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Campaz-Landazábal D, Vargas I, Vázquez ML. Impact of coordination mechanisms based on information and communication technologies on cross-level clinical coordination: A scoping review. Digit Health 2024; 10:20552076241271854. [PMID: 39130524 PMCID: PMC11311193 DOI: 10.1177/20552076241271854] [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: 01/17/2024] [Accepted: 07/04/2024] [Indexed: 08/13/2024] Open
Abstract
Background Coordination mechanisms based on information and communication technologies (ICTs) are gaining attention, especially since the pandemic, due to their potential to improve communication between health professionals. However, their impact on cross-level clinical coordination remains unclear. The aim is to synthesize the evidence on the impact of ICT-based coordination mechanisms on clinical coordination between primary care and secondary care (SC) doctors and to identify knowledge gaps. Methods A scoping review was conducted by searching for original articles in six electronic databases and a manual search, with no restrictions regarding time, area, or methodology. Titles and abstracts were screened. Full texts of the selected articles were reviewed and analysed to assess the impact of each mechanism, according to the cross-level clinical coordination conceptual framework. Results Of the 6555 articles identified, 30 met the inclusion criteria. All had been conducted in high-income countries, most (n = 26) evaluated the impact of a single mechanism - asynchronous electronic consultations via electronic health records (EHR) - and were limited in terms of design and types and dimensions of cross-level clinical coordination analysed. The evaluation of electronic consultations showed positive impacts on the appropriateness of referrals and accessibility to SC, yet the qualitative studies also highlighted potential risks. Studies on other mechanisms were scarce (shared EHR, email consultations) or non-existent (videoconferencing, mobile applications). Conclusions Evidence of the impact of ICT-based mechanisms on clinical coordination between levels is limited. Rigorous evaluations are needed to inform policies and strategies for improving coordination between healthcare levels, thus contributing to high-quality, efficient healthcare.
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Affiliation(s)
- Daniela Campaz-Landazábal
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
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Rendell N, Rosewell A, Lokuge K, Field E. Common Features of Selection Processes of Health System Performance Indicators in Primary Healthcare: A Systematic Review. Int J Health Policy Manag 2022; 11:2805-2815. [PMID: 35368205 PMCID: PMC10105193 DOI: 10.34172/ijhpm.2022.6239] [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: 04/15/2021] [Accepted: 03/06/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Health system performance indicators are widely used to assess primary healthcare (PHC) performance. Despite the numerous tools and some convergence on indicator criteria, there is not a clear understanding of the common features of indicator selection processes. We aimed to review the literature to identify papers that document indicator selection processes for health system performance indicators in PHC. METHODS We searched the online databases Scopus, Medline, and CINAHL, as well as the grey literature, without time restrictions, initially on July 31, 2019 followed by an update November 13, 2020. Empirical studies or reports were included if they described the selection of health system performance indicators or frameworks, that included PHC indicators. A combination of the process focussed research question and qualitative analysis meant a quality appraisal tool or assessment of bias could not meaningfully be applied to assess individual studies. We undertook an inductive analysis based on potential indicator selection processes criteria, drawn from health system performance indicator appraisal tools reported in the literature. RESULTS We identified 16 503 records of which 28 were included in the review. Most studies used a descriptive case study design. We found no consistent variations between indicator selection processes of health systems of high income and low- or lower-middle income countries. Identified common features of selection processes for indicators in PHC include literature review or adaption of an existing framework as an initial step; a consensus building process with stakeholders; structuring indicators into categories; and indicator criteria focusing on validity and feasibility. The evidence around field testing with utility and consideration of reporting burden was less clear. CONCLUSION Our findings highlight several characteristics of health system indicator selection processes. These features provide the groundwork to better understand how to value indicator selection processes in PHC.
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Affiliation(s)
- Nicole Rendell
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Alexander Rosewell
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kamalini Lokuge
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Emma Field
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
- Menzies School of Health Research, Brisbane, QLD, Australia
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Vázquez ML, Miranda-Mendizabal A, Eguiguren P, Mogollón-Pérez AS, Ferreira-de-Medeiros-Mendes M, López-Vázquez J, Bertolotto F, Vargas I. Evaluating the effectiveness of care coordination interventions designed and implemented through a participatory action research process: Lessons learned from a quasi-experimental study in public healthcare networks in Latin America. PLoS One 2022; 17:e0261604. [PMID: 35020735 PMCID: PMC8754346 DOI: 10.1371/journal.pone.0261604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/06/2021] [Indexed: 11/27/2022] Open
Abstract
Background Despite increasing recommendations for health professionals to participate in intervention design and implementation to effect changes in clinical practice, little is known about this strategy’s effectiveness. This study analyses the effectiveness of interventions designed and implemented through participatory action research (PAR) processes in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay to improve clinical coordination across care levels, and offers recommendations for future research. Methods The study was quasi-experimental. Two comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys of a sample of primary and secondary care doctors (174 doctors/network/year) were conducted using the COORDENA® questionnaire. Most of the interventions chosen were based on joint meetings, promoting cross-level clinical agreement and communication for patient follow-up. Outcome variables were: a) intermediate: interactional and organizational factors; b) distal: experience of cross-level clinical information coordination, of clinical management coordination and general perception of coordination between levels. Poisson regression models were estimated. Results A statistically significant increase in some of the interactional factors (intermediate outcomes) -knowing each other personally and mutual trust- was observed in Brazil and Chile INs; and in some organizational factors -institutional support- in Colombia and Mexico. Compared to CNs in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. In distal outcomes, care consistency items improved in Brazil, Colombia and Uruguay INs; and patient follow-up improved in Chile and Mexico. General perception of clinical coordination increased in Brazil, Colombia and Mexico INs. Compared to CNs in 2017, only Brazil showed significant differences. Conclusions Although more research is needed, results show that PAR-based interventions improved some outcomes regarding clinical coordination at network level, with differences between countries. However, a PAR process is, by definition, slow and gradual, and longer implementation periods are needed to achieve greater penetration and quantifiable changes. The participatory and flexible nature of interventions developed through PAR processes poses methodological challenges (such as defining outcomes or allocating individuals to different groups in advance), and requires a comprehensive mixed-methods approach that simultaneously evaluates effectiveness and the implementation process to better understand its outcomes.
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Affiliation(s)
- María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Andrea Miranda-Mendizabal
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
- School of Medicine and Health Sciences, International University of Catalonia (UIC), Sant Cugat del Vallès, Spain
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | | | | | | | | | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
- * E-mail:
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Esteve-Matalí L, Vargas I, Cots F, Ramon I, Sánchez E, Escosa A, Vázquez ML. [Does the integration of health services management improve clinical coordination? Experience in Catalonia]. GACETA SANITARIA 2021; 36:324-332. [PMID: 34334227 DOI: 10.1016/j.gaceta.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To analyze the experience and perception of clinical coordination across care levels and doctor's organizational and interactional related factors, according to the type of management integration of the healthcare services of the area, in Catalonia. METHOD Cross-sectional study based on an online survey by self-administration of the questionnaire COORDENA-CAT. DATA COLLECTION October-December 2017. STUDY POPULATION primary and secondary care (acute and long-term care) doctors of the public Catalan health system. SAMPLE 3308 doctors. OUTCOME VARIABLES experience and perception of clinical coordination, knowledge and use of coordination mechanisms and organizational and interactional factors; explanatory variables: area according to type of management (integrated, semi-integrated, non-integrated), socio-demographic, employment characteristics and attitude toward work. Descriptive analysis by type of area and multivariate analysis by robust Poisson regression. RESULTS Better clinical coordination was observed in integrated areas compared to those semi-integrated, mainly in relation to information transfer, adequate follow-up and perception of coordination in the area. No differences were found between integrated and non-integrated areas in the clinical coordination experience, although there were differences in perception and some related factors. There are common problems across areas, such as accessibility to secondary care. CONCLUSIONS Few differences were found between integrated and non-integrated areas, revealing that management integration may facilitate clinical coordination but is not enough. Differences with semi-integrated areas indicate the need to promote cooperation formulas between all the providers of the territory, with common objectives and coordination mechanisms, in order to avoid inequalities in quality of care.
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Affiliation(s)
- Laura Esteve-Matalí
- Servei d'Estudis i Prospectives en Polítiques de Salut, Grup de Recerca en Polítiques de Salut i Serveis Sanitaris (GRPSS), Consorci de Salut i Social de Catalunya, Barcelona, España; Departmento de Pediatría, Obstetricia y Ginecología, y Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España
| | - Ingrid Vargas
- Servei d'Estudis i Prospectives en Polítiques de Salut, Grup de Recerca en Polítiques de Salut i Serveis Sanitaris (GRPSS), Consorci de Salut i Social de Catalunya, Barcelona, España.
| | | | - Isabel Ramon
- Consorci Hospitalari de Vic, Vic, Barcelona, España
| | - Elvira Sánchez
- Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós, Girona, España
| | - Alex Escosa
- Institut Català de la Salut, Barcelona, España
| | - María-Luisa Vázquez
- Servei d'Estudis i Prospectives en Polítiques de Salut, Grup de Recerca en Polítiques de Salut i Serveis Sanitaris (GRPSS), Consorci de Salut i Social de Catalunya, Barcelona, España
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Almeida HBD, Vanderlei LCDM, Mendes MFDM, Frias PGD. [Communicational relations between healthcare professionals and their influence on coordination of care]. CAD SAUDE PUBLICA 2021; 37:e00022020. [PMID: 33624697 DOI: 10.1590/0102-311x00022020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/11/2020] [Indexed: 11/21/2022] Open
Abstract
The study aims to understand the influence of communicational relations among healthcare professionals in the coordination of care between levels. This is a qualitative study with data from the international multicenter study Equity-LA II, with dialectic hermeneutics as the theoretical reference. The authors listened to the audios from 15 interviews with professionals (7 physicians from primary care and 5 from specialized care, and 3 institutional supporters from primary care) in a municipal network in the Agreste region of the state of Pernambuco, Brazil, in 2016. The mixed categories were submitted to content analysis. The analysis revealed a lack of recognition, by nearly all of the professionals, of primary care as the organizational backbone for care, and the perception of coordination revealed obstacles related to disconnects in establishing dialogical relations. Knowledge of the physician's role in primary care is incomplete, and its praxis is viewed with distrust by specialists, while the reciprocal is not true. There was a visibly non-dialogical interpersonal relationship, based on asymmetric relations reflected in the specialist's authoritarian stance and that of inferiority of primary care physicians. The basis for the communicative action relates to pretensions of validity rather than of power, which is external to language, and impedes the discussion of reasons and arguments. There was little disposition for dialogue and reciprocal recognition between the parties involved, with interdiction of a communicative situation in which there is symmetry of participation. The results revealed communicational weaknesses, thus requiring strategies that allow achieving communicative understanding among the professionals and promoting satisfactory patient follow-up between levels of care.
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Anjos EFD, Martins PC, Prado NMBDL, Bezerra VM, Almeida PFD, Santos AMD. MONITORING OF CERVICAL CANCER CONTROL ACTIONS AND ASSOCIATED FACTORS. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to analyze factors associated with the monitoring of actions to control cervical cancer in the Family Health Strategy, in a health region of northeastern Brazil. Method: a cross-sectional study conducted from January to March 2019 by means of interviews with 241 physicians and nurses from the Family Health Teams of the Vitória da Conquista health region, Bahia, Brazil. Adequate monitoring was assessed by the degree of actions taken to promote, prevent and actively seek to control cervical cancer. Three blocks of variables were tested as explanatory: professional characterization and training; organization of the unit and access to cytopathological exam; and care coordination and integration. Poisson regression with robust variance was employed, adopting hierarchical entry of variables. Results: 51.9% (95% CI: 45.5-58.2) of the professionals performed adequate monitoring for the control of cervical cancer. Being a nurse, working in the municipality’s primary care network (≥2 years), disclosure of results collection through posters and other communication means, existence of a high-grade lesion, time to perform the biopsy ≤1 month, and agility in the release of the reports were elements associated to the outcome. Conclusion: even with the extended coverage of the Family Health Strategy, small municipalities in the Northeast have characteristics that impose obstacles to comprehensiveness, favoring the incidence of high-grade lesions and greater difficulty in the control of cervical cancer. Assessing the assistance quality in this level revealed challenges in the regionalized network.
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Vargas I, Eguiguren P, Mogollón-Pérez AS, Samico I, Bertolotto F, López-Vázquez J, Vázquez ML. Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries. BMC Health Serv Res 2020; 20:941. [PMID: 33046079 PMCID: PMC7552474 DOI: 10.1186/s12913-020-05781-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Finding new strategies for care integration has become a policy priority for many fragmented health systems in Latin America. Although the implementation of interventions through a participatory action research (PAR) approach is considered to be more effective in achieving organizational change, its application is scarce. This study, part of the research project Equity-LA II, aims to analyze the impact of PAR interventions on care coordination across levels, and key aspects for their sustainability and transferability, from the stakeholder viewpoint in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. Different interventions were designed and implemented through a PAR process to improve communication and clinical agreement between primary care and secondary care doctors: joint meetings to discuss clinical cases and/or training; shared care guidelines; offline virtual consultations; a referral and reply letter; and an induction program. METHODS A qualitative, descriptive-interpretative study was conducted in the healthcare network of each country. Focus groups and semi-structured individual interviews were conducted with a criterion sample of participants: local steering committee (29) and professional platform members (28), other health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and type of intervention. RESULTS Informants highlighted that joint meetings based on reflexive methods contributed substantially to improving contextually relevant elements of clinical management coordination - communication in patient follow-up, clinical agreement, appropriateness of referrals - and also administrative coordination. The meetings, alongside the PAR process, also helped to improve interaction between professionals - knowing each other personally and mutual trust - thus fostering willingness to collaborate. The PAR approach, moreover, served to spread awareness of the coordination problems and need for intervention, encouraging greater commitment and interest in participating. No noteworthy contributions were identified in remaining interventions due to low uptake. A necessary condition for the sustainability and replicability was that PAR process had to be used appropriately in a favourable context. CONCLUSIONS Evidence is provided on the substantial contribution of interventions to improving locally relevant clinical coordination elements and professional interaction when implemented through an adequate PAR process (in terms of time, method and participation levels), a necessary condition for their sustainability and replicability.
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Affiliation(s)
- Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo 21, 08022, Barcelona, Spain.
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Avenida Independencia, 939, Santiago de Chile, Chile
| | - Amparo-Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, 11001, Bogotá, Colombia
| | - Isabella Samico
- Grupo de Estudos de Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Rua Dos Coelhos No. 300, Boa Vista, 50070-550 Recife, Brazil
| | - Fernando Bertolotto
- Facultad de Enfermería, Universidad de la República, Avenida 18 de Julio 124, 11200, Montevideo, Uruguay
| | - Julieta López-Vázquez
- Instituto de Salud Pública, Universidad Veracruzana, Avenida Dr. Luis Castelazo Ayala s/n. Col. Industrial Ánimas, 91190 Xalapa, Veracruz, Mexico
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo 21, 08022, Barcelona, Spain
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Esteve-Matalí L, Vargas I, Sánchez E, Ramon I, Plaja P, Vázquez ML. Do primary and secondary care doctors have a different experience and perception of cross-level clinical coordination? Results of a cross-sectional study in the Catalan National Health System (Spain). BMC FAMILY PRACTICE 2020; 21:135. [PMID: 32640991 PMCID: PMC7346358 DOI: 10.1186/s12875-020-01207-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/23/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Clinical coordination across care levels is a priority for health systems around the world, especially for those based on primary health care. The aim of this study is to analyse the degree of clinical information and clinical management coordination across healthcare levels in the Catalan national health system experienced by primary (PC) and secondary care (SC) doctors and explore the associated factors. METHODS Cross-sectional study based on an online survey using the self-administered questionnaire COORDENA-CAT. DATA COLLECTION October-December 2017. STUDY POPULATION PC and SC (acute and long term) doctors of the Catalan national health system. Participation rate was 21%, with a sample of 3308 doctors. OUTCOME VARIABLES cross-level clinical information coordination, clinical management coordination, and perception of cross-level coordination within the area. Explanatory variables: socio-demographic, employment characteristics, attitude towards job, type of area (according to type of hospital and management), interactional factors, organizational factors and knowledge of existing coordination mechanisms. Stratification variable: level of care. Descriptive and multivariate analysis by logistic regression. RESULTS The degree of clinical coordination experienced across levels of care was high for both PC and SC doctors, although PC doctors experienced greater exchange and use of information and SC doctors experienced greater consistency of care. However, only 32.13% of PC and 35.72% of SC doctors found that patient care was coordinated across care levels within their area. In both levels of care, knowing the doctors of the other level, working in an area where the same entity manages SC and majority of PC, and holding joint clinical case conferences were factors positively associated with perceiving high levels of clinical coordination. Other associated factors were specific to the care level, such as being informed of a patient's discharge from hospital for PC doctors, or trusting in the clinical skills of the other care level for SC doctors. CONCLUSIONS Interactional and organizational factors are positively associated with perceiving high levels of clinical coordination. Introducing policies to enhance such factors can foster clinical coordination between different health care levels. The COORDENA questionnaire allows us to identify fields for improvement in clinical coordination.
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Affiliation(s)
- Laura Esteve-Matalí
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
- Department for Paediatrics, Obstetrics and Gynaecology, Preventive Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain.
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Elvira Sánchez
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós, Spain
| | | | | | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
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Runtu TM, Novieastari E, Handayani H. How does organizational culture influence care coordination in hospitals? A systematic review. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mohr DC, Benzer JK, Vimalananda VG, Singer SJ, Meterko M, McIntosh N, Harvey KLL, Seibert MN, Charns MP. Organizational Coordination and Patient Experiences of Specialty Care Integration. J Gen Intern Med 2019; 34:30-36. [PMID: 31098971 PMCID: PMC6542960 DOI: 10.1007/s11606-019-04973-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Delivering care to patients with complex healthcare needs benefits from coordination among healthcare providers. Greater levels of care coordination have been associated with more favorable patient experiences, cost management, and lower utilization of services. Organizational approaches consider how systems, practices, and relationships influence coordination and associated outcomes. OBJECTIVE Examine measures of organizational coordination and their association with patient experiences of care coordination involving specialists. DESIGN Cross-sectional surveys of patients and primary care providers (PCPs). PARTICIPANTS Final sample included 3183 patients matched to 233 PCPs from the Veterans Health Administration. All patients had a diagnosis of type 2 diabetes mellitus and one of four other conditions: hypertension; congestive heart failure; depression/anxiety; or severe mental illness/posttraumatic stress disorder. MAIN MEASURES Patients completed a survey assessing perceptions of coordinated care. We examined ratings on three domains: specialist knowledge management; knowledge integration across settings and time; and knowledge fragmentation across settings and time. We created care coordination measures involving the PCP and three specialty provider types. PCPs provided ratings on relational coordination for specialists, feedback coordination, and team coordination. We aligned patient's specialty services used with corresponding PCP ratings of that specialty. KEY RESULTS Patient ratings were significantly lower on specialist knowledge management and knowledge integration when either PCPs did not use feedback coordination (b = - .20; b = - .17, respectively) or rated feedback coordination lower (b = - .08 for both). Teamwork was significantly related to specialist knowledge management (b = .06), knowledge integration (b = .04); and knowledge fragmentation (b = - .04). Relational coordination was related to coordination between the primary care provider and (i) diabetes specialist (b = .09) and (ii) mental health provider (b = .12). CONCLUSIONS Practices to improve provider coordination within and across primary care and specialty care services may improve patient experiences of care coordination. Improvements in these areas may improve care efficiency and effectiveness.
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Affiliation(s)
- David C Mohr
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA. .,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Justin K Benzer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas VA Healthcare System, Waco, TX, USA.,Department of Psychiatry, Dell Medical School of the University of Texas at Austin, Austin, TX, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA.,Section of Endocrinology, Diabetes and Metabolism, Boston University School of Medicine, Boston, MA, USA
| | - Sara J Singer
- Stanford School of Medicine and Graduate School of Business, Stanford, USA
| | - Mark Meterko
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.,Patient Experience Survey Team, VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID), ENRM Veterans Affairs Medical Center, Bedford, MA, USA
| | | | - Kimberly L L Harvey
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Marjorie Nealon Seibert
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Martin P Charns
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Prakash G, Srivastava S. Developing a Care Coordination Model Using a Hybrid DEMATEL and PLS-SEM Approach. IIM KOZHIKODE SOCIETY & MANAGEMENT REVIEW 2019. [DOI: 10.1177/2277975218812958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this article is to develop and assess a model for care coordination (CC). A novel hybrid approach of Decision-Making Trial and Evaluation Laboratory (DEMATEL) and partial least square structural equation modelling (PLS-SEM) has been used to assess the CC model. The study has been conducted in four phases: (a) literature review, (b) Delphi session, (c) development of CC model through DEMATEL and (d) validation of the model through PLS-SEM. The study involves perspectives of service providers as well as service receivers, for which data were collected from hospitals across India. The literature review and Delphi session helped in finalising the seven measures of CC. Identified measures of CC are: IT-enabled coordination, inter-professional teamwork and consistency, patient centredness, communication and information transfer, physical infrastructural facilities and requirements, delivery of quality care, and facilitating transitions and accountability. Patient-centredness was found to be the most important construct of CC. Delivery of quality care is the most influenced construct and is affected by all the other constructs. Based on the results, practitioners may develop an overarching strategy to deliver seamless care and better health outcomes. This understanding may help in designing processes which in turn would deliver health as a social good.
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Affiliation(s)
- Gyan Prakash
- Atal Bihari Vajpayee Indian Institute of Information Technology and Management (ABV-IIITM), Gwalior, Madhya Pradesh, India
| | - Shefali Srivastava
- Atal Bihari Vajpayee Indian Institute of Information Technology and Management (ABV-IIITM), Gwalior, Madhya Pradesh, India
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Galvão JR, Almeida PFD, Santos AMD, Bousquat A. Percursos e obstáculos na Rede de Atenção à Saúde: trajetórias assistenciais de mulheres em região de saúde do Nordeste brasileiro. CAD SAUDE PUBLICA 2019; 35:e00004119. [DOI: 10.1590/0102-31100004119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/07/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo: O artigo tem como objetivo avaliar a organização e o acesso à Rede de Atenção à Saúde em uma região de saúde, na perspectiva das usuárias. Foram construídas trajetórias assistenciais de mulheres com lesão intraepitelial escamosa de alto grau do colo do útero, adscritas a diferentes modalidades de atenção primária à saúde (APS) de zonas urbana e rural, em municípios do interior e da sede de região de saúde do Nordeste do Brasil. As mulheres utilizavam a APS como serviço de busca regular para ações preventivas e assistenciais, mas reportaram barreiras de acesso para consultas médicas, sobretudo nas zonas rurais. Avaliações positivas foram vinculadas ao acolhimento e à representação da unidade básica de saúde/unidade de saúde da família (UBS/USF) como lócus disponível para cuidados. Percepção de baixa resolutividade da APS esteve ligada à demora para o agendamento das referências, abastecimento irregular/insuficiente de medicamentos e rotatividade de médicos. As mulheres indicaram dificuldade de acesso à atenção especializada, mais evidente nos municípios do interior da região, com utilização de serviços públicos e privados. Todas as usuárias da sede da região realizaram exames de confirmação diagnóstica e cirurgia pelo Sistema Único de Saúde. Apoio de familiares, amigos e políticos atravessaram as trajetórias assistenciais. Comunicação interprofissional foi quase inexistente e entre profissional/usuária, precária. A rede regionalizada apresentou-se desarticulada e com fluxos desordenados, não garantindo acesso oportuno às usuárias dos municípios do interior e apresentando dificuldades adicionais àquelas da área rural, mesmo no município sede, desvelando a incompletude dos arranjos regionais e a manutenção de desigualdades de acesso inter e intramunicipal.
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Aller MB, Vargas I, Coderch J, Calero S, Cots F, Abizanda M, Colomés L, Farré J, Vázquez-Navarrete ML. Doctors’ opinions on clinical coordination between primary and secondary care in the Catalan healthcare system. GACETA SANITARIA 2019; 33:66-73. [DOI: 10.1016/j.gaceta.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/21/2017] [Accepted: 06/07/2017] [Indexed: 12/01/2022]
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Almeida PFD, Oliveira SCD, Giovanella L. Integração de rede e coordenação do cuidado: o caso do sistema de saúde do Chile. CIENCIA & SAUDE COLETIVA 2018; 23:2213-2228. [DOI: 10.1590/1413-81232018237.09622018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/11/2018] [Indexed: 11/21/2022] Open
Abstract
Resumo O artigo analisa a implementação de redes integradas de serviços de saúde (RISS) e de estratégias para a coordenação do cuidado pela APS no sistema de saúde do Chile em seu segmento público. Foram realizadas entrevistas semiestruturadas com “policymakers” do sistema público de saúde e academia, complementado por análise documental e revisão bibliográfica. O país destaca-se pela institucionalização de instrumentos de coordenação do cuidado amplamente reconhecidos como mapas de derivação, médico gestor de demanda, prontuários eletrônicos e, sobretudo, definição de protocolos, sob forte liderança do Ministério da Saúde e condução pelos gestores dos “Servicios de Salud”, espaço regional de construção das RISS. Contudo, identificam-se camadas de segmentação e fragmentação no interior do subsistema público com a manutenção da livre-eleição para consultas especializadas e duplas filas de espera – uma para os procedimentos com garantias explícitas de acesso e outra para os demais. A experiência chilena demonstra a necessidade de maior protagonismo da APS para que seja capaz de assumir a condução das RISS. No país, as redes parecem orbitar ao redor de grandes e potentes hospitais. Elementos do contexto mais amplo do sistema de saúde também condicionam avanços e impasses no desenvolvimento das estratégias analisadas.
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Waibel S, Vargas I, Coderch J, Vázquez ML. Relational continuity with primary and secondary care doctors: a qualitative study of perceptions of users of the Catalan national health system. BMC Health Serv Res 2018; 18:257. [PMID: 29631622 PMCID: PMC5891958 DOI: 10.1186/s12913-018-3042-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 03/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background In the current context of increasingly fragmented healthcare systems where patients are seen by multiple doctors in different settings, patients’ relational continuity with one doctor is regaining relevance; however little is known about relational continuity with specialists. The aim of this study is to explore perceptions of relational continuity with primary care and secondary care doctors, its influencing factors and consequences from the viewpoint of users of the Catalan national health system (Spain). Methods We conducted a descriptive-interpretative qualitative study using a two-stage theoretical sample; (i) contexts: three healthcare areas in the Catalan national health system with differing characteristics; (ii) informants: users 18 years or older attended to at both care levels. Sample size (n = 49) was reached by saturation. Data were collected by individual semi-structured interviews, which were audio recorded and transcribed. A thematic content analysis was carried out segmenting data by study area, and leaving room for new categories to emerge from the data. Results Patients across the areas studied generally experienced consistency of primary care doctors (PCD), alongside some inconsistency of specialists. Consistency of specialists did not seem to be relevant to some patients when their clinical information was shared and used. Patients who experienced consistency and frequent visits with the same PCD or specialist described and valued having established an ongoing relationship characterised by personal trust and mutual accumulated knowledge. Identified consequences were diverse and included, for example, facilitated diagnosis or improved patient-doctor communication. The ascription to a PCD, a health system-related factor, facilitated relational continuity with the PCD, whereas organizational factors (for instance, the size of the primary care centre) favoured consistency of PCD and specialists. Doctor-related factors (for example, high technical competence or commitment to patient care) particulary fostered the development of an ongoing relationship. Conclusions Consistency of doctors differs depending on the care level as does the relevance attributed to it. Most influencing factors can be applied to both care levels and might be addressed by healthcare managers to foster relational continuity. More research is needed to fully understand the relevance patients assign to relational continuity with specialists. Electronic supplementary material The online version of this article (10.1186/s12913-018-3042-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sina Waibel
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Av. Tibidabo 21, 08022, Barcelona, Spain. .,Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Av. de Can Domènech 737, 08193, Bellaterra (Cerdanyola de Vallès), Spain.
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Av. Tibidabo 21, 08022, Barcelona, Spain
| | - Jordi Coderch
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut, Serveis de Salut Integrats Baix Empordà, Carrer Hospital 17-19 Edifici Fleming, 17230, Palamós, Spain
| | - María-Luisa Vázquez
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut, Serveis de Salut Integrats Baix Empordà, Carrer Hospital 17-19 Edifici Fleming, 17230, Palamós, Spain
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Jesus RPFSD, Santo ACGDE, Mendes MFDM, Samico IC. Percepção dos profissionais sobre a coordenação entre níveis de atenção à saúde em dois municípios pernambucanos de grande porte. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/1807-57622017.0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objetivou-se conhecer a percepção de profissionais de saúde sobre a coordenação da atenção entre níveis assistenciais em dois municípios do estado de Pernambuco, Brasil. Pesquisa qualitativa foi realizada por meio de entrevistas em profundidade, com 51 profissionais de atenção básica (AB) e especializada (AE) quanto à coordenação da gestão clínica e fatores que a influenciam. Os resultados mostraram que, embora se observe compreensão insuficiente do termo Coordenação da atenção entre níveis, há reconhecimento da importância e do esforço em investir nesse processo. A insuficiência de comunicação entre AB e AE é vista como causa e consequência de problemas que dificultam a coordenação da gestão clínica nas dimensões do seguimento, acessibilidade e coerência da atenção. Não se observaram iniciativas de aproximação entre profissionais da AB e AE, no sentido de promover conhecimento mútuo, fortalecer a qualificação profissional e o manejo conjunto dos casos.
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Aller MB, Vargas I, Coderch J, Vázquez ML. Doctors' opinion on the contribution of coordination mechanisms to improving clinical coordination between primary and outpatient secondary care in the Catalan national health system. BMC Health Serv Res 2017; 17:842. [PMID: 29273045 PMCID: PMC5741878 DOI: 10.1186/s12913-017-2690-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical coordination is considered a health policy priority as its absence can lead to poor quality of care and inefficiency. A key challenge is to identify which strategies should be implemented to improve coordination. The aim is to analyse doctors' opinions on the contribution of mechanisms to improving clinical coordination between primary and outpatient secondary care and the factors influencing their use. METHODS A qualitative descriptive study in three healthcare networks of the Catalan national health system. A two-stage theoretical sample was designed: in the first stage, networks with different management models were selected; in the second, primary care (n = 26) and secondary care (n = 24) doctors. Data were collected using semi-structured interviews. Final sample size was reached by saturation. A thematic content analysis was conducted, segmented by network and care level. RESULTS With few differences across networks, doctors identified similar mechanisms contributing to clinical coordination: 1) shared EMR facilitating clinical information transfer and uptake; 2) mechanisms enabling problem-solving communication and agreement on clinical approaches, which varied across networks (joint clinical case conferences, which also promote mutual knowledge and training of primary care doctors; virtual consultations through EMR and email); and 3) referral protocols and use of the telephone facilitating access to secondary care after referrals. Doctors identified organizational (insufficient time, incompatible timetables, design of mechanisms) and professional factors (knowing each other, attitude towards collaboration, concerns over misdiagnosis) that influence the use of mechanisms. DISCUSSION Mechanisms that most contribute to clinical coordination are feedback mechanisms, that is those based on mutual adjustment, that allow doctors to exchange information and communicate. Their use might be enhanced by focusing on adequate working conditions, mechanism design and creating conditions that promote mutual knowledge and positive attitudes towards collaboration.
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Affiliation(s)
- Marta-Beatriz Aller
- Health Policy and Health Services Research Group; Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
| | - Ingrid Vargas
- Health Policy and Health Services Research Group; Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
| | - Jordi Coderch
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut; Serveis de Salut Integrats Baix Empordà, Hospital, 17-19 Edif. Fleming, 17230 Palamós, Spain
| | - Maria-Luisa Vázquez
- Health Policy and Health Services Research Group; Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
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Rucci P, Foglino S, Bravi F, D'Avenia R, Altini M, Carradori T, Angelastro A, Fantini MP. Validation of the OPportunity for Treatment In ONcology (OPTION) questionnaire measuring continuity of care. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28895233 DOI: 10.1111/ecc.12765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 11/29/2022]
Abstract
Increasing efforts are ongoing to deliver effective cancer care through integrated networks of services. Measuring patients' experience of care is essential to identify problematic areas that require organisational adjustments. The aim of the present study was to examine the validity of OPTION questionnaire, designed to measure patient's perceived continuity of care across different phases of their care pathway. The study was carried at the Institute for Cancer Treatment and Research, Meldola and the oncology departments of the Local Health Authority of Romagna, Italy. Principal component analysis (PCA) was performed to identify factors underlying patients' perception of continuity of care. Factor scores were compared between patients with or without a care coordinator using Mann-Whitney test. The study sample consisted of 214 patients with breast or colorectal cancer, with a mean age of 62.3 years. Most patients identified the oncologist as their care coordinator. Five factors were extracted using PCA: (1) "trustful relationship with health care staff," (2) "information on care pathway," (3) "information on changes related to the illness," (4) "feelings of abandonment" and (5) "collaboration among health care professionals." The scores of factors 2 and 3 were significantly higher among those with a care coordinator. The OPTION questionnaire is a reliable instrument that can help clinicians and administrative stakeholder target efforts and resources in the pursuit of quality of care.
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Affiliation(s)
- Paola Rucci
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | | | - Rossella D'Avenia
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | | | - Angela Angelastro
- Area Qualità e Accreditamento, Agenzia nazionale per i servizi sanitari, Roma, Italy
| | - Maria Pia Fantini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
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Doctors' experience of coordination across care levels and associated factors. A cross-sectional study in public healthcare networks of six Latin American countries. Soc Sci Med 2017; 182:10-19. [DOI: 10.1016/j.socscimed.2017.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/27/2017] [Accepted: 04/01/2017] [Indexed: 11/21/2022]
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Waibel S, Vargas I, Aller MB, Coderch J, Farré J, Vázquez ML. Continuity of clinical management and information across care levels: perceptions of users of different healthcare areas in the Catalan national health system. BMC Health Serv Res 2016; 16:466. [PMID: 27590595 PMCID: PMC5010665 DOI: 10.1186/s12913-016-1696-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 08/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The integration of health care has become a priority in most health systems, as patients increasingly receive care from several professionals in various different settings and institutions, particularly those with chronic conditions and multi-morbidities. Continuity of care is defined as one patient experiencing care over time as connected and coherent with his or her health needs and personal circumstances. The objective is to analyse perceptions of continuity of clinical management and information across care levels and the factors influencing it, from the viewpoint of users of the Catalan national health system. METHODS A descriptive-interpretative qualitative study was conducted using a phenomenological approach. A two-stage theoretical sample was selected: (i) the study contexts: healthcare areas in Catalonia with different services management models; (ii) users ≥ 18 years of age who were attended to at both care levels for the same health problem. Data were collected by means of individual semi-structured interviews with patients (n = 49). All interviews were recorded and transcribed. A thematic content analysis was conducted segmented by study area, with a mixed generation of categories and triangulation of analysts. RESULTS Patients in all three areas generally perceived that continuity of clinical management across levels existed, on referring to consistent care (same diagnosis and treatment by doctors of both care levels, no incompatibilities of prescribed medications, referrals across levels when needed) and accessibility across levels (timeliness of appointments). In terms of continuity of information, patients in most areas mentioned the existence of information sharing via computer and its adequate usage. Only a few discontinuity elements were reported such as long waiting times for specific tests performed in secondary care or insufficient use of electronic medical records by locum doctors. Different factors influencing continuity were identified by patients, relating to the health system itself (clear distribution of roles between primary and secondary care), health services organizations (care coordination mechanisms, co-location, insufficient resources) and physicians (willingness to collaborate, commitment to patient care, the primary care physician's technical competence). CONCLUSIONS Care continuity across care levels is experienced by patients in the areas studied, with certain exceptions that highlight where there is room for improvement. Influencing factors offer valuable insights on where to direct coordination efforts.
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Affiliation(s)
- Sina Waibel
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Av. Tibidabo 21, 08022, Barcelona, Spain. .,Department for Paediatrics, Obstetrics and Gynaecology, Preventive Medicine, Universitat Autònoma de Barcelona, Av. de Can Domènech 737, Bellaterra (Cerdanyola del Vallès), 08193, Spain.
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Av. Tibidabo 21, 08022, Barcelona, Spain
| | - Marta-Beatriz Aller
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Av. Tibidabo 21, 08022, Barcelona, Spain
| | - Jordi Coderch
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut, Serveis de Salut Integrats Baix Empordà, Carrer Hospital 17-19 Edifici Fleming, Palamós, 17230, Spain
| | - Joan Farré
- Centre Integral de Salut Cotxers, Av. de Borbó 18 - 30, Barcelona, 08016, Spain
| | - M Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Av. Tibidabo 21, 08022, Barcelona, Spain
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