1
|
van Staalduinen DJ, van den Bekerom PE, Groeneveld SM, Stiggelbout AM, van den Akker-van Marle ME. Relational coordination in value-based health care. Health Care Manage Rev 2023; 48:334-341. [PMID: 37615943 PMCID: PMC10476589 DOI: 10.1097/hmr.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND An important element of value-based health care (VBHC) is interprofessional collaboration in integrated practice units (IPUs) for the delivery of the complete cycle of care. High levels of interprofessional collaboration between clinical and nonclinical staff in IPUs are assumed rather than proven. Factors that may stimulate interprofessional collaboration in the context of VBHC are underresearched. PURPOSE The aim of this study was to examine relational coordination (RC) in VBHC and its antecedents. APPROACH A questionnaire was used to examine the association of both team practices and organizational conditions with interprofessional collaboration in IPUs. Gittell's Relational Coordination Survey was drawn upon to measure interprofessional collaboration by capturing the relational dynamics in coordinated working. The questionnaire also included measures of team practices (team meetings and boundary spanning behavior) and organizational conditions (task interdependence and time constraints). RESULTS The number of different professional groups participating in team meetings is positively associated with RC in IPUs. Boundary spanning behavior, task interdependence, and time constraints are not associated with RC. CONCLUSIONS In IPUs, the diversity within interprofessional team meetings is important for establishing high-quality communication and relationships. PRACTICE IMPLICATIONS Hospital managers should prioritize facilitating and encouraging shared meetings to enhance RC levels among professional groups in IPUs.
Collapse
|
2
|
Šimec M, Krsnik S, Erjavec K. Integrated Clinical Pathways: Communication and Participation in a Multidisciplinary Team. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: An integrated clinical pathway (ICP) is a key method for structuring or planning processes of care, enabling the modernization of health-care delivery and coordination of multiple roles, forming a complete, patient-centered multidisciplinary health-care team and establishing the sequence of activities, promoting individual and team communication, collaboration, networking, and transparency, and reducing the cost of care.
AIM: As there is a research gap in the area of communication among members of a multidisciplinary team for the treatment of patients through an ICP, the aim of this study was to determine the impact of communication of a member of a multidisciplinary team on the active participation of an individual in this multidisciplinary team.
METHODS: A cross-sectional study of three ICPs, forchronic kidney disease, stroke, and total hip arthroplasty was conducted in a typical Slovenian general hospital.
RESULTS: The results show that in the analyzed hospital, two of the three clinical pathways are not yet fully integrated.
CONCLUSION: There is a weak influence of staff communication within a multidisciplinary team on an individual’s participation in this multidisciplinary team, indicating the need for various activities to actually implement clinical pathway “integration,” and promote better communication within teams to strengthen participation in multidisciplinary patient care pathways.
Collapse
|
3
|
Handoll HH, Cameron ID, Mak JC, Panagoda CE, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 2021; 11:CD007125. [PMID: 34766330 PMCID: PMC8586844 DOI: 10.1002/14651858.cd007125.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hip fracture is a major cause of morbidity and mortality in older people, and its impact on society is substantial. After surgery, people require rehabilitation to help them recover. Multidisciplinary rehabilitation is where rehabilitation is delivered by a multidisciplinary team, supervised by a geriatrician, rehabilitation physician or other appropriate physician. This is an update of a Cochrane Review first published in 2009. OBJECTIVES To assess the effects of multidisciplinary rehabilitation, in either inpatient or ambulatory care settings, for older people with hip fracture. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL, MEDLINE and Embase (October 2020), and two trials registers (November 2019). SELECTION CRITERIA We included randomised and quasi-randomised trials of post-surgical care using multidisciplinary rehabilitation of older people (aged 65 years or over) with hip fracture. The primary outcome - 'poor outcome' - was a composite of mortality and decline in residential status at long-term (generally one year) follow-up. The other 'critical' outcomes were health-related quality of life, mortality, dependency in activities of daily living, mobility, and related pain. DATA COLLECTION AND ANALYSIS Pairs of review authors independently performed study selection, assessed risk of bias and extracted data. We pooled data where appropriate and used GRADE for assessing the certainty of evidence for each outcome. MAIN RESULTS The 28 included trials involved 5351 older (mean ages ranged from 76.5 to 87 years), usually female, participants who had undergone hip fracture surgery. There was substantial clinical heterogeneity in the trial interventions and populations. Most trials had unclear or high risk of bias for one or more items, such as blinding-related performance and detection biases. We summarise the findings for three comparisons below. Inpatient rehabilitation: multidisciplinary rehabilitation versus 'usual care' Multidisciplinary rehabilitation was provided primarily in an inpatient setting in 20 trials. Multidisciplinary rehabilitation probably results in fewer cases of 'poor outcome' (death or deterioration in residential status, generally requiring institutional care) at 6 to 12 months' follow-up (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.80 to 0.98; 13 studies, 3036 participants; moderate-certainty evidence). Based on an illustrative risk of 347 people with hip fracture with poor outcome in 1000 people followed up between 6 and 12 months, this equates to 41 (95% CI 7 to 69) fewer people with poor outcome after multidisciplinary rehabilitation. Expressed in terms of numbers needed to treat for an additional harmful outcome (NNTH), 25 patients (95% CI 15 to 100) would need to be treated to avoid one 'poor outcome'. Subgroup analysis by type of multidisciplinary rehabilitation intervention showed no evidence of subgroup differences. Multidisciplinary rehabilitation may result in fewer deaths in hospital but the confidence interval does not exclude a small increase in the number of deaths (RR 0.77, 95% CI 0.58 to 1.04; 11 studies, 2455 participants; low-certainty evidence). A similar finding applies at 4 to 12 months' follow-up (RR 0.91, 95% CI 0.80 to 1.05; 18 studies, 3973 participants; low-certainty evidence). Multidisciplinary rehabilitation may result in fewer people with poorer mobility at 6 to 12 months' follow-up (RR 0.83, 95% CI 0.71 to 0.98; 5 studies, 1085 participants; low-certainty evidence). Due to very low-certainty evidence, we have little confidence in the findings for marginally better quality of life after multidisciplinary rehabilitation (1 study). The same applies to the mixed findings of some or no difference from multidisciplinary rehabilitation on dependence in activities of daily living at 1 to 4 months' follow-up (measured in various ways by 11 studies), or at 6 to 12 months' follow-up (13 studies). Long-term hip-related pain was not reported. Ambulatory setting: supported discharge and multidisciplinary home rehabilitation versus 'usual care' Three trials tested this comparison in 377 people mainly living at home. Due to very low-certainty evidence, we have very little confidence in the findings of little to no between-group difference in poor outcome (death or move to a higher level of care or inability to walk) at one year (3 studies); quality of life at one year (1 study); in mortality at 4 or 12 months (2 studies); in independence in personal activities of daily living (1 study); in moving permanently to a higher level of care (2 studies) or being unable to walk (2 studies). Long-term hip-related pain was not reported. One trial tested this comparison in 240 nursing home residents. There is low-certainty evidence that there may be no or minimal between-group differences at 12 months in 'poor outcome' defined as dead or unable to walk; or in mortality at 4 months or 12 months. Due to very low-certainty evidence, we have very little confidence in the findings of no between-group differences in dependency at 4 weeks or at 12 months, or in quality of life, inability to walk or pain at 12 months. AUTHORS' CONCLUSIONS In a hospital inpatient setting, there is moderate-certainty evidence that rehabilitation after hip fracture surgery, when delivered by a multidisciplinary team and supervised by an appropriate medical specialist, results in fewer cases of 'poor outcome' (death or deterioration in residential status). There is low-certainty evidence that multidisciplinary rehabilitation may result in fewer deaths in hospital and at 4 to 12 months; however, it may also result in slightly more. There is low-certainty evidence that multidisciplinary rehabilitation may reduce the numbers of people with poorer mobility at 12 months. No conclusions can be drawn on other outcomes, for which the evidence is of very low certainty. The generally very low-certainty evidence available for supported discharge and multidisciplinary home rehabilitation means that we are very uncertain whether the findings of little or no difference for all outcomes between the intervention and usual care is true. Given the prevalent clinical emphasis on early discharge, we suggest that research is best orientated towards early supported discharge and identifying the components of multidisciplinary inpatient rehabilitation to optimise patient recovery within hospital and the components of multidisciplinary rehabilitation, including social care, subsequent to hospital discharge.
Collapse
Affiliation(s)
- Helen Hg Handoll
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
- Department of Orthopaedics and Trauma, The University of Edinburgh, Edinburgh, UK
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Jenson Cs Mak
- Healthy Ageing, Mind & Body Institute, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Claire E Panagoda
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Terence P Finnegan
- Department of Aged Care and Rehabilitation Medicine, Royal North Shore Hospital of Sydney, St Leonards, Australia
| |
Collapse
|
4
|
Gervasi G, Bellomo G, Mayer F, Zaccaria V, Bacigalupo I, Lacorte E, Canevelli M, Corbo M, Di Fiandra T, Vanacore N. Integrated care pathways on dementia in Italy: a survey testing the compliance with a national guidance. Neurol Sci 2019; 41:917-924. [PMID: 31836948 PMCID: PMC7160089 DOI: 10.1007/s10072-019-04184-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/29/2019] [Indexed: 11/05/2022]
Abstract
Dementias are chronic, degenerative neurological disorders with a complex management that require the cooperation of different healthcare professionals. The Italian Ministry of Health produced the document “Guidance on Integrated Care pathway for People with Dementia” (GICPD) with the specific objective of providing a standardized framework for the definition, development, and implementation of integrated care pathways (ICP) dedicated to people with dementia. We searched all available Italian territorial ICPs. Two raters assessed the retrieved ICPs with a 2-point scale on a 43-item checklist based on the GICPD. Only 5 out of 21 regions and 5 out of 101 local health authorities had an ICP, with most ICPs having a moderate compliance to the GICPD, in particular for the items referring to the development and implementation of the care pathways. A low to moderate inter-rater agreement was observed, mainly due to a lack of standardized models to describe ICPs for dementias. Results suggest that policy- and decision-makers should pay more attention to the GICPD when producing ICPs. The direct communication with clinicians, and the implementation of more precise and appropriate clinical outcomes, could increase the involvement of clinicians, whose participation is crucial to guarantee that ICPs meet needs of patients and their carers.
Collapse
Affiliation(s)
- Giuseppe Gervasi
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Via Giano della Bella no. 34, 00162, Rome, Italy.,Department of Biomedicine and Prevention, Hygiene and Preventive Medicine School, University of Rome Tor Vergata, Rome, Italy
| | - Guido Bellomo
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Via Giano della Bella no. 34, 00162, Rome, Italy
| | - Flavia Mayer
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Via Giano della Bella no. 34, 00162, Rome, Italy
| | - Valerio Zaccaria
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Via Giano della Bella no. 34, 00162, Rome, Italy
| | - Ilaria Bacigalupo
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Via Giano della Bella no. 34, 00162, Rome, Italy
| | - Eleonora Lacorte
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Via Giano della Bella no. 34, 00162, Rome, Italy
| | - Marco Canevelli
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Via Giano della Bella no. 34, 00162, Rome, Italy.,Department of Human Neuroscience "Sapienza", University of Rome, Rome, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Via Dezza 48, 20144, Milan, Italy
| | - Teresa Di Fiandra
- General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Via Giano della Bella no. 34, 00162, Rome, Italy.
| |
Collapse
|
5
|
Seys D, Deneckere S, Lodewijckx C, Bruyneel L, Sermeus W, Boto P, Panella M, Vanhaecht K. Impact of care pathway implementation on interprofessional teamwork: An international cluster randomized controlled trial. J Interprof Care 2019:1-9. [PMID: 31390223 DOI: 10.1080/13561820.2019.1634016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/28/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
This study evaluates whether the implementation of an in-hospital care pathway (CP) improves interprofessional teamwork across countries and tests whether improved communications ("relational coordination") is the mechanism of action. A hospital-based cluster randomized controlled trial in Ireland, Belgium, Italy, and Portugal was performed. Fifty-six interprofessional teams caring for patients admitted with an exacerbation of chronic obstructive pulmonary disease or for patients with a proximal femur fracture were included and randomly assigned to an intervention group (31 teams and 567 team members), where a CP was implemented, and a control group (25 teams and 417 team members) representing usual care. Multilevel regression and mediation analysis were applied. First, although no significant effect was found on our primary outcome relational coordination, our CP significantly improved several team inputs, team processes (team climate for innovation) and team output (the level of organized care, level of competence) indicators. Second, our team process indicator of team climate for innovation partially mediated the association between CP implementation and team output indicator of better level of organized care. In conclusion, a CP sets in motion various mechanisms that improve some but not all aspects of interprofessional teamwork. Relational coordination does not appear to be the mechanism by which team outputs are enhanced.
Collapse
Affiliation(s)
- Deborah Seys
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Svin Deneckere
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Cathy Lodewijckx
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Luk Bruyneel
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
- b Department of Quality Management, University Hospitals Leuven , Leuven , Belgium
| | - Walter Sermeus
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Paulo Boto
- c Department of Health Services Policy and Management, Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL) , Lisbon , Portugal
| | - Massimiliano Panella
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
- d Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont , Vercilli , Italy
| | - Kris Vanhaecht
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
- b Department of Quality Management, University Hospitals Leuven , Leuven , Belgium
| |
Collapse
|
6
|
Seys D, Bruyneel L, Sermeus W, Lodewijckx C, Decramer M, Deneckere S, Panella M, Vanhaecht K. Teamwork and Adherence to Recommendations Explain the Effect of a Care Pathway on Reduced 30-day Readmission for Patients with a COPD Exacerbation. COPD 2018; 15:157-164. [PMID: 29461135 DOI: 10.1080/15412555.2018.1434137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to increase our understanding of processes that underlie the effect of care pathway implementation on reduced 30-day readmission rate. Adherence to evidence-based recommendations, teamwork and burnout have previously been identified as potential mechanisms in this association. We conducted a secondary data analysis of 257 patients admitted with chronic obstructive pulmonary disease exacerbation and 284 team members caring for these patients in 19 Belgian, Italian and Portuguese hospitals. Clinical measures included 30-day readmission and adherence to a specific set of five care activities. Teamwork measures included team climate for innovation, level of organized care and burnout (emotional exhaustion, level of competence and mental detachment). Care pathway implementation was significantly associated with better adherence and reduced 30-day readmission. Better adherence and higher level of competence were also related to reduced 30-day readmission. Only better adherence fully mediated the association between care pathway implementation and reduced 30-day readmission. Better team climate for innovation and level of organized care, although both improved after care pathway implementation, did not show any explanatory mechanisms in the association between care pathway implementation and reduced 30-day readmission. Implementation of a care pathway had an impact on clinical and team indicators. To reduce 30-day readmission rates, in the development and implementation of a care pathway, hospitals should measure adherence to evidence-based recommendations during the whole process, as this can give information regarding the success of implementation.
Collapse
Affiliation(s)
- Deborah Seys
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium
| | - Luk Bruyneel
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
| | - Walter Sermeus
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium
| | - Cathy Lodewijckx
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,c AZ Sint Maarten , Mechelen , Belgium
| | - Marc Decramer
- d Department of Clinical and Experimental Medicine , KU Leuven - University of Leuven , Leuven , Belgium.,e Chief Executive Officer , University Hospitals Leuven , Leuven , Belgium
| | - Svin Deneckere
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,f Delta hospitals Roeselare , Roeselare , Belgium
| | - Massimiliano Panella
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,g Department of Translational Medicine , University of Eastern Piedmont , Piedmont , Italy
| | - Kris Vanhaecht
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
| |
Collapse
|
7
|
Asmirajanti M, Syuhaimie Hamid AY, Hariyati TS. Clinical care pathway strenghens interprofessional collaboration and quality of health service: a literature review. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30076-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
8
|
Lenferink A, Brusse‐Keizer M, van der Valk PDLPM, Frith PA, Zwerink M, Monninkhof EM, van der Palen J, Effing TW. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; 8:CD011682. [PMID: 28777450 PMCID: PMC6483374 DOI: 10.1002/14651858.cd011682.pub2] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. OBJECTIVES To evaluate the efficacy of COPD-specific self-management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health-related quality of life, respiratory-related hospital admissions and other health outcomes. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. SELECTION CRITERIA We included randomised controlled trials evaluating a self-management intervention for people with COPD published since 1995. To be eligible for inclusion, the self-management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community-based setting to avoid overlap with pulmonary rehabilitation as much as possible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random-effects modelling meta-analysis. The primary outcomes of the review were health-related quality of life (HRQoL) and number of respiratory-related hospital admissions. MAIN RESULTS We included 22 studies that involved 3,854 participants with COPD. The studies compared the effectiveness of COPD self-management interventions that included an action plan for AECOPD with usual care. The follow-up time ranged from two to 24 months and the content of the interventions was diverse.Over 12 months, there was a statistically significant beneficial effect of self-management interventions with action plans on HRQoL, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score, where a lower score represents better HRQoL. We found a mean difference from usual care of -2.69 points (95% CI -4.49 to -0.90; 1,582 participants; 10 studies; high-quality evidence). Intervention participants were at a statistically significant lower risk for at least one respiratory-related hospital admission compared with participants who received usual care (OR 0.69, 95% CI 0.51 to 0.94; 3,157 participants; 14 studies; moderate-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over one year was 12 (95% CI 7 to 69) for participants with high baseline risk and 17 (95% CI 11 to 93) for participants with low baseline risk (based on the seven studies with the highest and lowest baseline risk respectively).There was no statistically significant difference in the probability of at least one all-cause hospital admission in the self-management intervention group compared to the usual care group (OR 0.74, 95% CI 0.54 to 1.03; 2467 participants; 14 studies; moderate-quality evidence). Furthermore, we observed no statistically significant difference in the number of all-cause hospitalisation days, emergency department visits, General Practitioner visits, and dyspnoea scores as measured by the (modified) Medical Research Council questionnaire for self-management intervention participants compared to usual care participants. There was no statistically significant effect observed from self-management on the number of COPD exacerbations and no difference in all-cause mortality observed (RD 0.0019, 95% CI -0.0225 to 0.0263; 3296 participants; 16 studies; moderate-quality evidence). Exploratory analysis showed a very small, but significantly higher respiratory-related mortality rate in the self-management intervention group compared to the usual care group (RD 0.028, 95% CI 0.0049 to 0.0511; 1219 participants; 7 studies; very low-quality evidence).Subgroup analyses showed significant improvements in HRQoL in self-management interventions with a smoking cessation programme (MD -4.98, 95% CI -7.17 to -2.78) compared to studies without a smoking cessation programme (MD -1.33, 95% CI -2.94 to 0.27, test for subgroup differences: Chi² = 6.89, df = 1, P = 0.009, I² = 85.5%). The number of behavioural change techniques clusters integrated in the self-management intervention, the duration of the intervention and adaptation of maintenance medication as part of the action plan did not affect HRQoL. Subgroup analyses did not detect any potential variables to explain differences in respiratory-related hospital admissions among studies. AUTHORS' CONCLUSIONS Self-management interventions that include a COPD exacerbation action plan are associated with improvements in HRQoL, as measured with the SGRQ, and lower probability of respiratory-related hospital admissions. No excess all-cause mortality risk was observed, but exploratory analysis showed a small, but significantly higher respiratory-related mortality rate for self-management compared to usual care.For future studies, we would like to urge only using action plans together with self-management interventions that meet the requirements of the most recent COPD self-management intervention definition. To increase transparency, future study authors should provide more detailed information regarding interventions provided. This would help inform further subgroup analyses and increase the ability to provide stronger recommendations regarding effective self-management interventions that include action plans for AECOPD. For safety reasons, COPD self-management action plans should take into account comorbidities when used in the wider population of people with COPD who have comorbidities. Although we were unable to evaluate this strategy in this review, it can be expected to further increase the safety of self-management interventions. We also advise to involve Data and Safety Monitoring Boards for future COPD self-management studies.
Collapse
Affiliation(s)
- Anke Lenferink
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineEnschedeNetherlands
- University of TwenteDepartment of Health Technology and Services Research, Faculty of Behavioural SciencesEnschedeNetherlands
- Flinders UniversitySchool of MedicineAdelaideAustralia
| | | | | | - Peter A Frith
- Flinders UniversitySchool of MedicineAdelaideAustralia
- Repatriation General HospitalDepartment of Respiratory MedicineAdelaideAustralia
| | - Marlies Zwerink
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineEnschedeNetherlands
| | - Evelyn M Monninkhof
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CarePO Box 85500UtrechtNetherlands
| | - Job van der Palen
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineEnschedeNetherlands
- University of TwenteDepartment of Research Methodology, Measurement, and Data‐Analysis, Faculty of Behavioral SciencesHaaksbergerstraat 55EnschedeNetherlands
| | - Tanja W Effing
- Flinders UniversitySchool of MedicineAdelaideAustralia
- Repatriation General HospitalDepartment of Respiratory MedicineAdelaideAustralia
| | | |
Collapse
|
9
|
Ogletree BT. Addressing the Communication and Other Needs of Persons With Severe Disabilities Through Engaged Interprofessional Teams: Introduction to a Clinical Forum. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:157-161. [PMID: 28514471 DOI: 10.1044/2017_ajslp-15-0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 01/06/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE Interprofessional collaborative practice (IPCP) is introduced as a viable and preferred clinical methodology for speech-language pathologists and others serving persons with severe disabilities. Contributions to this clinical forum dedicated to IPCP and severe disabilities are described. METHOD This clinical focus article introduces IPCP and reviews literature specific to its origins and effectiveness, defines severe disabilities, and proposes IPCP as a vital tenet in effective communication-related and other service delivery for this population. CONCLUSION IPCP is supported as a recommended practice methodology for speech-language pathologists and other team members providing services to persons with severe disabilities.
Collapse
Affiliation(s)
- Billy T Ogletree
- Communication Sciences and Disorders, Western Carolina University, Cullowhee, NC
| |
Collapse
|
10
|
The role of the physician in transforming the culture of healthcare. Leadersh Health Serv (Bradf Engl) 2016; 29:300-12. [DOI: 10.1108/lhs-12-2015-0043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The healthcare system in the USA is undergoing unprecedented change and its share of unintended consequences. This paper explores the leadership role of the physician in transforming the present culture of healthcare to restore, refine and preserve its traditional care components.
Design/methodology/approach
The literature on change, organizational culture and leadership is leveraged to describe the structural interdependencies and dynamic complexity of the present healthcare system and to suggest how physicians can strengthen the care components of the healthcare culture.
Findings
When an organization’s culture does not support internal integration and external adaptation, it is the responsibility of leadership to transform it. Leaders can influence culture to strengthen the care components of the healthcare system. The centrality of professionalism in the delivery of patient services places a moral, societal and ethical responsibility on physicians to lead a revitalization of the care culture.
Practical implications
This paper focuses on cultural issues in healthcare and provides options and guidance for physicians as they attempt to lead and manage the context in which services are delivered.
Originality/value
The Competing Values Framework, the major interdependent domains and five principal mechanisms for leaders to embed and fine tune culture serve as the main tenets for describing the ongoing changes in healthcare and defining the role of the physician as leaders and advocates for the Patient Care Culture.
Collapse
|
11
|
Aeyels D, Van Vugt S, Sinnaeve PR, Panella M, Van Zelm R, Sermeus W, Vanhaecht K. Lack of evidence and standardization in care pathway documents for patients with ST-elevated myocardial infarction. Eur J Cardiovasc Nurs 2015; 15:e45-51. [DOI: 10.1177/1474515115580237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/12/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Daan Aeyels
- Department of Public Health and Primary Care, University of Leuven, Belgium
- European Pathway Association, Belgium
| | - Stijn Van Vugt
- Department of Public Health and Primary Care, University of Leuven, Belgium
| | - Peter R Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium
| | - Massimiliano Panella
- Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy
| | - Ruben Van Zelm
- European Pathway Association, Belgium
- QConsult, The Netherlands
| | - Walter Sermeus
- Department of Public Health and Primary Care, University of Leuven, Belgium
- European Pathway Association, Belgium
| | - Kris Vanhaecht
- Department of Public Health and Primary Care, University of Leuven, Belgium
- European Pathway Association, Belgium
- Department of Quality Management, University Hospitals Leuven, Belgium
| |
Collapse
|
12
|
Hwang JI, Ahn J. Teamwork and clinical error reporting among nurses in Korean hospitals. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:14-20. [PMID: 25829205 DOI: 10.1016/j.anr.2014.09.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 08/09/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To examine levels of teamwork and its relationships with clinical error reporting among Korean hospital nurses. METHODS The study employed a cross-sectional survey design. We distributed a questionnaire to 674 nurses in two teaching hospitals in Korea. The questionnaire included items on teamwork and the reporting of clinical errors. We measured teamwork using the Teamwork Perceptions Questionnaire, which has five subscales including team structure, leadership, situation monitoring, mutual support, and communication. Using logistic regression analysis, we determined the relationships between teamwork and error reporting. RESULTS The response rate was 85.5%. The mean score of teamwork was 3.5 out of 5. At the subscale level, mutual support was rated highest, while leadership was rated lowest. Of the participating nurses, 522 responded that they had experienced at least one clinical error in the last 6 months. Among those, only 53.0% responded that they always or usually reported clinical errors to their managers and/or the patient safety department. Teamwork was significantly associated with better error reporting. Specifically, nurses with a higher team communication score were more likely to report clinical errors to their managers and the patient safety department (odds ratio = 1.82, 95% confidence intervals [1.05, 3.14]). CONCLUSIONS Teamwork was rated as moderate and was positively associated with nurses' error reporting performance. Hospital executives and nurse managers should make substantial efforts to enhance teamwork, which will contribute to encouraging the reporting of errors and improving patient safety.
Collapse
Affiliation(s)
- Jee-In Hwang
- College of Nursing Science, Kyung Hee University, Seoul, South Korea
| | - Jeonghoon Ahn
- Office of Health Services Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea.
| |
Collapse
|
13
|
Saliba V, Muscat NA, Vella M, Montalto SA, Fenech C, McKee M, Knai C. Clinicians', policy makers' and patients' views of pediatric cross-border care between Malta and the UK. J Health Serv Res Policy 2014; 19:153-160. [PMID: 24486988 DOI: 10.1177/1355819614521408] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The Malta-UK cross-border health care collaboration gives Maltese patients access to highly specialized care that is not available locally. Our aim was to identify the issues that arise in cross-border specialized care for rare childhood diseases. METHODS We conducted 31 semi-structured face-to-face interviews with policy makers, consultant pediatricians from Mater Dei Hospital in Malta, the Royal Marsden Hospital and Great Ormond Street Hospital in England and the parents of a random sample of children referred for treatment abroad in 2011. We conducted qualitative thematic analysis of the data. RESULTS Respondents viewed the collaboration as successful in providing timely access to high quality specialist care. Four factors facilitated implementation: long established personal relationships; communication and data sharing; shared care approach; and well established support systems. The key challenges are logistical, financial, communication and cultural and psychological. CONCLUSION Cross-border care pathways can successfully support access to high quality specialized care that is acceptable to health professionals and patients.
Collapse
Affiliation(s)
- Vanessa Saliba
- Research fellow, European Centre on the Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Natasha Azzopardi Muscat
- Lecturer, Health Services Management Department, Faculty of Health Sciences, University of Malta, Msida, Malta Faculty of Health, Medicine and Life Sciences, CAPHRI School of Public Health and Primary Care, Department of International Health Maastricht University
| | - Mairi Vella
- Higher Specialist Trainee, Department of Paediatrics, Mater Dei Hospital, Msida, Malta
| | - Simon Attard Montalto
- Head Academic Department of Paediatrics, The Medical School, University of Malta, Msida, Malta
| | - Charlene Fenech
- Manager, Treatment Abroad, Ministry of Health, Elderly and Community Care, Valletta, Malta
| | - Martin McKee
- Professor of European Public Health, European Centre on the Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cécile Knai
- Lecturer, European Centre on the Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
14
|
Seys D, Deneckere S, Sermeus W, Van Gerven E, Panella M, Bruyneel L, Mutsvari T, Bejarano RC, Kul S, Vanhaecht K. The Care Process Self-Evaluation Tool: a valid and reliable instrument for measuring care process organization of health care teams. BMC Health Serv Res 2013; 13:325. [PMID: 23958206 PMCID: PMC3751913 DOI: 10.1186/1472-6963-13-325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 08/15/2013] [Indexed: 11/10/2022] Open
Abstract
Background Patient safety can be increased by improving the organization of care. A tool that evaluates the actual organization of care, as perceived by multidisciplinary teams, is the Care Process Self-Evaluation Tool (CPSET). CPSET was developed in 2007 and includes 29 items in five subscales: (a) patient-focused organization, (b) coordination of the care process, (c) collaboration with primary care, (d) communication with patients and family, and (e) follow-up of the care process. The goal of the present study was to further evaluate the psychometric properties of the CPSET at the team and hospital levels and to compile a cutoff score table. Methods The psychometric properties of the CPSET were assessed in a multicenter study in Belgium and the Netherlands. In total, 3139 team members from 114 hospitals participated. Psychometric properties were evaluated by using confirmatory factor analysis (CFA), Cronbach’s alpha, interclass correlation coefficients (ICCs), Kruskall-Wallis test, and Mann–Whitney test. For the cutoff score table, percentiles were used. Demographic variables were also evaluated. Results CFA showed a good model fit: a normed fit index of 0.93, a comparative fit index of 0.94, an adjusted goodness-of-fit index of 0.87, and a root mean square error of approximation of 0.06. Cronbach’s alpha values were between 0.869 and 0.950. The team-level ICCs varied between 0.127 and 0.232 and were higher than those at the hospital level (0.071-0.151). Male team members scored significantly higher than females on 2 of the 5 subscales and on the overall CPSET. There were also significant differences among age groups. Medical doctors scored significantly higher on 4 of the 5 subscales and on the overall CPSET. Coordinators of care processes scored significantly lower on 2 of the 5 subscales and on the overall CPSET. Cutoff scores for all subscales and the overall CPSET were calculated. Conclusions The CPSET is a valid and reliable instrument for health care teams to measure the extent care processes are organized. The cutoff table permits teams to compare how they perceive the organization of their care process relative to other teams.
Collapse
Affiliation(s)
- Deborah Seys
- Department of Public Health, Center for Health Services and Nursing Research, University of Leuven, Kapucijnenvoer 35 4th Floor, Leuven B-3000, Belgium
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Better Interprofessional Teamwork, Higher Level of Organized Care, and Lower Risk of Burnout in Acute Health Care Teams Using Care Pathways. Med Care 2013; 51:99-107. [DOI: 10.1097/mlr.0b013e3182763312] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|