METHODS A literature review for the selection of potential indicators was conducted, followed by a three-step process: (i) initial screening round that rated the indicators; (ii) a 1-day in-person consensus meeting in which the panel refined the parameters regarding the proposed quality indicators; and (iii) a final anonymous survey that assessed consensus among panel members. The study setting was a survey and consensus meeting with national representation, held in Toronto, ON, Canada. A ten-member expert panel with broad geographical and clinical representation participated and was made up of registered nurses, physicians, pharmacists, policy makers and academic researchers. A 75% agreement threshold was required for consensus, as measured on a 9-point Likert-type scale. The panel evaluated quality indicators for effectiveness, relevance and feasibility, using currently available healthcare administrative data. RESULTS The panel reached consensus on four quality indicators to assess the unintentional discontinuation of medications prescribed to LTC residents for chronic diseases upon return to LTC after an acute-care admission. The selected indicators were (i) HMG-CoA reductase inhibitors (statins) for all indications; (ii) anticoagulants (e.g. warfarin) for the indication of atrial fibrillation; (iii) proton-pump inhibitors for the indication of post-gastrointestinal haemorrhage; and (iv) thyroxine for all indications. The panel identified three additional treatment groups for future consideration as quality indicators: anti-Parkinson's disease, anti-diabetes and antidepressant medications. CONCLUSION A novel set of quality indicators has been developed to evaluate medication continuity between acute and LTC facilities. The adoption and implementation of these indicators in clinical practice can help inform quality improvement efforts at various local and regional levels.
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Affiliation(s)
- Chaim M Bell
- St Michaels Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute, Toronto, ON, Canada
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Minkman M, Vat L. A self-evaluation tool for integrated care services: the Development Model for Integrated Care applied in practice. Int J Integr Care 2012. [PMCID: PMC3617779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Purpose Context Data sources Case description Conclusions and discussion
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Tsasis P, Evans JM, Owen S. Reframing the challenges to integrated care: a complex-adaptive systems perspective. Int J Integr Care 2012; 12:e190. [PMID: 23593051 PMCID: PMC3601537 DOI: 10.5334/ijic.843] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/10/2012] [Accepted: 07/10/2012] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite over two decades of international experience and research on health systems integration, integrated care has not developed widely. We hypothesized that part of the problem may lie in how we conceptualize the integration process and the complex systems within which integrated care is enacted. This study aims to contribute to discourse regarding the relevance and utility of a complex-adaptive systems (CAS) perspective on integrated care. METHODS In the Canadian province of Ontario, government mandated the development of fourteen Local Health Integration Networks in 2006. Against the backdrop of these efforts to integrate care, we collected focus group data from a diverse sample of healthcare professionals in the Greater Toronto Area using convenience and snowball sampling. A semi-structured interview guide was used to elicit participant views and experiences of health systems integration. We use a CAS framework to describe and analyze the data, and to assess the theoretical fit of a CAS perspective with the dominant themes in participant responses. RESULTS Our findings indicate that integration is challenged by system complexity, weak ties and poor alignment among professionals and organizations, a lack of funding incentives to support collaborative work, and a bureaucratic environment based on a command and control approach to management. Using a CAS framework, we identified several characteristics of CAS in our data, including diverse, interdependent and semi-autonomous actors; embedded co-evolutionary systems; emergent behaviours and non-linearity; and self-organizing capacity. DISCUSSION AND CONCLUSION One possible explanation for the lack of systems change towards integration is that we have failed to treat the healthcare system as complex-adaptive. The data suggest that future integration initiatives must be anchored in a CAS perspective, and focus on building the system's capacity to self-organize. We conclude that integrating care requires policies and management practices that promote system awareness, relationship-building and information-sharing, and that recognize change as an evolving learning process rather than a series of programmatic steps.
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Affiliation(s)
- Peter Tsasis
- School of Health Policy and Management, Faculty of Health, York University, 4700 Keele Street, Toronto, Ontario, Canada M3J1P3
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Minkman MMN, Vermeulen RP, Ahaus KTB, Huijsman R. The implementation of integrated care: the empirical validation of the Development Model for Integrated care. BMC Health Serv Res 2011; 11:177. [PMID: 21801428 PMCID: PMC3160357 DOI: 10.1186/1472-6963-11-177] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 07/30/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the integration of care. We have empirically validated this model in practice by assessing the relevance, implementation and plans of the elements in three integrated care service settings in The Netherlands: stroke, acute myocardial infarct (AMI), and dementia. METHODS Based on the DMIC, a survey was developed for integrated care coordinators. We invited all Dutch stroke and AMI-services, as well as the dementia care networks to participate, of which 84 did (response rate 83%). Data were collected on relevance, presence, and year of implementation of the 89 elements. The data analysis was done by means of descriptive statistics, Chi Square, ANOVA and Kruskal-Wallis H tests. RESULTS The results indicate that the integrated care practice organizations in all three care settings rated the nine clusters and 89 elements of the DMIC as highly relevant. The average number of elements implemented was 50 ± 18, 42 ± 13, and 45 ± 22 for stroke, acute myocardial infarction, and dementia care services, respectively. Although the dementia networks were significantly younger, their numbers of implemented elements were comparable to those of the other services. The analyses of the implementation timelines showed that the older integrated care services had fewer plans for further implementation than the younger ones. Integrated care coordinators stated that the DMIC helped them to assess their integrated care development in practice and supported them in obtaining ideas for expanding their integrated care activities. CONCLUSIONS Although the patient composites and the characteristics of the 84 participating integrated care services differed considerably, the results confirm that the clusters and the vast majority of DMIC elements are relevant to all three groups. Therefore, the DMIC can serve as a general quality management tool for integrated care. Applying the model in practice can help in steering further implementations as well as the development of new integrated care practices.
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Affiliation(s)
- Mirella MN Minkman
- Vilans, National Center of Excellence for Long-term care, PO Box 8228, 3503 RE Utrecht, The Netherlands
| | - Robbert P Vermeulen
- Thorax Center, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Kees TB Ahaus
- University of Groningen, Faculty of Economics and Business, Research Center on Healthcare Organization & Innovation. University Medical Center Groningen Landleven 5, 9747 AD, Groningen, The Netherlands
| | - Robbert Huijsman
- Erasmus University Rotterdam, Institute of Health Policy and Management, PO Box 1738, 3000 DR Rotterdam, The Netherlands
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