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Oddy C, Zhang J, Morley J, Ashrafian H. Promising algorithms to perilous applications: a systematic review of risk stratification tools for predicting healthcare utilisation. BMJ Health Care Inform 2024; 31:e101065. [PMID: 38901863 PMCID: PMC11191805 DOI: 10.1136/bmjhci-2024-101065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/14/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES Risk stratification tools that predict healthcare utilisation are extensively integrated into primary care systems worldwide, forming a key component of anticipatory care pathways, where high-risk individuals are targeted by preventative interventions. Existing work broadly focuses on comparing model performance in retrospective cohorts with little attention paid to efficacy in reducing morbidity when deployed in different global contexts. We review the evidence supporting the use of such tools in real-world settings, from retrospective dataset performance to pathway evaluation. METHODS A systematic search was undertaken to identify studies reporting the development, validation and deployment of models that predict healthcare utilisation in unselected primary care cohorts, comparable to their current real-world application. RESULTS Among 3897 articles screened, 51 studies were identified evaluating 28 risk prediction models. Half underwent external validation yet only two were validated internationally. No association between validation context and model discrimination was observed. The majority of real-world evaluation studies reported no change, or indeed significant increases, in healthcare utilisation within targeted groups, with only one-third of reports demonstrating some benefit. DISCUSSION While model discrimination appears satisfactorily robust to application context there is little evidence to suggest that accurate identification of high-risk individuals can be reliably translated to improvements in service delivery or morbidity. CONCLUSIONS The evidence does not support further integration of care pathways with costly population-level interventions based on risk prediction in unselected primary care cohorts. There is an urgent need to independently appraise the safety, efficacy and cost-effectiveness of risk prediction systems that are already widely deployed within primary care.
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Affiliation(s)
- Christopher Oddy
- Department of Anaesthesia, Critical Care and Pain, Kingston Hospital NHS Foundation Trust, London, UK
| | - Joe Zhang
- Imperial College London Institute of Global Health Innovation, London, UK
- London AI Centre, Guy's and St. Thomas' Hospital, London, UK
| | - Jessica Morley
- Digital Ethics Center, Yale University, New Haven, Connecticut, USA
| | - Hutan Ashrafian
- Imperial College London Institute of Global Health Innovation, London, UK
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Joseph L, Krishnan A, Lekha TR, Sasidharan N, Thulaseedharan JV, Valamparampil MJ, Harikrishnan S, Greenfield S, Gill P, Davies J, Manaseki-Holland S, Jeemon P. Experiences and challenges of people living with multiple long-term conditions in managing their care in primary care settings in Kerala, India: A qualitative study. PLoS One 2024; 19:e0305430. [PMID: 38870110 PMCID: PMC11175503 DOI: 10.1371/journal.pone.0305430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Multimorbidity or multiple long-term conditions (MLTCs), the coexistence of two or more chronic conditions within an individual, presents a growing concern for healthcare systems and individuals' well-being. However, we know little about the experiences of those living with MLTCs in low- and middle-income countries (LMICs) such as India. We explore how people living with MLTCs describe their illness, their engagements with healthcare services, and challenges they face within primary care settings in Kerala, India. METHODS We designed a qualitative descriptive study and conducted in-depth, semi-structured interviews with 31 people (16 males and 15 females) from family health centres (FHCs) in Kerala. Interview data were recorded, transcribed, and thematic analysis using the Framework Method was undertaken. FINDINGS Two main themes and three sub-themes each were identified; (1) Illness impacts on life (a)physical issues (b) psychological difficulties (c) challenges of self-management and (2) Care-coordination maze (a)fragmentation and poor continuity of care (b) medication management; an uphill battle and (c) primary care falling short. All participants reported physical and psychological challenges associated with their MLTCs. Younger participants reported difficulties in their professional lives, while older participants found household activities challenging. Emotional struggles encompassed feelings of hopelessness and fear rooted in concerns about chronic illness and physical limitations. Older participants, adhering to Kerala's familial support norms, often found themselves emotionally distressed by the notion of burdening their children. Challenges in self-management, such as dietary restrictions, medication adherence, and physical activity engagement, were common. The study highlighted difficulties in coordinating care, primarily related to traveling to multiple healthcare facilities, and patients' perceptions of FHCs as fit for diabetes and hypertension management rather than their multiple conditions. Additionally, participants struggled to manage the task of remembering and consistently taking multiple medications, which was compounded by confusion and memory-related issues. CONCLUSION This study offers an in-depth view of the experiences of individuals living with MLTCs from Kerala, India. It emphasizes the need for tailored and patient-centred approaches that enhance continuity and coordination of care to manage complex MLTCs in India and similar LMICs.
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Affiliation(s)
- Linju Joseph
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Athira Krishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Neethu Sasidharan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Paramjit Gill
- Academic Unit of Primary Care (AUPC) Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Justine Davies
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Semira Manaseki-Holland
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Duevel JA, Gruhn S, Grosser J, Elkenkamp S, Greiner W. Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers. Healthcare (Basel) 2024; 12:1157. [PMID: 38891232 PMCID: PMC11172283 DOI: 10.3390/healthcare12111157] [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: 04/22/2024] [Revised: 05/21/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Strokes remain a leading cause of death and disability worldwide. The STROKE OWL study evaluated a novel case management approach for patients with stroke (modified Rankin Scale 0-4) or transient ischemic attack (TIA) who received support across healthcare settings and secondary prevention training from case managers for one year. The primary aim of this quasi-experimental study was a reduction in stroke recurrence. Here, we report the results of a health economic analysis of the STROKE OWL study, conducted in accordance with CHEERS guidelines. The calculations were based on claims data of cooperating statutory health insurance companies. In addition to a regression analysis for cost comparison, the incremental cost-effectiveness ratio was determined, and a probabilistic sensitivity analysis was carried out. In total, 1167 patients per group were included in the analysis. The intervention group incurred 32.3% higher direct costs (p < 0.001) than the control group. With a difference of EUR 1384.78 (95% CI: [1.2384-1.4143], p < 0.0001) and a 5.32% increase in hazards for the intervention group (HR = 1.0532, 95% CI: [0.7869-1.4096], p = 0.7274) resulting in an ICER of EUR 260.30, we found that the case management intervention dominated in the total stroke population, even for an arbitrarily high willingness to pay. In the TIA subgroup, however, the intervention was cost-effective even for a low willingness to pay. Our results are limited by small samples for both TIA and severe stroke patients and by claims data heterogeneity for some cost components, which had to be excluded from the analysis. Future research should investigate the cost-effectiveness of case management interventions for both severe stroke and TIA populations using appropriate data.
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Affiliation(s)
- Juliane A. Duevel
- AG 5—Health Economy and Healthcare Management, Faculty of Public Health, Bielefeld University, 33615 Bielefeld, Germany
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Tilhou A, Baldwin M, Alves J. No Time to Wait: Leveraging Primary Care to Treat Stimulant Use Disorder. Am J Prev Med 2024:S0749-3797(24)00145-4. [PMID: 38762205 DOI: 10.1016/j.amepre.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Alyssa Tilhou
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Marielle Baldwin
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
| | - Justin Alves
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
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5
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Rasmussen MK, Benthien KS, Nielsen CP, Rasmussen K, Grønkjær M, Toft U, Kidholm K. Cost-effectiveness of proactive health support-telephone-based self-management support compared with standard care for persons at risk of hospital admission. Age Ageing 2024; 53:afae036. [PMID: 38476101 DOI: 10.1093/ageing/afae036] [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: 06/16/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND A small share of patients account for a large proportion of costs to the healthcare system in Denmark as in many Western countries. A telephone-based self-management support, proactive health support (PaHS), was suggested for prevention of hospitalisations for persons at risk of hospital admission. These persons have chronic diseases, unplanned hospitalisations and age ≥ 65 years. However, evidence is limited on whether this type of intervention is cost-effective. AIM The aim of this study was to assess the incremental cost-utility ratio (ICER) of PaHS, compared with standard care. METHODS The economic evaluation was nested within a randomised controlled trial, and was based on a health system perspective, with follow-up and time horizon of 12 months. We measured incremental costs per quality-adjusted life years (QALY) gained. Total average costs per patient included PaHS programme costs, and costs in hospitals, primary care and municipalities. We analysed differences by generalised linear models with Gamma distribution for costs and mixed models for QALY. RESULTS We analysed data on 6,139 patients, where 3,041 received PaHS and 3,098 received usual care. We found no difference in healthcare costs, and programme costs were on average €1,762 per patient, providing incremental costs of €2,075. Incremental effects on QALY were 0.007, resulting in an ICER of €296,389 per QALY gained. CONCLUSION We found no evidence of PaHS being cost-effective in this study, but the results will be used to identify new ways to organise similar interventions and identify patients with the objective to reduce health system costs per patient.
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Affiliation(s)
- Maja Kjær Rasmussen
- Centre for Innovative Medical Technology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Kirstine Skov Benthien
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Palliative Care Unit, Copenhagen University Hospital, Hvidovre, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM-Social & Health Services and Labour Market, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Knud Rasmussen
- Department of Data and Development Support, Region Zealand, Sorø, Denmark
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Toft
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
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Ress V, Wild EM. The impact of integrated care on health care utilization and costs in a socially deprived urban area in Germany: A difference-in-differences approach within an event-study framework. HEALTH ECONOMICS 2024; 33:229-247. [PMID: 37876111 DOI: 10.1002/hec.4771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/16/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
We investigated the impact of an integrated care initiative in a socially deprived urban area in Germany. Using administrative data, we empirically assessed the causal effect of its two sub-interventions, which differed by the extent to which their instruments targeted the supply and demand side of healthcare provision. We addressed confounding using propensity score matching via the Super Learner machine learning algorithm. For our baseline model, we used a two-way fixed-effects difference-in-differences approach to identify causal effects. We then employed difference-in-differences analyses within an event-study framework to explore the heterogeneity of treatment effects over time, allowing us to disentangle the effects of the sub-interventions and improve causal interpretation and generalizability. The initiative led to a significant increase in hospital and emergency admissions and non-hospital outpatient visits, as well as inpatient, non-hospital outpatient, and total costs. Increased utilization may indicate that the intervention improved access to care or identified unmet need.
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Affiliation(s)
- Vanessa Ress
- Department of Health Care Management, University of Hamburg, Hamburg, Germany
- Hamburg Center for Health Economics (HCHE), Hamburg, Germany
| | - Eva-Maria Wild
- Department of Health Care Management, University of Hamburg, Hamburg, Germany
- Hamburg Center for Health Economics (HCHE), Hamburg, Germany
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Kroenke K, Corrigan JD, Ralston RK, Zafonte R, Brunner RC, Giacino JT, Hoffman JM, Esterov D, Cifu DX, Mellick DC, Bell K, Scott SG, Sander AM, Hammond FM. Effectiveness of care models for chronic disease management: A scoping review of systematic reviews. PM R 2024; 16:174-189. [PMID: 37329557 DOI: 10.1002/pmrj.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To conduct a scoping review of models of care for chronic disease management to identify potentially effective components for management of chronic traumatic brain injury (TBI). METHODS Information sources: Systematic searches of three databases (Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews) from January 2010 to May 2021. ELIGIBILITY CRITERIA Systematic reviews and meta-analyses reporting on the effectiveness of the Chronic Care Model (CCM), collaborative/integrated care, and other chronic disease management models. DATA Target diseases, model components used (n = 11), and six outcomes (disease-specific, generic health-related quality of life and functioning, adherence, health knowledge, patient satisfaction, and cost/health care use). SYNTHESIS Narrative synthesis, including proportion of reviews documenting outcome benefits. RESULTS More than half (55%) of the 186 eligible reviews focused on collaborative/integrated care models, with 25% focusing on CCM and 20% focusing on other chronic disease management models. The most common health conditions were diabetes (n = 22), depression (n = 16), heart disease (n = 12), aging (n = 11), and kidney disease (n = 8). Other single medical conditions were the focus of 22 reviews, multiple medical conditions of 59 reviews, and other or mixed mental health/behavioral conditions of 20 reviews. Some type of quality rating for individual studies was conducted in 126 (68%) of the reviews. Of reviews that assessed particular outcomes, 80% reported disease-specific benefits, and 57% to 72% reported benefits for the other five types of outcomes. Outcomes did not differ by the model category, number or type of components, or target disease. CONCLUSIONS Although there is a paucity of evidence for TBI per se, care model components proven effective for other chronic diseases may be adaptable for chronic TBI care.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Rick K Ralston
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas, USA
| | - Steven G Scott
- Center of Innovation on Disability & Rehab Research (CINDRR), James A Haley Veterans' Hospital, Tampa, Florida, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Bull LM, Arendarczyk B, Reis S, Nguyen A, Werr J, Lovegrove-Bacon T, Stone M, Sherlaw-Johnson C. Impact on all-cause mortality of a case prediction and prevention intervention designed to reduce secondary care utilisation: findings from a randomised controlled trial. Emerg Med J 2023; 41:51-59. [PMID: 37827821 DOI: 10.1136/emermed-2022-212908] [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: 10/14/2022] [Accepted: 09/03/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Health coaching services could help to reduce emergency healthcare utilisation for patients targeted proactively by a clinical prediction model (CPM) predicting patient likelihood of future hospitalisations. Such interventions are designed to empower patients to confidently manage their own health and effectively utilise wider resources. Using CPMs to identify patients, rather than prespecified criteria, accommodates for the dynamic hospital user population and for sufficient time to provide preventative support. However, it is unclear how this care model would negatively impact survival. METHODS Emergency Department (ED) attenders and hospital inpatients between 2015 and 2019 were automatically screened for their risk of hospitalisation within 6 months of discharge using a locally trained CPM on routine data. Those considered at risk and screened as suitable for the intervention were contacted for consent and randomised to one-to-one telephone health coaching for 4-6 months, led by registered health professionals, or routine care with no contact after randomisation. The intervention involved motivational guidance, support for self-care, health education, and coordination of social and medical services. Co-primary outcomes were emergency hospitalisation and ED attendances, which will be reported separately. Mortality at 24 months was a safety endpoint. RESULTS Analysis among 1688 consented participants (35% invitation rate from the CPM, median age 75 years, 52% female, 1139 intervention, 549 control) suggested no significant difference in overall mortality between treatment groups (HR (95% CI): 0.82 (0.62, 1.08), pr(HR<1=0.92), but did suggest a significantly lower mortality in men aged >75 years (HR (95% CI): 0.57 (0.37, 0.84), number needed to treat=8). Excluding one site unable to adopt a CPM indicated stronger impact for this patient subgroup (HR (95% CI): 0.45 (0.26, 0.76)). CONCLUSIONS Early mortality in men aged >75 years may be reduced by supporting individuals at risk of unplanned hospitalisation with a clear outreach, out-of-hospital nurse-led, telephone-based coaching care model.
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Affiliation(s)
- Lucy M Bull
- Modelling and Insights, Health Navigator, London, UK
| | | | - Sara Reis
- Modelling and Insights, Health Navigator, London, UK
| | - An Nguyen
- Data Science and Strategy, Health Navigator, London, UK
| | | | - Thomas Lovegrove-Bacon
- Strategic Development, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Mark Stone
- North Place Clinical Lead, Staffordshire and Stoke ICB, Stafford, UK
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Parry E, Ahmed K, Evans S, Guest E, Klaire V, Koodaruth A, Labutale P, Matthews D, Lampitt J, Pickavance G, Sidhu M, Warren K, Singh B. GP assessment of unmet need in a complex multimorbid population using a data-driven and clinical triage system: a prospective cohort study. BJGP Open 2023; 7:BJGPO.2023.0078. [PMID: 37385665 PMCID: PMC11176674 DOI: 10.3399/bjgpo.2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Patients with unmet healthcare needs are more likely to access unscheduled care. Identifying these patients through data-driven and clinical risk stratification for active case management in primary care can help address patient need and reduce demand on acute services. AIM To determine how a proactive digital healthcare system can be used to undertake comprehensive needs analysis of patients at risk of unplanned admission and mortality. DESIGN & SETTING Prospective cohort study of six general practices in a deprived UK city. METHOD To identify those with unmet needs, the study's population underwent digitally-driven risk stratification into Escalated and Non-escalated groups using seven risk factors. The Escalated group underwent further stratification using GP clinical assessment into Concern and No concern groups. The Concern group underwent Unmet Needs Analysis (UNA). RESULTS From 24 746 patients, 516 (2.1%) were triaged into the Concern group and 164 (0.7%) underwent UNA. These patients were more likely to be older (t = 4.69, P<0.001), female (X2 = 4.46, P<0.05), have a Patients At Risk of Re-hospitalisation (PARR) score ≥80 (X2 = 4.31, P<0.05), be a nursing home resident (X2 = 6.75, P<0.01), or on an end-of-life (EOL) register (X2 = 14.55, P<0.001). Following UNA, 143 (87.2%) patients had further review planned or were referred for further input. The majority of patients had four domains of need. In those who GPs would not be surprised if they died within the next few months, n = 69 (42.1%) were not on an EOL register. CONCLUSION This study showed how an integrated, patient-centred, digital care system working with GPs can highlight and implement resources to address the escalating care needs of complex individuals.
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Affiliation(s)
- Emma Parry
- School of Medicine, Keele University, Staffordshire, UK
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Simon Evans
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Vijay Klaire
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | | | - Dawn Matthews
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Jonathan Lampitt
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Mona Sidhu
- Lee Road Medical Practice, Wolverhampton, UK
| | - Kate Warren
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- The City of Wolverhampton Council, Wolverhampton, UK
| | - Baldev Singh
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- University of Wolverhampton, School of Medicine and Clinical Practice, Faculty of Science and Engineering, Wolverhampton, UK
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10
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Hempel S, Bolshakova M, Hochman M, Jimenez E, Thompson G, Motala A, Ganz DA, Gabrielian S, Edwards S, Zenner J, Dennis B, Chang E. Caring for high-need patients. BMC Health Serv Res 2023; 23:1289. [PMID: 37996845 PMCID: PMC10668484 DOI: 10.1186/s12913-023-10236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE We aimed to explore the construct of "high need" and identify common need domains among high-need patients, their care professionals, and healthcare organizations; and to describe the interventions that health care systems use to address these needs, including exploring the potential unintended consequences of interventions. METHODS We conducted a modified Delphi panel informed by an environmental scan. Expert stakeholders included patients, interdisciplinary healthcare practitioners (physicians, social workers, peer navigators), implementation scientists, and policy makers. The environmental scan used a rapid literature review and semi-structured interviews with key informants who provide healthcare for high-need patients. We convened a day-long virtual panel meeting, preceded and followed by online surveys to establish consensus. RESULTS The environmental scan identified 46 systematic reviews on high-need patients, 19 empirical studies documenting needs, 14 intervention taxonomies, and 9 studies providing construct validity for the concept "high need." Panelists explored the construct and terminology and established that individual patients' needs are unique, but areas of commonality exist across all high-need patients. Panelists agreed on 11 domains describing patient (e.g., social circumstances), 5 care professional (e.g., communication), and 8 organizational (e.g., staffing arrangements) needs. Panelists developed a taxonomy of interventions with 15 categories (e.g., care navigation, care coordination, identification and monitoring) directed at patients, care professionals, or the organization. The project identified potentially unintended consequences of interventions for high-need patients, including high costs incurred for patients, increased time and effort for care professionals, and identification of needs without resources to respond appropriately. CONCLUSIONS Care for high-need patients requires a thoughtful approach; differentiating need domains provides multiple entry points for interventions directed at patients, care professionals, and organizations. Implementation efforts should consider outlined intended and unintended downstream effects on patients, care professionals, and organizations.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA.
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Michael Hochman
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA
| | - Elvira Jimenez
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Gina Thompson
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - David A Ganz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | | | - James Zenner
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | - Ben Dennis
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Evelyn Chang
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Arakelyan S, Mikula-Noble N, Ho L, Lone N, Anand A, Lyall MJ, Mercer SW, Guthrie B. Effectiveness of holistic assessment-based interventions for adults with multiple long-term conditions and frailty: an umbrella review of systematic reviews. THE LANCET. HEALTHY LONGEVITY 2023; 4:e629-e644. [PMID: 37924844 DOI: 10.1016/s2666-7568(23)00190-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 11/06/2023] Open
Abstract
Holistic assessment-based interventions (HABIs) are effective in older people admitted to hospital, but it is unclear whether similar interventions are effective in adults with multiple long-term conditions or frailty in the community. We conducted an umbrella review to comprehensively evaluate the literature on HABIs for adults (aged ≥18 years) with multiple long-term conditions, and frailty. We searched eight databases for systematic reviews reporting on experimental or quasi-experimental studies. Of 9803 titles screened, we identified 29 eligible reviews (14 with meta-analysis) reporting on 14 types of HABIs. The evidence for the effectiveness of HABIs was largely inconsistent across different types of interventions, settings, and outcomes. We found evidence of no benefit from hospital HABIs on health-related quality of life (HRQoL) and emergency department re-attendance, and evidence of no benefit from community HABIs on overall health-care utilisation rates, emergency department attendance, nursing home admissions, and mortality. The best evidence of effectiveness was for hospital comprehensive geriatric assessment (CGA) on nursing home admissions, keeping patients alive and in their own homes. There was some evidence of benefit from community CGA on hospital admissions, and from CGA spanning community and hospital settings on HRQoL. Patient-centred medical homes had beneficial effects on HRQoL, mental health, self-management, and hospital admissions.
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Affiliation(s)
- Stella Arakelyan
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | | | - Leonard Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Atul Anand
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Marcus J Lyall
- NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
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12
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Lugo‐Palacios DG, Clarke JM, Kristensen SR. Back to basics: A mediation analysis approach to addressing the fundamental questions of integrated care evaluations. HEALTH ECONOMICS 2023; 32:2080-2097. [PMID: 37232044 PMCID: PMC10947178 DOI: 10.1002/hec.4713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 03/23/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
Health systems around the world are aiming to improve the integration of health and social care services to deliver better care for patients. Existing evaluations have focused exclusively on the impact of care integration on health outcomes and found little effect. That suggests the need to take a step back and ask whether integrated care programmes actually lead to greater clinical integration of care and indeed whether greater integration is associated with improved health outcomes. We propose a mediation analysis approach to address these two fundamental questions when evaluating integrated care programmes. We illustrate our approach by re-examining the impact of an English integrated care program on clinical integration and assessing whether greater integration is causally associated with fewer admissions for ambulatory care sensitive conditions. We measure clinical integration using a concentration index of outpatient referrals at the general practice level. While we find that the scheme increased integration of primary and secondary care, clinical integration did not mediate a decrease in unplanned hospital admissions. Our analysis emphasizes the need to better understand the hypothesized causal impact of integration on health outcomes and demonstrates how mediation analysis can inform future evaluations and program design.
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Affiliation(s)
- David G. Lugo‐Palacios
- Centre for Health PolicyInstitute of Global Health InnovationImperial College LondonLondonUK
- Department of Health Services Research & PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Jonathan M. Clarke
- Centre for Health PolicyInstitute of Global Health InnovationImperial College LondonLondonUK
- EPSRC Centre for Mathematics of Precision HealthcareImperial College LondonLondonUK
| | - Søren Rud Kristensen
- Centre for Health PolicyInstitute of Global Health InnovationImperial College LondonLondonUK
- Danish Centre for Health Economics (DaCHE)University of Southern DenmarkOdenseDenmark
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13
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Wang P, Vienneau M, Vogeli C, Schiavoni K, Jubelt L, Mendu ML. Reframing Value-Based Care Management: Beyond Cost Reduction and Toward Patient Centeredness. JAMA HEALTH FORUM 2023; 4:e231502. [PMID: 37327007 DOI: 10.1001/jamahealthforum.2023.1502] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Importance Care management programs are increasingly being utilized by health systems as a new foundational strategy to advance value-based care. These programs offer the promise of improving patient outcomes while decreasing health care utilization and costs. However, as these programs proliferate in number and specialization, the field of care management is increasingly at risk of fragmentation, inefficiency, and failure to meet the core needs of the patient. Observations This review of the current state of care management identifies several key challenges for the field, including an unclear value proposition, a focus on system- vs patient-centered outcomes, increased specialization by private and public entrants that produces care fragmentation, and lack of coordination among health and social service entities. A framework is proposed for reorienting care management to truly address the needs of patients through acknowledging the dynamic nature of patient care needs, providing a continuum of need-targeted programming, coordinating care among all involved entities and staff, and performing regular evaluations of outcomes that include patient-centered and health equity measures. Guidance on how this framework can be implemented within a health system and an outline of recommendations is provided for how policymakers may incentivize the development of high value and more equitable care management programs. Conclusions and Relevance With increased focus on care management as a cornerstone of value-based care, value-based health leaders and policymakers can improve the effectiveness and value of care management programs, reduce patient financial burden for care management services, and promote stakeholder coordination.
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Affiliation(s)
- Priscilla Wang
- Population Health Management, Mass General Brigham, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Maryann Vienneau
- Population Health Management, Mass General Brigham, Boston, Massachusetts
| | - Christine Vogeli
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
| | - Katherine Schiavoni
- Population Health Management, Mass General Brigham, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Lindsay Jubelt
- Population Health Management, Mass General Brigham, Boston, Massachusetts
| | - Mallika L Mendu
- Office of the Chief Medical Officer, Brigham and Women's Hospital, Boston, Massachusetts
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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14
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Sadler E, Khadjesari Z, Ziemann A, Sheehan KJ, Whitney J, Wilson D, Bakolis I, Sevdalis N, Sandall J, Soukup T, Corbett T, Gonçalves-Bradley DC, Walker DM. Case management for integrated care of older people with frailty in community settings. Cochrane Database Syst Rev 2023; 5:CD013088. [PMID: 37218645 PMCID: PMC10204122 DOI: 10.1002/14651858.cd013088.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Ageing populations globally have contributed to increasing numbers of people living with frailty, which has significant implications for use of health and care services and costs. The British Geriatrics Society defines frailty as "a distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves". This leads to an increased susceptibility to adverse outcomes, such as reduced physical function, poorer quality of life, hospital admissions, and mortality. Case management interventions delivered in community settings are led by a health or social care professional, supported by a multidisciplinary team, and focus on the planning, provision, and co-ordination of care to meet the needs of the individual. Case management is one model of integrated care that has gained traction with policymakers to improve outcomes for populations at high risk of decline in health and well-being. These populations include older people living with frailty, who commonly have complex healthcare and social care needs but can experience poorly co-ordinated care due to fragmented care systems. OBJECTIVES To assess the effects of case management for integrated care of older people living with frailty compared with usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Health Systems Evidence, and PDQ Evidence and databases from inception to 23 September 2022. We also searched clinical registries and relevant grey literature databases, checked references of included trials and relevant systematic reviews, conducted citation searching of included trials, and contacted topic experts. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared case management with standard care in community-dwelling people aged 65 years and older living with frailty. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures recommended by Cochrane and the Effective Practice and Organisation of Care Group. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 20 trials (11,860 participants), all of which took place in high-income countries. Case management interventions in the included trials varied in terms of organisation, delivery, setting, and care providers involved. Most trials included a variety of healthcare and social care professionals, including nurse practitioners, allied healthcare professionals, social workers, geriatricians, physicians, psychologists, and clinical pharmacists. In nine trials, the case management intervention was delivered by nurses only. Follow-up ranged from three to 36 months. We judged most trials at unclear risk of selection and performance bias; this consideration, together with indirectness, justified downgrading the certainty of the evidence to low or moderate. Case management compared to standard care may result in little or no difference in the following outcomes. • Mortality at 12 months' follow-up (7.0% in the intervention group versus 7.5% in the control group; risk ratio (RR) 0.98, 95% confidence interval (CI) 0.84 to 1.15; I2 = 11%; 14 trials, 9924 participants; low-certainty evidence) • Change in place of residence to a nursing home at 12 months' follow-up (9.9% in the intervention group versus 13.4% in the control group; RR 0.73, 95% CI 0.53 to 1.01; I2 = 0%; 4 trials, 1108 participants; low-certainty evidence) • Quality of life at three to 24 months' follow-up (results not pooled; mean differences (MDs) ranged from -6.32 points (95% CI -11.04 to -1.59) to 6.1 points (95% CI -3.92 to 16.12) when reported; 11 trials, 9284 participants; low-certainty evidence) • Serious adverse effects at 12 to 24 months' follow-up (results not pooled; 2 trials, 592 participants; low-certainty evidence) • Change in physical function at three to 24 months' follow-up (results not pooled; MDs ranged from -0.12 points (95% CI -0.93 to 0.68) to 3.4 points (95% CI -2.35 to 9.15) when reported; 16 trials, 10,652 participants; low-certainty evidence) Case management compared to standard care probably results in little or no difference in the following outcomes. • Healthcare utilisation in terms of hospital admission at 12 months' follow-up (32.7% in the intervention group versus 36.0% in the control group; RR 0.91, 95% CI 0.79 to 1.05; I2 = 43%; 6 trials, 2424 participants; moderate-certainty evidence) • Change in costs at six to 36 months' follow-up (results not pooled; 14 trials, 8486 participants; moderate-certainty evidence), which usually included healthcare service costs, intervention costs, and other costs such as informal care. AUTHORS' CONCLUSIONS We found uncertain evidence regarding whether case management for integrated care of older people with frailty in community settings, compared to standard care, improved patient and service outcomes or reduced costs. There is a need for further research to develop a clear taxonomy of intervention components, to determine the active ingredients that work in case management interventions, and identify how such interventions benefit some people and not others.
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Affiliation(s)
- Euan Sadler
- School of Health Sciences, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | | | - Alexandra Ziemann
- Department of Social & Policy Sciences, University of Bath, Bath, UK
| | - Katie J Sheehan
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Julie Whitney
- School of Life Course & Population Sciences, King's College London, London, UK
- Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, London, UK
| | - Dan Wilson
- Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Health Service & Population Research Department, King's College London, London, UK
| | - Nick Sevdalis
- Centre for Behavioural & Implementation Science Interventions (BISI), National University of Singapore, Singapore, Singapore
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, London, UK
| | - Tayana Soukup
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Teresa Corbett
- Faculty of Sport, Health and Social Sciences, Solent University, Southampton, UK
| | | | - Dawn-Marie Walker
- School of Health Sciences, University of Southampton, Southampton, UK
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15
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Herberg S, Teuteberg F. Reducing hospital admissions and transfers to long-term inpatient care: A systematic literature review. Health Serv Manage Res 2023; 36:10-24. [PMID: 35128972 DOI: 10.1177/09514848211068620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Individuals in need of long-term care and their relatives prefer to receive and give care in their domestic environment for as long as possible. Residential long-term care is to be avoided for as long as possible. To achieve this goal, the care setting must be optimally oriented to the needs of the person in need of care. Moreover, relatives who provide care must be professionally supported. The Regional Care Competence Center (ReKo), launched on October 1, 2019, is a quasi-experimental study (two groups and pre-post design), funded by the Innovation Fund. As part of the ReKo project, people in need of care and their relatives are assisted by a case management (CM) system. An independent CM, supported by an IT network that includes the most important service providers, is to establish a comprehensive CM for people in need of care. Based on a literature review, this paper aimed to take a conceptual approach to the ReKo project by drawing on previous research and comparing the findings with the ReKo approach. The review considered CM projects that defined avoidance of hospitalization and/or delay in the transition of care recipients to long-term inpatient care as endpoints. Using PubMed and Google Scholar, the study screened 270 articles, abstracted and quality-assessed data, and included eight randomized clinical trials, two other studies, and seven reviews in the analysis. The review results and ReKo approaches are presented along the dimensions of clinical and medical benefits, community and public health benefits, economic benefits, and political and legislative benefits. CM organizations will continue to be established internationally in aging societies. The questions of improving quality of care, avoiding service costs, and the costs of establishing a CM must be raised, even if clear evidence is difficult to provide.
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Affiliation(s)
- Stephan Herberg
- 9186Osnabrück University, Accounting and Information Systems, Katharinenstr. 1, 49074 Osnabrück, Germany {sherberg, frank.teuteberg}@uni-osnabrueck.de
| | - Frank Teuteberg
- 9186Osnabrück University, Accounting and Information Systems, Katharinenstr. 1, 49074 Osnabrück, Germany {sherberg, frank.teuteberg}@uni-osnabrueck.de
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16
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Wilfling D, Budke J, Warkentin N, Goetz K. How Do Health Care Professionals Perceive a Holistic Care Approach for Geriatric Patients? A Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1033. [PMID: 36673787 PMCID: PMC9858644 DOI: 10.3390/ijerph20021033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Geriatric patients require holistic care in order to meet their complex care needs. The project RubiN (Continuous Care in a Regional Network) provides case and care management (CCM) for older people to address these needs in a primary care setting in Germany. This study aimed to explore the experiences of health care professionals who provided CCM for geriatric patients. METHODS Focus group interviews with general practitioners (GPs), health care assistants (HCAs), and case managers (CMs) were conducted. Transcribed data were analyzed by using qualitative content analysis. RESULTS Ten focus group discussions (n = 15 GPs, n = 14 HCAs, n = 17 CMs) were conducted. The different health care professionals emphasized the importance of a holistic care approach to geriatric care. Moreover, the GPs stated that the CMs supported the patients in organizing their care. A CCM could help encourage patients to remain at their own homes, which would have an effect on patients' quality of life and satisfaction. CONCLUSION A well-functioning and effective cooperation between those health professionals involved is a prerequisite for a trustful relationship in the holistic care of older people. This creates a feeling of security for all people involved in the care process.
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Affiliation(s)
| | | | | | - Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
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17
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Francia L, Lam T, Berg A, Morgan K, Savic M, Lubman DI, Nielsen S. Putting out the welcome mat-A qualitative exploration of service delivery processes and procedures as barriers to treatment-seeking for people who use alcohol and other drugs. Drug Alcohol Rev 2023; 42:193-202. [PMID: 36169553 PMCID: PMC10947049 DOI: 10.1111/dar.13551] [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: 03/24/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION There are a range of models and structures that determine features of alcohol and other drug treatment. Despite some structures being long-established, less is known about how specific aspects of service delivery impact treatment-seeking for people who use alcohol and other drugs. This Australian qualitative study explored both people with lived experience of problematic alcohol and other drug use, and health care staff's experiences of service delivery. METHODS Thirty-nine semi-structured interviews with people with lived experience and staff from either alcohol and other drug specialist, or broader health-care services, explored experiences of service delivery processes and procedures. Transcripts were thematically analysed and guided by a broad interest in barriers to treatment-seeking. RESULTS Within alcohol and other drug specialist services (i) time spent on wait lists; and (ii) poor implementation of assessment processes were identified barriers to treatment-seeking and engagement. Within broader health-care services (i) organisational expectations around behaviour and engagement; (ii) alcohol and other drugs viewed as separate to service role; and (iii) limited opportunities to informally engage were identified barriers to treatment-seeking. DISCUSSION AND CONCLUSIONS Results suggest opportunities to engage and undertake needs-based care planning are yet to be fully realised, particularly at the intake and assessment stages of alcohol and other drug service delivery; with frequent reassessment resulting in people repeatedly recounting traumatic experiences, often to different people, only to be placed back on wait lists with no support. Within broader health-care services aspects of service delivery may perpetuate stigma that places such people outside the purview of health care.
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Affiliation(s)
- Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Amelia Berg
- Association of Participating Services UsersSelf Help Addiction Resource CentreMelbourneAustralia
| | | | - Michael Savic
- Turning PointEastern Health Clinical SchoolMelbourneAustralia
- Monash UniversityMelbourneAustralia
| | - Dan I. Lubman
- Turning PointEastern Health Clinical SchoolMelbourneAustralia
- Monash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
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18
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Fleming MD, Safaeinili N, Knox M, Hernandez E, Esteban EE, Sarkar U, Brewster AL. Conceptualizing the effective mechanisms of a social needs case management program shown to reduce hospital use: a qualitative study. BMC Health Serv Res 2022; 22:1585. [PMID: 36572882 PMCID: PMC9791730 DOI: 10.1186/s12913-022-08979-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Social needs case management programs are a strategy to coordinate social and medical care for high-risk patients. Despite widespread interest in social needs case management, not all interventions have shown effectiveness. A lack of evidence about the mechanisms through which these complex interventions benefit patients inhibits effective translation to new settings. The CommunityConnect social needs case management program in Contra Costa County, California recently demonstrated an ability to reduce inpatient hospital admissions by 11% in a randomized study. We sought to characterize the mechanisms through which the Community Connect social needs case management program was effective in helping patients access needed medical and social services and avoid hospitalization. An in-depth understanding of how this intervention worked can support effective replication elsewhere. METHODS Using a case study design, we conducted semi-structured, qualitative interviews with case managers (n = 30) and patients enrolled in social needs case management (n = 31), along with field observations of patient visits (n = 31). Two researchers coded all interview transcripts and observation fieldnotes. Analysis focused on program elements identified by patients and staff as important to effectiveness. RESULTS Our analyses uncovered three primary mechanisms through which case management impacted patient access to needed medical and social services: [1] Psychosocial work, defined as interpersonal and emotional support provided through the case manager-patient relationship, [2] System mediation work to navigate systems, coordinate resources, and communicate information and [3] Addressing social needs, or working to directly mitigate the impact of social conditions on patient health. CONCLUSIONS These findings highlight that the system mediation tasks which are the focus of many social needs assistance interventions offered by health care systems may be necessary but insufficient. Psychosocial support and direct assistance with social needs, enabled by a relationship-focused program, may also be necessary for effectiveness.
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Affiliation(s)
- Mark D. Fleming
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Nadia Safaeinili
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Margae Knox
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Elizabeth Hernandez
- grid.421504.60000 0004 0442 6009Contra Costa Health Services, Contra Costa County—Concord, California, USA
| | - Emily E. Esteban
- grid.421504.60000 0004 0442 6009Contra Costa Health Services, Contra Costa County—Concord, California, USA
| | - Urmimala Sarkar
- grid.267103.10000 0004 0461 8879Department of Medicine—San Francisco, University of California, San Francisco, California, USA
| | - Amanda L. Brewster
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
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19
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Cohidon C, Gallay E, Wild P, Stiefel F, Bourquin C, Senn N. Identifying complex patients in family medicine for potential benefit from a case manager: a short questionnaire derived from the INTERMED Self-Assessment (IMSA) questionnaire. BMC PRIMARY CARE 2022; 23:276. [PMID: 36333794 PMCID: PMC9636696 DOI: 10.1186/s12875-022-01876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
Purpose To investigate how useful the Intermed-Self Assessment (IMSA) questionnaire and its components were for identifying which patient candidates would benefit most from case management (CM) in general practice. Methods The study was carried out in a group family medicine practice in Lausanne comprising seven GPs and four medical assistants, from February to April 2019. All the patients attending the practice between February and April 2019 were invited to complete the IMSA questionnaire. Additionally, their GPs were asked for their opinions on the potential benefits of each patient being assigned a case manager. Each IMSA item’s value has been assessed as a predictor of GPs’ opinions by using multivariate logistic models. A score including items retained as predictor was built. Results Three hundred and thirty one patients participated in the study (participation rate: 62%). Three items from the 20 item IMSA were sufficient to predict GPs’ opinions about whether their patients could be expected to benefit if assigned a case manager. Those items addressed the patient’s existing chronic diseases (item1), quality of life in relation to existing diseases (item 3), and their social situation (item 9). Using these three items as a score, a cut-off at 4 gave a sensitivity of 70% (ability to correctly identify patients who could benefit from a CM) and specificity of 73% (ability to correctly identify patients who should not benefit from a CM) and concerned about one patient in two. Conclusion Identifying complex patients suitable for case management remains a challenge for primary care professionals. This paper describes a novel approach using a structured process of combining the results of standardized tools such as the one defined in this study, and the experience of the primary care team. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01876-8.
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Affiliation(s)
- Christine Cohidon
- grid.9851.50000 0001 2165 4204Department of Family Medicine, Center for Primary Care and General Medicine (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Emilie Gallay
- grid.9851.50000 0001 2165 4204Department of Family Medicine, Center for Primary Care and General Medicine (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Friedrich Stiefel
- grid.8515.90000 0001 0423 4662Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Céline Bourquin
- grid.8515.90000 0001 0423 4662Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Nicolas Senn
- grid.9851.50000 0001 2165 4204Department of Family Medicine, Center for Primary Care and General Medicine (Unisanté), University of Lausanne, Lausanne, Switzerland
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Wang N, Chen J, Chen W, Shi Z, Yang H, Liu P, Wei X, Dong X, Wang C, Mao L, Li X. The effectiveness of case management for cancer patients: an umbrella review. BMC Health Serv Res 2022; 22:1247. [PMID: 36242021 PMCID: PMC9562054 DOI: 10.1186/s12913-022-08610-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/21/2022] [Indexed: 11/12/2022] Open
Abstract
Background Case management (CM) is widely utilized to improve health outcomes of cancer patients, enhance their experience of health care, and reduce the cost of care. While numbers of systematic reviews are available on the effectiveness of CM for cancer patients, they often arrive at discordant conclusions that may confuse or mislead the future case management development for cancer patients and relevant policy making. We aimed to summarize the existing systematic reviews on the effectiveness of CM in health-related outcomes and health care utilization outcomes for cancer patient care, and highlight the consistent and contradictory findings. Methods An umbrella review was conducted followed the Joanna Briggs Institute (JBI) Umbrella Review methodology. We searched MEDLINE (Ovid), EMBASE (Ovid), PsycINFO, CINAHL, and Scopus for reviews published up to July 8th, 2022. Quality of each review was appraised with the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. A narrative synthesis was performed, the corrected covered area was calculated as a measure of overlap for the primary studies in each review. The results were reported followed the Preferred reporting items for overviews of systematic reviews checklist. Results Eight systematic reviews were included. Average quality of the reviews was high. Overall, primary studies had a slight overlap across the eight reviews (corrected covered area = 4.5%). No universal tools were used to measure the effect of CM on each outcome. Summarized results revealed that CM were more likely to improve symptom management, cognitive function, hospital (re)admission, treatment received compliance, and provision of timely treatment for cancer patients. Overall equivocal effect was reported on cancer patients’ quality of life, self-efficacy, survivor status, and satisfaction. Rare significant effect was reported on cost and length of stay. Conclusions CM showed mixed effects in cancer patient care. Future research should use standard guidelines to clearly describe details of CM intervention and its implementation. More primary studies are needed using high-quality well-powered designs to provide solid evidence on the effectiveness of CM. Case managers should consider applying validated and reliable tools to evaluate effect of CM in multifaced outcomes of cancer patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08610-1.
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Affiliation(s)
- Nina Wang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Jia Chen
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Wenjun Chen
- School of Nursing, University of Ottawa, Ottawa, Canada. .,Center for Research on Health and Nursing, University of Ottawa, Ottawa, Canada.
| | - Zhengkun Shi
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Huaping Yang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Peng Liu
- Intensive Care Unit of Cardiovascular Surgery Department, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Wei
- The 956th Army Hospital, Linzhi, China
| | - Xiangling Dong
- Intensive Care Unit of Cardiovascular Surgery Department, Xiangya Hospital, Central South University, Changsha, China
| | - Chen Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Ling Mao
- School of Nursing, Changsha Medical University, Changsha, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, China
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21
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Benthien KS, Rasmussen K, Nielsen CP, Kidholm K, Grønkjær M, Toft U. Proactive Health Support: a randomised controlled trial of telephone-based self-management support for persons at risk of hospital admission. Age Ageing 2022; 51:6749361. [PMID: 36201327 DOI: 10.1093/ageing/afac212] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Persons with frequent hospital admissions have a disease burden that may exceed their self-management skills. The evidence base of telephone-based interventions to support self-management is poor with mixed results. The aim of this study is to evaluate the effect of Proactive Health Support (PaHS): telephone-based self-management support for persons with risk of hospitalizations. METHODS This study is a national randomised controlled trial of PaHS versus usual universal tax-funded healthcare. Participants were persons at risk of emergency hospital admissions. The intervention began with a physical start-up session followed by telephone sessions of self-management support. The two co-primary outcomes were Health-Related Quality of Life (HRQoL) (Mental Health Component Summary Score of SF36v2) analysed with mixed models and hospital admissions analysed with Poisson regression at 6 months. Secondary outcomes were at 3- and 12-month follow-up and disease subgroup analyses. RESULTS During the study period, 6,402 persons were randomised (3,190 intervention, 3,212 control). HRQoL was significantly improved at 6 months (Est. 1.4992, P = <0.0001) and at 3 and 12 months on all 10 scales. There was no overall effect on hospital admissions at 6 months with an adjusted estimate of 0.0074 (P = 0.8691). Persons with diabetes had significant improvement of HRQoL and reduced hospital admissions. CONCLUSIONS The PaHS intervention improved HRQoL for all participants and reduced hospital admissions for persons with diabetes only.
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Affiliation(s)
- Kirstine Skov Benthien
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Palliative Care Unit, Copenhagen University Hospital - Hvidovre, Denmark
| | - Knud Rasmussen
- Data and Development Support, Region Zealand, Sorø, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Social & Health Services and Labour Market, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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22
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Duminy L, Ress V, Wild EM. Complex community health and social care interventions – Which features lead to reductions in hospitalizations for ambulatory care sensitive conditions? A systematic literature review. Health Policy 2022; 126:1206-1225. [DOI: 10.1016/j.healthpol.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022]
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23
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Mc Namara KP, Rosenbaum S, Rocks T, Manias E, Freeman CR, Shee AW, Schlicht KG, Calder RV, Moloney J, Morgan M. Workforce development for better management of physical comorbidities among people with serious mental illness. Med J Aust 2022; 217 Suppl 7:S39-S42. [PMID: 36183315 PMCID: PMC9828575 DOI: 10.5694/mja2.51705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/09/2022] [Accepted: 06/29/2022] [Indexed: 01/11/2023]
Affiliation(s)
| | | | - Tetyana Rocks
- Institute for Mental and Physical Health and Clinical Translation (IMPACT)Deakin UniversityMelbourneVIC
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityMelbourneVIC
| | | | - Anna Wong Shee
- Deakin UniversityWarrnamboolVIC,Grampians HealthBallaratVIC
| | - Katherine G Schlicht
- Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityMelbourneVIC
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24
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Goldzahl L, Stokes J, Sutton M. The effects of multi-disciplinary integrated care on healthcare utilization: Evidence from a natural experiment in the UK. HEALTH ECONOMICS 2022; 31:2142-2169. [PMID: 35932257 DOI: 10.1002/hec.4561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Better integration is a priority for most international health systems. However, multiple interventions are often implemented simultaneously, making evaluation difficult and providing limited evidence for policy makers about specific interventions. We evaluate a common integrated care intervention, multi-disciplinary group (MDG) meetings for discussion of high-risk patients, introduced in one socio-economically deprived area in the UK in spring 2015. Using data from multiple waves of the national GP Patient Survey and Hospital Episode Statistics, we estimate its effects on primary and secondary care utilization and costs, health status and patient experience. We use triple differences, exploiting the targeting at people aged 65 years and over, parsing effects from other population-level interventions implemented simultaneously. The intervention reduced the probability of visiting a primary care nurse by three percentage points and decreased length of stay by 1 day following emergency care admission. However, since planned care use increased, overall costs were unaffected. MDG meetings are presumably fulfilling public health objectives by decreasing length of stay and detecting previously unmet needs. However, the effect of MDGs on health system cost is uncertain and health remains unchanged. Evaluations of specific integrated care interventions may be more useful to public decision makers facing budget constraints.
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Affiliation(s)
- Léontine Goldzahl
- IESEG School of Management, Lille, France
- Université de Lille, CNRS, UMR 9221 - LEM - Lille Economie Management, Lille, France
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25
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Organization of primary care. Prim Health Care Res Dev 2022; 23:e49. [PMID: 36047002 PMCID: PMC9472237 DOI: 10.1017/s1463423622000275] [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] [Indexed: 11/17/2022] Open
Abstract
Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units.
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26
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Values Underpinning Integrated, People-Centred Health Services: Similarities and Differences among Actor Groups Across Europe. Int J Integr Care 2022; 22:6. [PMID: 36043027 PMCID: PMC9374025 DOI: 10.5334/ijic.6015] [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: 07/15/2021] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: In addition to the functional aspects of healthcare integration, an understanding of its normative aspects is needed. This study explores the importance of values underpinning integrated, people-centred health services, and examines similarities and differences among the values prioritised by actors across Europe. Methods: Explorative cross-sectional design with quantitative analysis. A questionnaire of 18 values was conducted across Europe. A total of 1,013 respondents indicated the importance of each of the values on a nine-point scale and selected three most important values. Respondents were clustered in four actor groups, and countries in four European sub-regions. Results: The importance scores of values ranged from 7.62 to 8.55 on a nine-point scale. Statistically significant differences among actor groups were found for ten values. Statistically significant differences across European sub-regions were found for six values. Our analysis revealed two clusters of values: ‘people related’ and ‘governance and organisation’. Discussion and conclusion: The study found that all 18 values in the set are considered important by the respondents. Additionally, it revealed distinctions in emphasis among the values prioritised by actor groups and across sub-regions. The study uncovered two clusters of values that contribute to a conceptually based definition of integrated, people-centred health services.
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27
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Stockdale SE, Rose DE, McClean M, Rosland AM, Chang ET, Zulman DM, Stewart G, Nelson KM. Factors Associated With Patient-Centered Medical Home Teams' Use of Resources for Identifying and Approaches for Managing Patients With Complex Needs. J Ambul Care Manage 2022; 45:171-181. [PMID: 35612388 PMCID: PMC9178911 DOI: 10.1097/jac.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Using data from a Veterans Health Administration national primary care survey, this study identified the most highly rated tools and care approaches for patients with complex needs and how preferences varied by professional role, staffing, and training. Nurses were significantly more likely to rate most tools as very important as compared with primary care providers. Having a fully staffed team was also significantly associated with a very important rating on all tools. Nurses and fully staffed teams reported a greater likeliness to use most care approaches, and those with perceived need for training reporting a lower likeliness to use.
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Affiliation(s)
- Susan E Stockdale
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Drs Stockdale, Rose, and Chang and Mr McClean); Department of Psychiatry and Biobehavioral Sciences (Dr Stockdale), and Department of Medicine, David Geffen School of Medicine (Dr Chang), University of California, Los Angeles; Center for Health Equity Research and Promotion, VA Pittsburgh, Pittsburgh, Pennsylvania (Dr Rosland); Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Rosland); Division of General Internal Medicine, Department of Medicine, VA Greater Los Angeles, Los Angeles, California (Dr Chang); Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California (Dr Zulman); Department of Medicine, Stanford University, Stanford, California (Dr Zulman); Department of Management, University of Iowa, Iowa City (Dr Stewart); HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington (Dr Nelson); and Division of General Internal Medicine, University of Washington, Seattle (Dr Nelson)
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28
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Smith MA, Yu M, Huling JD, Wang X, DeLonay A, Jaffery J. Impactability Modeling for Reducing Medicare Accountable Care Organization Payments and Hospital Events in High-Need High-Cost Patients: Longitudinal Cohort Study. J Med Internet Res 2022; 24:e29420. [PMID: 35699983 PMCID: PMC9237769 DOI: 10.2196/29420] [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: 04/08/2021] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background Impactability modeling promises to help solve the nationwide crisis in caring for high-need high-cost patients by matching specific case management programs with patients using a “benefit” or “impactability” score, but there are limitations in tailoring each model to a specific program and population. Objective We evaluated the impact on Medicare accountable care organization savings from developing a benefit score for patients enrolled in a historic case management program, prospectively implementing the score, and evaluating the results in a new case management program. Methods We conducted a longitudinal cohort study of 76,140 patients in a Medicare accountable care organization with multiple before-and-after measures of the outcome, using linked electronic health records and Medicare claims data from 2012 to 2019. There were 489 patients in the historic case management program, with 1550 matched comparison patients, and 830 patients in the new program, with 2368 matched comparison patients. The historic program targeted high-risk patients and assigned a centrally located registered nurse and social worker to each patient. The new program targeted high- and moderate-risk patients and assigned a nurse physically located in a primary care clinic. Our primary outcomes were any unplanned hospital events (admissions, observation stays, and emergency department visits), count of event-days, and Medicare payments. Results In the historic program, as expected, high-benefit patients enrolled in case management had fewer events, fewer event-days, and an average US $1.15 million reduction in Medicare payments per 100 patients over the subsequent year when compared with the findings in matched comparison patients. For the new program, high-benefit high-risk patients enrolled in case management had fewer events, while high-benefit moderate-risk patients enrolled in case management did not differ from matched comparison patients. Conclusions Although there was evidence that a benefit score could be extended to a new case management program for similar (ie, high-risk) patients, there was no evidence that it could be extended to a moderate-risk population. Extending a score to a new program and population should include evaluation of program outcomes within key subgroups. With increased attention on value-based care, policy makers and measure developers should consider ways to incorporate impactability modeling into program design and evaluation.
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Affiliation(s)
- Maureen A Smith
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States.,Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Menggang Yu
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Jared D Huling
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, United States
| | - Xinyi Wang
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Allie DeLonay
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Jonathan Jaffery
- University of Wisconsin Health Office of Population Health, Madison, WI, United States.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
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29
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Löwe C, Mark P, Sommer S, Weltermann B. Collaboration between general practitioners and social workers: a scoping review. BMJ Open 2022; 12:e062144. [PMID: 36691249 PMCID: PMC9171253 DOI: 10.1136/bmjopen-2022-062144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/08/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Aim of the study is to present an overview of collaboration structures and processes between general practitioners and social workers, the target groups addressed as well the quality of available scientific literature. DESIGN A scoping review following the guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). INCLUDED SOURCES AND ARTICLES According to a pre-published protocol, three databases (PubMed, Web of Science, DZI SoLit) were searched using the participant-concept-context framework. The searches were performed on 21 January 2021 and on 10 August 2021. Literature written in English and German since the year 2000 was included. Two independent researchers screened all abstracts for collaboration between general practitioners and social workers. Articles selected were analysed regarding structures, processes, outcomes, effectiveness and patient target groups. RESULTS A total of 72 articles from 17 countries were identified. Collaborative structures and their routine differ markedly between healthcare systems: 36 publications present collaboration structures and 33 articles allow an insight into the processual routines. For all quantitative studies, a level of evidence was assigned. Various measurements are used to determine the effectiveness of collaborations, for example, hospital admissions and professionals' job satisfaction. Case management as person-centred care for defined patient groups is a central aspect of all identified collaborations between general practitioners and social workers. CONCLUSION This scoping review showed evidence for benefits on behalf of patients, professionals and healthcare systems by collaborations between general practitioners and social workers, yet more rigorous research is needed to better understand the impact of these collaborations. TRIAL REGISTRATION NUMBER www.osf.io/w673q.
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Affiliation(s)
- Cornelia Löwe
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Patrick Mark
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Samira Sommer
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Birgitta Weltermann
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
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30
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Mansour MHH, Pokhrel S, Anokye N. Effectiveness of integrated care interventions for patients with long-term conditions: a review of systematic reviews. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2021-000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To examine the effectiveness of integrated care intervention (ICI) models (stand-alone or combination of self-management, discharge management, case management and multidisciplinary teams models) targeting patients with one or more chronic conditions, and to identify outcome measures/indicators of effectiveness, we conducted a systematic review of published systematic reviews and meta-analyses. Included reviews comprise ICIs targeting adult patients with one or more long-term conditions. We searched MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews: 60 reviews were included in the final analysis; 28 reviews evaluated ICIs focused on self-management, 4 on case management, 10 on discharge management and 5 on multidisciplinary teams; 13 reviews assessed multiple interventions that were labelled as complex. Across all reviews, only 19 reviews included intervention with multiple ICIs. Overall, interventions with multiple components, compared with interventions with single components, were more likely to improve hospital use outcomes effectively. Clinical/lifestyle/condition-specific outcomes were more likely to be improved by self-management interventions. Outcome measures identified could be classified into three main categories: organisational, patient-centred and clinical/lifestyle/condition-specific. The findings of this review may provide inputs to future design and evaluation of ICIs.
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31
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Hulen E, Laliberte AZ, Katz ML, Giannitrapani KF, Chang ET, Stockdale SE, Eng JA, Jimenez E, Edwards ST. Patient selection strategies in an intensive primary care program. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2022; 10:100627. [PMID: 35421803 DOI: 10.1016/j.hjdsi.2022.100627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intensive primary care programs have had variable impacts on clinical outcomes, possibly due to a lack of consensus on appropriate patient-selection. The US Veterans Health Administration (VHA) piloted an intensive primary care program, known as Patient Aligned Care Team Intensive Management (PIM), in five medical centers. We sought to describe the PIM patient selection process used by PIM teams and to explore perspectives of PIM team members regarding how patient selection processes functioned in context. METHODS This study employs an exploratory sequential mixed-methods design. We analyzed qualitative interviews with 21 PIM team and facility leaders and electronic health record (EHR) data from 2,061 patients screened between July 2014 and September 2017 for PIM enrollment. Qualitative data were analyzed using a hybrid inductive/deductive approach. Quantitative data were analyzed using descriptive statistics. RESULTS Of 1,887 patients identified for PIM services using standardized criteria, over half were deemed inappropriate for PIM services, either because of not having an ambulatory care sensitive condition, living situation, or were already receiving recommended care. Qualitative analysis found that team members considered standardized criteria to be a useful starting point but too broad to be relied on exclusively. Additional data collection through chart review and communication with the current primary care team was needed to adequately assess patient complexity. Qualitative analysis further found that differences in conceptualizing program goals led to conflicting opinions of which patients should be enrolled in PIM. CONCLUSIONS A combined approach that includes clinical judgment, case review, standardized criteria, and targeted program goals are all needed to support appropriate patient selection processes.
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Affiliation(s)
- Elizabeth Hulen
- Center to Improve Veteran to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
| | - Avery Z Laliberte
- Center to Improve Veteran to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Marian L Katz
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Karleen F Giannitrapani
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Evelyn T Chang
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA; Division of General Internal Medicine, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Medicine, VA Greater Los Angles Health Care System, Los Angeles, CA, USA
| | - Susan E Stockdale
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Jessica A Eng
- Geriatrics, Palliative, and Extended Care Service, San Francisco VA Medical Center, San Francisco, CA, USA; Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Elvira Jimenez
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA; Behavioral Neurology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Samuel T Edwards
- Center to Improve Veteran to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA; School of Medicine, Oregon Health and Science University, Portland, OR, USA; Section of General Internal Medicine, VA Portland Health Care System, Portland, OR, USA
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32
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Lloyd T, Crellin E, Brine RJ, Shen JY, Wolters AT. Association between household context and emergency hospital use in older people: a retrospective cohort study on indicators for people living alone or living with somebody with frailty, developed from routine healthcare data in England. BMJ Open 2022; 12:e059371. [PMID: 35501076 PMCID: PMC9062795 DOI: 10.1136/bmjopen-2021-059371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To derive two household context factors - living alone and living in a two-person household with a person who is frail - from routine administrative health data and to assess their association with emergency hospital use in people aged 65 or over. DESIGN Retrospective cohort study using national pseudonymised hospital data and pseudonymised address data derived from a minimised version of the Master Patient Index, a central database of all patient registrations in England. SETTING England-wide. PARTICIPANTS 4 876 285 people aged 65 years or older registered at GP practices in England on 16 December 2018 who were living alone or in a household of up to six people, and with at least one hospital admission in the last 3 years. OUTCOMES Rates of accident and emergency (A&E) attendance and inpatient emergency admissions over a 1-year follow-up period. RESULTS Older people living alone had higher rates of A&E attendances (adjusted rate ratio 1.09, 95% CI 1.09 to 1.10) and emergency admissions (1.14, 95% CI 1.14 to 1.15) than older people living in households of 2-6 people. Older people living with someone with frailty in a two-person household had higher rates of A&E attendance (adjusted rate ratio 1.09, 95% CI 1.08 to 1.10) and emergency admissions (1.10, 95% CI 1.09 to 1.11) than other older people living in a two-person household. CONCLUSIONS We show that household context factors can be derived from linked routine administrative health data and that these are strongly associated with higher emergency hospital use in older people. Using household context factors can improve analyses, as well as support in the understanding of local population needs and in population health management.
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Affiliation(s)
- Therese Lloyd
- Improvement Analytics Unit, The Health Foundation, London, UK
| | | | | | - Julia Y Shen
- Improvement Analytics Unit, The Health Foundation, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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33
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Longhini J, Canzan F, Mezzalira E, Saiani L, Ambrosi E. Organisational models in primary health care to manage chronic conditions: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e565-e588. [PMID: 34672051 DOI: 10.1111/hsc.13611] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
Chronic diseases are increasing incessantly, and more efforts are needed in order to develop effective organisational models in primary health care, which may address the challenges posed by the consequent multimorbidity. The aim of this study was to assess and map methods, interventions and outcomes investigated over the last decade regarding the effectiveness of chronic care organisational models in primary care settings. We conducted a scoping review including systematic reviews, clinical trials, and observational studies, published from 2010 to 2020, that evaluated the effectiveness of organisational models for chronic conditions in primary care settings, including home care, community, and general practice. We included 67 international studies out of the 6,540 retrieved studies. The prevalent study design was the observational design (25 studies, 37.3%), and 62 studies (92.5%) were conducted on the adult population. Four main models emerged, called complex integrated care models. These included models grounded on the Chronic Care Model framework and similar, case or care management, and models centred on involvement of pharmacists or community health workers. Across the organisational models, self-management support and multidisciplinary teams were the most common components. Clinical outcomes have been investigated the most, while caregiver outcomes have been detected in the minority of cases. Almost one-third of the included studies reported only significant effects in the outcomes. No sufficient data were available to determine the most effective models of care. However, more complex models seem to lead to better outcomes. In conclusion, in the development of more comprehensive organisational models to manage chronic conditions in primary health care, more efforts are needed on the paediatric population, on the inclusion of caregiver outcomes in the effectiveness evaluation of organisational models and on the involvement of social community resources. As regarding the studies investigating organisational models, more detailed descriptions should be provided with regard to interventions, and the training, roles and responsibilities of health and lay figures in delivering care.
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Affiliation(s)
- Jessica Longhini
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Federica Canzan
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisabetta Mezzalira
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Luisa Saiani
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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34
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Hasemann L, Lampe D, Nebling T, Thiem U, von Renteln-Kruse W, Greiner W. Effectiveness of a multi-component community-based care approach for older people at risk of care dependency - results of a prospective quasi-experimental study. BMC Geriatr 2022; 22:348. [PMID: 35448956 PMCID: PMC9022407 DOI: 10.1186/s12877-022-02923-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/07/2022] [Indexed: 12/21/2022] Open
Abstract
Background Due to demographic changes, the elderly population in western countries is constantly growing. As the risk of functional decline and multimorbidity increases with age, health care systems need to face the challenge of high demand for health care services and related costs. Therefore, innovative health care approaches and geriatric screenings are needed to provide individualised care. This study aims to expand the state of research by investigating the effectiveness of a multi-component care approach for the elderly in a German community setting. Methods A prospective, quasi-experimental study was initiated by statutory health insurance (SHI) companies. The innovative care approach includes a geriatric assessment, a case and network management as well as digital supporting tools and was implemented at the Center for Geriatrics and Gerontology (Albertinen Haus, Hamburg-Eimsbuettel). Participants of the intervention were compared to matched controls recruited in comparable urban areas. The primary outcome measure was the progression in long-term care grade during the period of observation (21 months), which was analysed on the basis of SHI claims data. Secondary endpoints were morbidity, mortality and self-reported health-related quality of life (HRQoL) measured by SF-36. Results Overall, 2,670 patients (intervention group (IG) n=873; control group (CG) n=1,797) were analysed. Logistic regression analysis showed no statistically significant difference in progression of long-term care grade between IG and CG (Odds Ratio (OR)=1.054; 95% confidence interval (CI) 0.856-1.296; p-value=0.616). Differentiated analyses indicated an initial effect, which might be attributable to the geriatric assessment. However, an adapted regression model resulted in a reversed but even non-significant effect (OR=0.945; 95% CI 0.757-1.177; p-value=0.619). While secondary analyses of long-term care grade, mortality and HRQoL did not show intervention effects, a statistically significant relative change of 0.865 (95% CI 0.780, 0.960; p-value=0.006) in morbidity indicated a potential benefit for the IG. Conclusions The analyses did not reveal a significant effect of the community-based intervention on the primary outcome and thus we are not able to recommend a transfer into SHI standard care. Tendencies in secondary analyses need to be proved in further research. Trial registration German Clinical Trials Register, retrospective registration on February 01, 2022 (DRKS00027866). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02923-w.
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Affiliation(s)
- Lena Hasemann
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany.
| | - David Lampe
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
| | - Thomas Nebling
- Department Care Management, Techniker Krankenkasse, Bramfelder Strasse 140, 22305, Hamburg, Germany
| | - Ulrich Thiem
- Center for Geriatrics and Gerontology, Albertinen-Haus, Sellhopsweg 18-22, 22459, Hamburg, Germany.,University Medical Center Hamburg, Martinistrasse 52, 20251, Hamburg, Germany
| | | | - Wolfgang Greiner
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
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Cohen JN, Nguyen A, Rafiq M, Taylor P. Impact of a case-management intervention for reducing emergency attendance on primary care: randomised control trial. Br J Gen Pract 2022; 72:BJGP.2021.0545. [PMID: 35577585 PMCID: PMC9119815 DOI: 10.3399/bjgp.2021.0545] [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: 09/17/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The impact on primary care workload of case-management interventions to reduce emergency department (ED) attendances is unknown. AIM To examine the impact of a telephone-based case-management intervention targeting people with high ED attendance on primary care use. DESIGN AND SETTING A single-site data extract from a larger randomised control trial, using the patient-level data from primary care electronic health records (2015-2020), was undertaken. METHOD A total of 363 patients at high risk of ED usage were randomised to receive a 6-month case-management intervention (253 patients) or standard care (110 patients). Poisson regression models were used to calculate monthly rates of primary care use over time for the 2 years post-randomisation, comparing both arms. Usage was subclassified into face-to-face, telephone, letter, and community and secondary care referrals, stratified by patient demographics. RESULTS No significant difference was found in the mean annual rate of primary care events between the intervention and control arms (P = 0.70). Secondary care referrals saw a 26% reduction in the mean annual referral rate (incident rate ratio [IRR] 0.74, 95% confidence interval [CI] = 0.64 to 0.86, P<0.001) and letters sent increased by 6% in the intervention arm compared with the control arm (IRR 1.06, 95% CI = 1.01 to 1.11, P = 0.01). In the case-managed arm, in patients aged ≥80 years there was a 33% increase in primary care usage (IRR 1.33, 95% CI = 1.28 to 1.40, P<0.001); with a corresponding 10% decrease in patients aged <80 years when compared with controls (IRR 0.90, 95% CI = 0.87 to 0.92, P<0.001). CONCLUSION A targeted case-management intervention to reduce ED attendances did not increase overall primary care use. Redistribution of usage is seen among some patient groups, particularly older people, which may have important implications for primary healthcare planning.
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Affiliation(s)
- Jonathan N Cohen
- Institute of Health Informatics, University College London, London
| | | | - Meena Rafiq
- Epidemiology of Cancer and Healthcare Outcomes, Institute of Epidemiology and Health Care, University College London, London
| | - Paul Taylor
- Institute of Health Informatics, University College London, London
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The impact of an integrated care intervention on mortality and unplanned hospital admissions in a disadvantaged community in England: A difference-in-differences study. Health Policy 2022; 126:549-557. [DOI: 10.1016/j.healthpol.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/22/2022]
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Gessl AS, Flörl A, Schulc E. Demand for community-based Case Management in Austria - a qualitative analysis. BMC Nurs 2022; 21:5. [PMID: 34983497 PMCID: PMC8725559 DOI: 10.1186/s12912-021-00775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/24/2021] [Indexed: 12/03/2022] Open
Abstract
Background The number of people with complex nursing and care needs living in their own homes is increasing. The implementation of Case and Care Management has shown to have a positive effect on unmet care needs. Research on and implementation of Case and Care Management in the community setting in Austria is limited. This study aimed to understand the changes and challenges of changing care needs by mobile nurses and to evaluate the need for Case Management in mobile care organizations by investigating the evolution of mobile care nurses‘task profiles and the challenges in working in a dynamic field with changing target groups and complexifying care needs. Methods A qualitative study with reductive-interpretative data analysis consisting of semi-structured focus groups was conducted. Community care nurses, head nurses, and managers of community mobile care units as well as discharge managers of a community hospital (n = 24) participated in nine qualitative, semi-structured focus groups. The recorded focus groups were transcribed and analyzed using qualitative content analysis. Results The analysis revealed three main categories: the complexity of the case, innerinstitutional frameworks, and interinstitutional collaboration, which influence the perception of need for further development in the direction of Case and Care Management. Feelings of overwhelmedness among nurses were predominantly tied to cases that presented with issues beyond healthcare such as legal, financial, or social that necessitated communication and collaboration across multiple care providers. Conclusions Care institutions need to adapt to changing and increasingly complex care needs that necessitate cooperation between organizations within and across the health and social sectors. A key facilitator for care coordination and the adequate service provision for complex care needs are multidisciplinary institutional networks, which often remain informal, leaving nurses in the role of petitioner without equal footing. Embedding Case and Care Management in the community has the potential to fill this gap and facilitate flexible, timely, and coordinated care across multiple care providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00775-0.
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Affiliation(s)
- Alessandra Schirin Gessl
- LMU Munich School of Management, Ludwig-Maximilians-Universität (LMU) München, Geschwister-Scholl-Platz 1, 80539, Munich, Germany
| | - Angela Flörl
- Division of Integrated Care, Institute of Nursing Science, Department of Nursing Science & Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria.
| | - Eva Schulc
- Division of Integrated Care, Institute of Nursing Science, Department of Nursing Science & Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
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Martin M, Suri Y, Doebbeling B, Andrew R, Kathol R. Value-Based Integrated Case Management at Payor Level. Prof Case Manag 2022; 28:11-19. [DOI: 10.1097/ncm.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Mayer V, Mijanovich T, Egorova N, Flory J, Mushlin A, Calvo M, Deshpande R, Siscovick D. Impact of New York State's Health Home program on access to care among patients with diabetes. BMJ Open Diabetes Res Care 2021; 9:9/Suppl_1/e002204. [PMID: 34933873 PMCID: PMC8679110 DOI: 10.1136/bmjdrc-2021-002204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/04/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Access to care is essential for patients with diabetes to maintain health and prevent complications, and is important for health equity. New York State's Health Homes (HHs) provide care management services to Medicaid-insured patients with chronic conditions, including diabetes, and aim to improve quality of care and outcomes. There is inconsistent evidence on the impact of HHs, and care management programs more broadly, on access to care. RESEARCH DESIGN AND METHODS Using a cohort of patients with diabetes derived from electronic health records from the INSIGHT Clinical Research Network, we analyzed Medicaid data for HH enrollees and a matched comparison group of HH non-enrollees. We estimated HH impacts on several access measures using natural experiment methods. RESULTS We identified and matched 11 646 HH enrollees; patients were largely non-Hispanic Black (29.9%) and Hispanic (48.7%), and had high rates of dual eligibility (33.0%), Supplemental Security Income disability enrollment (49.1%), and multiple comorbidities. In the 12 months following HH enrollment, HH enrollees had one more month of Medicaid coverage (p<0.001) and 4.6 more outpatient visits than expected (p<0.001, evenly distributed between primary and specialty care). There were also positive impacts on the proportions of patients with follow-up visits within 7 days (4 percentage points (pp), p<0.001) and 30 days (6pp, p<0.001) after inpatient care, and on the proportion of patients with follow-up visits within 30 days after emergency department (ED) care (4pp, p<0.001). We did not find meaningful differences in continuity of care. We found small positive impacts on the proportion of patients with an inpatient visit and the proportion with an ED visit. CONCLUSIONS New York State's HH program improved access to care for Medicaid recipients with diabetes. These findings have implications for New York State Medicaid as well as other providers and care management programs.
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Affiliation(s)
- Victoria Mayer
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Tod Mijanovich
- Department of Applied Statistics, Social Sciences, and Humanities, Steinhardt School, New York University, New York City, New York, USA
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - James Flory
- Endocrinology Service, Department of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Alvin Mushlin
- Departments of Population Health Sciences and Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Michele Calvo
- Research, Evaluation & Policy, New York Academy of Medicine, New York City, New York, USA
| | - Richa Deshpande
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - David Siscovick
- Research, Evaluation & Policy, New York Academy of Medicine, New York City, New York, USA
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Connelly LB, Fiorentini G. Structural factors and integrated care interventions: is there a role for economists in the policy debate? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1141-1150. [PMID: 33387138 DOI: 10.1007/s10198-020-01253-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Luke B Connelly
- Centre for the Business and Economics of Health, The University of Queensland and Dipartimento di Sociologia e Diritto dell'Economia, Università di Bologna, Bologna, Italy.
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Hahn-Goldberg S, Pariser P, Schwenk C, Boozary A. Opportunity to inform social needs within a hospital setting using data-driven patient engagement. BMJ Open Qual 2021; 10:bmjoq-2021-001540. [PMID: 34706871 PMCID: PMC8552177 DOI: 10.1136/bmjoq-2021-001540] [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: 04/26/2021] [Accepted: 10/12/2021] [Indexed: 12/04/2022] Open
Abstract
Background High-risk patients account for a disproportionate amount of healthcare use, necessitating the development of care delivery solutions aimed specifically at reducing this use. These interventions have largely been unsuccessful, perhaps due to a lack of attention to patients’ social needs and engagement of patients in developing solutions. Methods The project team used a combination of administrative data, information culled from charts and interviews with high-risk patients to understand social needs, the current experience of addressing social needs in the hospital, and patient preferences and identified opportunities for improvement. Interviews were conducted in March and April 2020, and patients were asked to reflect on their experiences both before and during the COVID-19 pandemic. Results A total of 4579 patients with 26 168 visits to the emergency department and 2904 inpatient admissions in the previous year were identified. Qualitative analysis resulted in three themes: (1) the interaction between social needs, demographics, and health; (2) the hospital’s role in addressing social needs; and (3) the impact of social needs on experiences of care. Themes related to experiences before and during COVID-19 did not differ. Three opportunities were identified: (1) training for staff related to stigma and trauma, (2) improved documentation of social needs and (3) creation of navigation programmes. Discussion Certain demographic factors were clearly associated with an increased need for social support. Unfortunately, many factors identified by patients as mediating their need for such support were not consistently captured. Going forward, high-risk patients should be included in the development of quality improvement initiatives and programmes to address social needs.
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Affiliation(s)
- Shoshana Hahn-Goldberg
- OpenLab, University Health Network, Toronto, Ontario, Canada .,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Pauline Pariser
- Gattuso Centre for Social Medicine, University Health Network, Toronto, Ontario, Canada.,Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colton Schwenk
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Andrew Boozary
- Gattuso Centre for Social Medicine, University Health Network, Toronto, Ontario, Canada
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Stockdale SE, Katz ML, Bergman AA, Zulman DM, Denietolis A, Chang ET. What Do Patient-Centered Medical Home (PCMH) Teams Need to Improve Care for Primary Care Patients with Complex Needs? J Gen Intern Med 2021; 36:2717-2723. [PMID: 33511564 PMCID: PMC8390729 DOI: 10.1007/s11606-020-06563-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intensive primary care (IPC) programs for patients with complex needs do not generate cost savings in most settings. Strengthening existing patient-centered medical homes (PCMH) to address the needs of these patients in primary care is a potential high-value alternative. OBJECTIVES Explore PCMH team functioning and characteristics that may impact their ability to perform IPC tasks; identify the IPC components that could be incorporated into PCMH teams' workflow; and identify additional resources, trainings, and staff needed to better manage patients with complex needs in primary care. METHODS We interviewed 44 primary care leaders, PCMH team members (providers, nurses, social workers), and IPC program leaders at 5 VA IPC sites and analyzed a priori themes using a matrix analysis approach. RESULTS Higher-functioning PCMH teams were described as already performing most IPC tasks, including panel management and care coordination. All sites reported that PCMH teams had the knowledge and skills to perform IPC tasks, but not with the same intensity as specialized IPC teams. Home visits/assessments and co-attending appointments were perceived as not feasible to perform. Key stakeholders identified 6 categories of supports and capabilities that PCMH teams would need to better manage complex patients, with care coordination/management and fully staffed teams as the most frequently mentioned. Many thought that PCMH teams could make better use of existing VA and non-VA resources, but might need training in identifying and using those resources. CONCLUSIONS PCMH teams can potentially offer certain clinic-based services associated with IPC programs, but tasks that are time intensive or require physical absence from clinic might require collaboration with community service providers and better use of internal and external healthcare system resources. Future studies should explore the feasibility of PCMH adoption of IPC tasks and the impact on patient outcomes.
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Affiliation(s)
- Susan E Stockdale
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
| | - Marian L Katz
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Alicia A Bergman
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Evelyn T Chang
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
- VA Greater Los Angeles Healthcare System, Division of General Internal Medicine, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Implementing emergency admission risk prediction in general practice: a qualitative study. Br J Gen Pract 2021; 72:e138-e147. [PMID: 34782316 PMCID: PMC8597766 DOI: 10.3399/bjgp.2021.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/23/2021] [Indexed: 11/14/2022] Open
Abstract
Background Using computer software in general practice to predict patient risk of emergency hospital admission has been widely advocated, despite limited evidence about effects. In a trial evaluating the introduction of a Predictive Risk Stratification Model (PRISM), statistically significant increases in emergency hospital admissions and use of other NHS services were reported without evidence of benefits to patients or the NHS. Aim To explore GPs’ and practice managers’ experiences of incorporating PRISM into routine practice. Design and setting Semi-structured interviews were carried out with GPs and practice managers in 18 practices in rural, urban, and suburban areas of south Wales. Method Interviews (30–90 min) were conducted at 3–6 months after gaining PRISM access, and ∼18 months later. Data were analysed thematically using Normalisation Process Theory. Results Responders (n = 22) reported that the decision to use PRISM was based mainly on fulfilling Quality and Outcomes Framework incentives. Most applied it to <0.5% practice patients over a few weeks. Using PRISM entailed undertaking technical tasks, sharing information in practice meetings, and making small-scale changes to patient care. Use was inhibited by the model not being integrated with practice systems. Most participants doubted any large-scale impact, but did cite examples of the impact on individual patient care and reported increased awareness of patients at high risk of emergency admission to hospital. Conclusion Qualitative results suggest mixed views of predictive risk stratification in general practice and raised awareness of highest-risk patients potentially affecting rates of unplanned hospital attendance and admissions. To inform future policy, decision makers need more information about implementation and effects of emergency admission risk stratification tools in primary and community settings.
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Roblin DW, Segel JE, McCarthy RJ, Mendiratta N. Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients: a Retrospective Cohort Study. J Gen Intern Med 2021; 36:2021-2029. [PMID: 33742306 PMCID: PMC8298622 DOI: 10.1007/s11606-021-06676-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-cost/high-need (HCHN) adults and the healthcare systems that provide their care may benefit from a new patient-centered model of care involving a dedicated physician and nurse team who coordinate both clinical and social services for a small patient panel. OBJECTIVE Evaluate the impact of a Complex Care Program (CCP) on likelihood of patient survival and hospital admission in 180 days following empanelment to the CCP. DESIGN Retrospective cohort study using a quasi-experimental design with CCP patients propensity score matched to a concurrent control group of eligible but unempaneled patients. SETTING Kaiser Permanente Mid-Atlantic States (KPMAS) during 2017-2018. PARTICIPANTS Nine hundred twenty-nine CCP patients empaneled January 2017-June 2018, 929 matched control patients for the same period. INTERVENTIONS The KPMAS CCP is a new program consisting of 8 teams each staffed by a physician and nurse who coordinate care across a continuum of specialty care, tertiary care, and community services for a panel of 200 patients with advanced clinical disease and recent hospitalizations. MAIN OUTCOMES Time to death and time to first hospital admission in the 180 days following empanelment or eligibility. RESULTS Compared to matched control patients, CCP patients had prolonged time to death (hazard ratio [HR]: 0.577, 95% CI: 0.474, 0.704), and CCP decedents had longer survival (median days 69.5 vs. 53.0, p=0.03). CCP patients had similar time to hospital admission (HR: 1.081, 95% CI: 0.930, 1.258), with similar results when adjusting for competing risk of death (HR: 1.062, 95% CI: 0.914, 1.084). LIMITATIONS Non-randomized intervention; single healthcare system; patient eligibility limited to specific conditions. CONCLUSION The KPMAS CCP was associated with significantly reduced short-term mortality risk for eligible patients who volunteered to participate in this intervention.
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Affiliation(s)
- Douglas W Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.
| | - Joel E Segel
- The Pennsylvania State University, University Park, PA, USA
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Acosta-García H, Alfaro-Lara ER, Sánchez-Fidalgo S, Sevilla-Sánchez D, Delgado-Silveira E, Juanes-Borrego A, Santos-Ramos B. Intervention effectiveness by pharmacists integrated within an interdisciplinary health team on chronic complex patients. Eur J Public Health 2021; 30:886-899. [PMID: 32052027 DOI: 10.1093/eurpub/ckz224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nowadays, it is difficult to establish a specific method of intervention by the pharmacist and its clinical repercussions. Our aim was to identify interventions by pharmacists integrated within an interdisciplinary team for chronic complex patients (CCPs) and determine which of them produce the best results. METHODS A systematic review (SR) was performed based on PICO(d) question (2008-18): (Population): CCPs; (Intervention): carried out by health system pharmacists in collaboration with an interdisciplinary team; (Comparator): any; (Outcome): clinical and health resources usage outcomes; (Design): meta-analysis, SR and randomized clinical trials. RESULTS Nine articles were included: one SR and eight randomized clinical trials. The interventions consisted mainly in putting in order the pharmacotherapy and the review of the medication adequacy, medication reconciliation in transition of care and educational intervention for health professionals. Only one showed significant improvements in mortality (27.9% vs. 38.5%; HR = 1.49; P = 0.026), two in health-related quality of life [according to EQ-5D (European Quality of Life-5 Dimensions) and EQ-VAS (European Quality of Life-Visual Analog Scale) tests] and four in other health-related results (subjective self-assessment scales, falls or episodes of delirium and negative health outcomes associated with medication). Significant differences between groups were found in hospital stay and frequency of visits to the emergency department. No better results were observed in hospitalization rate. Otherwise, one study measured cost utility and found a cost of €45 987 per quality-adjusted life year gained due to the intervention. CONCLUSIONS It was not possible to determine with certainty which interventions produce the best results in CCPs. The clinical heterogeneity of the studies and the short follow-up of most studies probably contributed to this uncertainty.
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Affiliation(s)
| | | | - Susana Sánchez-Fidalgo
- Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Daniel Sevilla-Sánchez
- Pharmacy Service, Vic Hospital Consortium, Central Catalonia Chronicity Research Group (C3RG), Vic, Spain
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Hayes H, Stokes J, Kristensen SR, Sutton M. The effect of payment method and multimorbidity on health and healthcare utilisation. J Health Organ Manag 2021. [DOI: 10.1108/jhom-05-2020-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThree types of payment methods have been introduced across European countries in attempts to encourage better, more integrated care of persons with multimorbidity: pay-for-performance; pay-for-coordination; and an all-inclusive payment method. We examine whether there are differences in the way these payment methods affect health and healthcare use in persons with multimorbidity.Design/methodology/approachUsing individual-level survey data from twenty European countries, we examine unadjusted differences in average outcomes for the years 2011–2015 by whether countries adopted new payment methods for integrated care. We then test for a differential effect for multimorbid persons using linear, individual random effects regressions, including country and time fixed effects and clustering standard errors at the country level.FindingsWe find little effect of varying payment methods on key outcomes for multimorbid individuals despite the theoretical predictions and the rhetoric in many policy documents.Research limitations/implicationsPolicymakers should bear in mind that the success of the payment method relies on the specific design of the incentives and their implementation. New effective models of care and how to incentivise these for multimorbid patients is an ongoing research priority.Originality/valueThis paper is the first to study the effects of payments for integration on the dimensions and populations these schemes intend to affect; health and healthcare use at the individual level for multimorbid individuals.
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Smith MA, Vaughan-Sarrazin MS, Yu M, Wang X, Nordby PA, Vogeli C, Jaffery J, Metlay JP. The importance of health insurance claims data in creating learning health systems: evaluating care for high-need high-cost patients using the National Patient-Centered Clinical Research Network (PCORNet). J Am Med Inform Assoc 2021; 26:1305-1313. [PMID: 31233126 DOI: 10.1093/jamia/ocz097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Case management programs for high-need high-cost patients are spreading rapidly among health systems. PCORNet has substantial potential to support learning health systems in rapidly evaluating these programs, but access to complete patient data on health care utilization is limited as PCORNet is based on electronic health records not health insurance claims data. Because matching cases to comparison patients on baseline utilization is often a critical component of high-quality observational comparative effectiveness research for high-need high-cost patients, limited access to claims may negatively affect the quality of the matching process. We sought to determine whether the evaluation of programs for high-need high-cost patients required claims data to match cases to comparison patients. MATERIALS AND METHODS A retrospective cohort study design with multiple measures of before-and-after health care utilization for 1935 case management patients and 3833 matched comparison patients aged 18 years and older from 2011 to 2015. EHR and claims data were extracted from 3 health systems participating in PCORNet. RESULTS Without matching on claims-based health care utilization, the case management programs at 2 of 3 health systems were associated with fewer hospital admissions and emergency visits over the subsequent 12 months. With matching on claims-based health care utilization, case management was no longer associated with admissions and emergency visits at those 2 programs. DISCUSSION The results of a PCORNet-facilitated evaluation of 3 programs for high-need high-cost patients differed substantially depending on whether claims data were available for matching cases to comparison patients. CONCLUSIONS Partnering with learning health systems to rapidly evaluate programs for high-need high-cost patients will require that PCORNet facilitates comprehensive and timely access to both electronic health records and health insurance claims data.
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Affiliation(s)
- Maureen A Smith
- Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.,Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.,Health Innovation Program, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Mary S Vaughan-Sarrazin
- Department of Internal Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Menggang Yu
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Xinyi Wang
- Health Innovation Program, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Peter A Nordby
- Health Innovation Program, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Christine Vogeli
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan Jaffery
- Office of Population Health, UW Health, Madison, Wisconsin, USA.,Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Joshua P Metlay
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Doménech-Briz V, Gómez Romero R, de Miguel-Montoya I, Juárez-Vela R, Martínez-Riera JR, Mármol-López MI, Verdeguer-Gómez MV, Sánchez-Rodríguez Á, Gea-Caballero V. Results of Nurse Case Management in Primary Heath Care: Bibliographic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9541. [PMID: 33419267 PMCID: PMC7766905 DOI: 10.3390/ijerph17249541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The new characteristics of today's population, together with the presence of chronic diseases in the elderly, require a new approach to care, promoting coordination between different levels of care. In this sense, we find the figure of the nurse case manager (NCM) in primary health care mainly responsible for ensuring continuity of care in complex patients with chronic diseases. OBJECTIVE to describe the role of the NCM in care management, determining its effectiveness in addressing chronic disease (health outcomes and quality of life) and its efficiency in the health system. METHODS Bibliographic review of scientific evidence on case management applied to nursing. Between March and April 2020 a bibliographic search was carried out in the Dialnet, Scielo, Scopus and Pubmed databases. INCLUSION CRITERIA articles written in the last 5 years, which analyze how this nursing rol influences the care and health of patients. RESULTS A total of 16 articles were selected. The NCM reduced the use of the emergency department, hospital admissions, readmissions, and the duration of these in the patients studied. CONCLUSION The NCM is effective and efficient for both patients and health institutions, and a common practice model is needed that includes standardized protocols and evidence-based practices.
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Affiliation(s)
- Vicente Doménech-Briz
- Hospital Universitario de la Ribera, km 1, Ctra. Corbera, 46600 Alzira, Spain; (V.D.-B.); (Á.S.-R.)
| | - Rosario Gómez Romero
- Nursing School La Fe, adscript center of Universidad de Valencia, 46026 Valencia, Spain; (I.d.M.-M.); (M.I.M.-L.); (V.G.-C.)
- Research Group GREIACC, Health Research Institute La Fe, Avda. Fernando Abril Martorell, 106. Pabellón docente Torre H, Hospital La Fe, 46016 Valencia, Spain
| | - Isabel de Miguel-Montoya
- Nursing School La Fe, adscript center of Universidad de Valencia, 46026 Valencia, Spain; (I.d.M.-M.); (M.I.M.-L.); (V.G.-C.)
- Research Group GREIACC, Health Research Institute La Fe, Avda. Fernando Abril Martorell, 106. Pabellón docente Torre H, Hospital La Fe, 46016 Valencia, Spain
| | - Raúl Juárez-Vela
- Department of Nursing, University of La Rioja, 26006 Logroño, La Rioja, Spain
- Research Group BMP Idi-Paz. Hospital La- Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - José Ramón Martínez-Riera
- Departamento Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, E-03080 Alicante, Spain;
| | - María Isabel Mármol-López
- Nursing School La Fe, adscript center of Universidad de Valencia, 46026 Valencia, Spain; (I.d.M.-M.); (M.I.M.-L.); (V.G.-C.)
- Research Group GREIACC, Health Research Institute La Fe, Avda. Fernando Abril Martorell, 106. Pabellón docente Torre H, Hospital La Fe, 46016 Valencia, Spain
| | - María Virtudes Verdeguer-Gómez
- Dirección Atención Primaria, Departamento de Salud de Alzira, Alzira, Valencia, Spain. km 1, Ctra. Corbera, 46600 Alzira, Valencia;
| | - Álvaro Sánchez-Rodríguez
- Hospital Universitario de la Ribera, km 1, Ctra. Corbera, 46600 Alzira, Spain; (V.D.-B.); (Á.S.-R.)
| | - Vicente Gea-Caballero
- Nursing School La Fe, adscript center of Universidad de Valencia, 46026 Valencia, Spain; (I.d.M.-M.); (M.I.M.-L.); (V.G.-C.)
- Research Group GREIACC, Health Research Institute La Fe, Avda. Fernando Abril Martorell, 106. Pabellón docente Torre H, Hospital La Fe, 46016 Valencia, Spain
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Roles, Training, and Qualifications of a Case Manager in the Canadian Health Care Industry: A Narrative Review. Prof Case Manag 2020; 26:27-33. [PMID: 33214509 DOI: 10.1097/ncm.0000000000000425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this article is to explore primary roles, training, competencies, and qualifications of a case manager in the Canadian health care industry and how to improve case management practice in Canada. PRIMARY PRACTICE SETTING Case managers' primary practice setting investigated in this article is the Canadian health care industry, which includes clinics, hospitals, continuing care, short-term and long-term care facilities, as well as palliative and end-of-life care settings. CONCLUSION The main role of case managers is to help clients meet their goals. Assessment, monitoring, interpersonal communication, and collaboration are essential roles and competencies of case managers. Many case managers come from regulated health care professions and have prior years of professional experience, and many of them come from a nursing profession. This article is a narrative review based on the current literature about case managers' roles, training, and competencies in the Canadian health care industry and how to improve Canadian case management practice. Certification and standardization of case managers in Canada are needed to better understand the roles, training, and qualifications of case managers in the Canadian health care industry. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Case managers require skills in assessment, monitoring, cultural competency, interpersonal communication, collaboration, coordinating, and advocating for resources and services to meet clients' goals in the health care industry. Case managers must also consider how to combat and address other social determinants of health such as a client's social economic status, literacy, income, employment, and working conditions that influence client's health. Ongoing professional development for case managers is fundamental in achieving effective case management practice. Finally, it is important to have case management certification in Canada in order to better understand case manager's roles and qualifications in the Canadian health care industry.
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Frost R, Rait G, Wheatley A, Wilcock J, Robinson L, Harrison Dening K, Allan L, Banerjee S, Manthorpe J, Walters K. What works in managing complex conditions in older people in primary and community care? A state-of-the-art review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1915-1927. [PMID: 32671922 DOI: 10.1111/hsc.13085] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
The number of older people living with complex health conditions is increasing, with the majority of these managed in primary and community settings. Many models of care have been developed to support them, however, there is mixed evidence on their value and they include multiple overlapping components. We aimed to synthesise the evidence to learn what works for managing complex conditions in older people in primary and community care. We carried out a state-of-the-art review of systematic reviews. We searched three databases (January 2009 to July 2019) for models of primary and community care for long-term conditions, frailty, multimorbidity and complex neurological conditions common to older people such as dementia. We narratively synthesised review findings to summarise the evidence for each model type and identify components which influenced effectiveness. Out of 2,129 unique titles and abstracts, 178 full texts were reviewed and 54 systematic reviews were included. We found that the models of care were more likely to improve depressive symptoms and mental health outcomes than physical health or service use outcomes. Interventions including self-management, patient education, assessment with follow-up care procedures, and structured care processes or pathways had greater evidence of effectiveness. The level of healthcare service integration appeared to be more important than inclusion of specific professional types within a team. However, more experienced and qualified nurses were associated with better outcomes. These conclusions are limited by the overlap between reviews, reliance on vote counting within some included reviews and the quality of study reports. In conclusion, primary and community care interventions for complex conditions in older people should include: (a) clear intervention targets; (b) explicit theoretical underpinnings; and (c) elements of self-management and patient education, structured collaboration between healthcare professionals and professional support. Further work needs to determine the optimal intensity, length, team composition and role of technology in interventions.
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Affiliation(s)
- Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Alison Wheatley
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Louise Allan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jill Manthorpe
- NIHR Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
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