1
|
Vallée A, Arutkin M. The Transformative Power of Virtual Hospitals for Revolutionising Healthcare Delivery. Public Health Rev 2024; 45:1606371. [PMID: 38962359 PMCID: PMC11221308 DOI: 10.3389/phrs.2024.1606371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 05/27/2024] [Indexed: 07/05/2024] Open
Abstract
Objectives: The objective of this narrative review is to explore the advantages and limitations of VHs in delivering healthcare, including access to specialized professionals, streamlined communication, efficient scheduling, integration of electronic health records, ongoing monitoring, and support, transcending geographical boundaries, and resource optimization. Methods: Review of literature. Results: The national healthcare systems are facing an alarming rise in pressure due to global shifts. Virtual hospitals (VH) offer a practical solution to numerous systemic challenges, including rising costs and increased workloads for healthcare providers. VH also facilitate the delivery of personalized services and enable the monitoring of patients beyond the conventional confines of healthcare settings, reducing the reliance on waiting medicine carried out in doctors' offices or hospitals. Conclusion: VH can mirror the conventional healthcare referral system.
Collapse
Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
| | - Maxence Arutkin
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
- School of Chemistry, Center for the Physics and Chemistry of Living Systems, Tel Aviv University, Tel Aviv-Yafo, Israel
| |
Collapse
|
2
|
Forstner J, Mangold J, Litke N, Weis A, Szecsenyi J, Wensing M, Ullrich C. [Between New Responsibility and Daily Routines - The Role of the VERAH in GP Care: A Qualitative Secondary Data Case Study of the Introduction of Software-Based Case Management]. DAS GESUNDHEITSWESEN 2023; 85:1124-1130. [PMID: 37852278 PMCID: PMC10713334 DOI: 10.1055/a-2144-5767] [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: 10/20/2023]
Abstract
BACKGROUND The concept of Care Assistant in General Practice (VERAH) was developed in order to integrate non-medical staff more strongly into primary care and thus to meet the increasing demand for care and the simultaneous shortage of medical staff. VERAHs are increasingly responsible for software-supported case management and are thus confronted with new tasks. The aim of this study was therefore to explore the role of the VERAH in primary care practices. METHODS The present study is a qualitative secondary data analysis; the data collection took place within the projects VESPEERA and TelePraCMan. Twenty individual interviews and two focus group meetings were conducted with a total of 30 physicians, VERAHs and medical assistants from primary care. The data were analysed qualitatively according to Emerson. Contextual and socio-demographic data were collected with an accompanying questionnaire. RESULTS The VERAHs of all primary care practices from which interview partners participated performed tasks within software-supported case management. Concerning the role of the VERAH, three themes were identified in the interviews: a) concrete tasks of the VERAH in software-supported case management within the practice team, b) relevance of software-supported case management within the activities of the VERAHS and c) relationship between VERAHs and patients. CONCLUSION Taking over tasks in software-supported case management can contribute to strengthening and expanding the role of the VERAH. In the future, more attention should be paid to a clear description of the new role, and the conditions of the VERAHs' task fulfilment should be considered.
Collapse
Affiliation(s)
- Johanna Forstner
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Jasmin Mangold
- Institut für Gesundheitswissenschaften, Abteilung
Pflegewissenschaft, Universitätsklinikum Tübingen,
Tübingen, Germany
- Zentrum für öffentliches Gesundheitswesen und
Versorgungsforschung (ZÖGV), Universitätsklinikum
Tübingen, Tübingen, Germany
| | - Nicola Litke
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Aline Weis
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Charlotte Ullrich
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| |
Collapse
|
3
|
Klein AA, Petermann J, Brosse F, Piller S, Kramer M, Hanf M, Dinh TS, Schulz-Rothe S, Engler J, Mergenthal K, Seidling HM, Klasing S, Timmesfeld N, van den Akker M, Voigt K. Implementation and evaluation of a complex intervention to improve information availability at the interface between inpatient and outpatient care in older patients with multimorbidity and polypharmacy (HYPERION-TransCare) - study protocol for a pilot and feasibility cluster-randomized controlled trial in general practice in Germany. Pilot Feasibility Stud 2023; 9:146. [PMID: 37608345 PMCID: PMC10463488 DOI: 10.1186/s40814-023-01375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Despite attempts to improve the cross-sectoral flow of information, difficulties remain in routine healthcare. The resulting negative impact on continuity of care is often associated with poor health outcomes, especially in older patients. Our intervention aims to increase information availability with respect to medications and health conditions at the interface between inpatient and outpatient care and to contribute towards improving the quality of care in older patients. This pilot study focuses on feasibility and implementability. METHODS The idea of the complex intervention has been developed in a previous study. This intervention will be tested in a prospective, multicenter, cluster-randomized (via web tool), controlled pilot trial with two parallel study arms (intervention and control group). The pilot study will be conducted in 20 general practices in Hesse and Saxony (Germany) and include 200 patients (≥ 65 years of age with multimorbidity and polypharmacy) recruited by the practices. Practice staff and patients will be blinded. We will use qualitative and quantitative methods to assess the feasibility and implementability of the intervention and the study design in a process evaluation covering topics ranging from expectations to experiences. In addition, the feasibility of proposed outcome parameters for the future definitive trial will be explored. The composite endpoint will include health-related patient outcomes (hospitalization, falls, and mortality using, e.g., the FIMA questionnaire), and we will assess information on medications (SIMS questionnaire), symptoms and side effects of the medication (pro-CTCAE questionnaire), and health literacy (HLQ questionnaire). Data will be collected at study begin (baseline) and after 6 months. Furthermore, the study will include surveys and interviews with patients, general practitioners, and healthcare assistants. DISCUSSION The intervention was developed using a participatory approach involving stakeholders and patients. It aims to empower general practice teams as they provide patient-centered care and play a key role in the coordination and continuity of care. We aim to encourage patients to adopt an active role in their health care. Overall, we want to increase the availability of health-related information for patients and healthcare providers. The results of the pilot study will be used in the design and implementation of the future definitive trial. TRIAL REGISTRATION The study was registered in DRKS-German Clinical Trials Register: registration number DRKS00027649 (date: 19 January 2022). Date and version identifier 10.07.2023; Version 1.3.
Collapse
Affiliation(s)
- Astrid-Alexandra Klein
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
| | - Jenny Petermann
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
| | - Franziska Brosse
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
| | - Steve Piller
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
| | - Martin Kramer
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
| | - Maria Hanf
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Truc Sophia Dinh
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Sylvia Schulz-Rothe
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Jennifer Engler
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Hanna M. Seidling
- Cooperation Unit Clinical Pharmacy, Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Sophia Klasing
- Cooperation Unit Clinical Pharmacy, Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Universitätsstraße 105, 44789 Bochum, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
| |
Collapse
|
4
|
Wensing M, Roth C, Krug K. Measuring valued output in primary care: challenges and reconciliation. Expert Rev Pharmacoecon Outcomes Res 2023; 23:723-731. [PMID: 37306502 DOI: 10.1080/14737167.2023.2224566] [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] [Received: 12/15/2022] [Accepted: 06/08/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Strong primary care has positive impact on patients' and population health, and high continuity of care is one of its hallmarks. Insight into the underlying mechanisms is limited and research on this topic requires measures of primary care outputs, which are states that mediate between processes and outcomes of primary care. AREAS COVERED Nine potential outputs of high continuity of care were specified to examine 45 validated patient questionnaires, which were identified in a systematic review. Eighteen questionnaires covered one or more primary care outputs, yet at variable and mostly limited extent. EXPERT OPINION Measures of primary care outputs can strengthen clinical and health services research, but such measures have yet to be developed and validated for most primary care outputs. The use of these measures in outcome evaluations of interventions in healthcare would enhance the interpretation of intervention effects. Validated measures are also needed to tap the full potential of advanced methods of data-analysis in clinical and health services research. Better understanding of the primary care outputs may also help to mitigate broader challenges in healthcare systems.
Collapse
Affiliation(s)
- Michel Wensing
- Heidelberg University Hospital, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Catharina Roth
- Heidelberg University Hospital, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Katja Krug
- Heidelberg University Hospital, Department of General Practice and Health Services Research, Heidelberg, Germany
| |
Collapse
|
5
|
Forstner J, Koetsenruijjter J, Arnold C, Laux G, Wensing M. The Influence of Provider Connectedness on Continuity of Care and Hospital Readmissions in Patients With COPD: A Claims Data Based Social Network Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2023; 10:77-88. [PMID: 36516332 PMCID: PMC9995233 DOI: 10.15326/jcopdf.2022.0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Hospital readmission rates are very high in patients with chronic obstructive pulmonary disease (COPD). Continuity of care (CoC) with general practitioners (GPs) and ambulatory specialists can impact readmission rates. This study aimed to identify shared patient networks of ambulatory care physicians and to examine the effect of provider connectedness on CoC and hospital readmissions. Methods A retrospective observational study was conducted in claims data from the years 2016 to 2018 in patients with COPD (aged 40 years or older; hospital stay in 2017). Linkages between GPs, pneumologists, and cardiologists were determined on the basis of shared patients. Multilevel regression models were used to analyze the impact of provider connectedness, operationalized by several social network characteristics, on continuity of care (sequential continuity [SECON] index) and hospital readmission rates. Results A total of 7294 patients linked to 3673 GPs were available for analysis. Closeness centrality (β=- 0.029) and the external-internal (EI)-index (β =0.037) impacted on the SECON index. The EI-index (odds ratio [OR]=1.25) and degree centrality (OR=1.257) impacted 30-day readmission. Network density (OR=0.811) and the SECON index (OR=1.121) affected the likelihood of a 90-day readmission. None of the predictors had a significant impact on 180-day and 365-day readmissions. Conclusions Ambulatory care providers' connectedness showed some effects on hospital readmissions and CoC in patients with COPD up to 90 days after hospital discharge, but the additional predictive power is limited.
Collapse
Affiliation(s)
- Johanna Forstner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany
| | - Jan Koetsenruijjter
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany
| | - Christine Arnold
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany
| |
Collapse
|
6
|
Hospital Admission and Discharge: Lessons Learned from a Large Programme in Southwest Germany. Int J Integr Care 2023; 23:4. [PMID: 36741970 PMCID: PMC9881439 DOI: 10.5334/ijic.6534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
Introduction In the context of a GP-based care programme, we implemented an admission, discharge and follow-up programme. Description The VESPEERA programme consists of three sets of components: pre-admission interventions, in-hospital interventions and post-discharge interventions. It was aimed at all patients with a hospital stay participating in the GP-based care programme and was implemented in 7 hospitals and 72 general practices in southwest Germany using a range of strategies. Its' effectiveness was evaluated using readmissions within 90 days after discharge as primary outcome. Questionnaires with staff were used to explore the implementation process. Discussion A statistically significant effect was not found, but the effect size was similar to other interventions. Intervention fidelity was low and contextual factors affecting the implementation, amongst others, were available resources, external requirements such as legal regulations and networking between care providers. Lessons learned were derived that can aid to inform future political or scientific initiatives. Conclusion Structured information transfer at hospital admission and discharge makes sense but the added value in the context of a GP-based programme seems modest. Primary care teams should be involved in pre- and post-hospital care.
Collapse
|
7
|
Direct phone communication to primary care physician to plan discharge from hospital: feasibility and benefits. BMC Health Serv Res 2021; 21:1352. [PMID: 34922549 PMCID: PMC8684651 DOI: 10.1186/s12913-021-07398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The discharge summary is the main vector of communication at the time of hospital discharge, but it is known to be insufficient. Direct phone contact between hospitalist and primary care physician (PCP) at discharge could ensure rapid transmission of information, improve patient safety and promote interprofessional collaboration. The objective of this study was to evaluate the feasibility and benefit of a phone call from hospitalist to PCP to plan discharge. METHODS This study was a prospective, single-center, cross-sectional observational study. It took place in an acute medicine unit of a French university hospital. The hospitalist had to contact the PCP by telephone within 72 h prior discharge, making a maximum of 3 call attempts. The primary endpoint was the proportion of patients whose primary care physician could be reached by telephone at the time of discharge. The other criteria were the physicians' opinions on the benefits of this contact and its effect on readmission rates. RESULTS 275 patients were eligible. 8 hospitalists and 130 PCPs gave their opinion. Calls attempts were made for 71% of eligible patients. Call attempts resulted in successful contact with the PCP 157 times, representing 80% of call attempts and 57% of eligible patients. The average call completion rate was 47%. The telephone contact was perceived by hospitalist as useful and providing security. The PCPs were satisfied and wanted this intervention to become systematic. Telephone contact did not reduce the readmission rate. CONCLUSIONS Despite the implementation of a standardized process, the feasibility of the intervention was modest. The main obstacle was hospitalists lacking time and facing difficulties in reaching the PCPs. However, physicians showed desire to communicate directly by telephone at the time of discharge. TRIAL REGISTRATION French C.N.I.L. registration number 2108852. Registration date October 12, 2017.
Collapse
|