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Stockman LS, Gundersen DA, Gikandi A, Akindele RN, Svoboda L, Pohl S, Drews MR, Lathan CS. The Colocation Model in Community Cancer Care: A Description of Patient Clinical and Demographic Attributes and Referral Pathways. JCO Oncol Pract 2023:OP2200487. [PMID: 36940391 DOI: 10.1200/op.22.00487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
PURPOSE Cancer disparities are well documented among Black, Indigenous, and People of Color, yet little is known about the characteristics of programs that serve these populations. Integrating specialized cancer care services within community settings is important for addressing the needs of historically marginalized populations. Our National Cancer Institute-Designated Cancer Center initiated a clinical outreach program incorporating cancer diagnostic services and patient navigation within a Federally Qualified Health Center (FQHC) to expedite evaluation and resolution of potential cancer diagnoses with the goal of collaboration between oncology specialists and primary care providers in a historically marginalized community in Boston, MA. MATERIALS AND METHODS Sociodemographic and clinical characteristics were analyzed from patients who were referred to the program for cancer-related care between January 2012 and July 2018. RESULTS The majority of patients self-identified as Black (non-Hispanic) followed by Hispanic (Black and White). Twenty-two percent of patients had a cancer diagnosis. Treatment and surveillance plans were established for those with and without cancer at a median time to diagnostic resolution of 12 and 28 days, respectively. The majority of patients presented with comorbid health conditions. There was a high prevalence of self-reported financial distress among patients seeking care through this program. CONCLUSION These findings highlight the wide spectrum of cancer care concerns in historically marginalized communities. This review of the program suggests that integrating cancer evaluation services within community-based primary health care settings offers promise for enhancing the coordination and delivery of cancer diagnostic services among historically marginalized populations and could be a method to address clinical access disparities.
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Affiliation(s)
- Leah S Stockman
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Daniel A Gundersen
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ajami Gikandi
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ruth N Akindele
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ludmila Svoboda
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Sarah Pohl
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Christopher S Lathan
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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Hedqvist A, Svensson A, Larsson LG. Nurses' experiences of person-centred care planning using video-conferencing. Nurs Open 2022; 10:1879-1888. [PMID: 36326034 PMCID: PMC9912454 DOI: 10.1002/nop2.1452] [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: 10/17/2021] [Revised: 05/05/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
AIM The aim was to illuminate how nurses experience person-centred care planning using video conferencing upon hospital discharge of frail older persons. DESIGN Care planning via video conferencing requires collaboration, communication and information transfer between involved parties, both with regard to preparing and conducting meetings. Participation of involved parties is required to achieve a collaborative effort, but the responsibilities and roles of the involved professions are unclear, despite the existence of regulations. METHOD A qualitative content analysis was conducted based on 11 individual semi-structured interviews with nurses from hospitals, municipalities and primary care in Sweden. RESULTS This study provides valuable insights into challenges associated with care planning via video conferencing. The meeting format, that is video conferencing, is perceived as a barrier that makes the interaction challenging. Shortcomings in video technology make a person-centred approach difficult. The person-centred approach is also difficult for nurses to maintain when the older person or relatives are not involved in the planning.
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Affiliation(s)
| | - Ann Svensson
- School of Business, Economics and ITUniversity WestTrollhättanSweden
| | - Lena G. Larsson
- Department of Health SciencesUniversity WestTrollhättanSweden,Research, Education, Development and Innovation, Primary Health CareRegion Västra GötalandGothenburgSweden
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After Hospital: Should Older Care-Needing Patients Be Transferred to Their Homes or to an Intermediate Care Institution? Healthcare (Basel) 2022; 10:healthcare10030475. [PMID: 35326952 PMCID: PMC8955582 DOI: 10.3390/healthcare10030475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/26/2022] [Accepted: 02/27/2022] [Indexed: 02/01/2023] Open
Abstract
Background: In most European countries, communities need to provide health and social care services to an increasing number of severely ill patients discharged from hospitals. We investigated whether nurses in hospitals and in the communities’ health and social care services experienced that the administration in the municipalities allocated older patients the right type of services after hospital discharge. Methods: We used data from Norway, with a qualitative pilot study and quantitative analysis (structural equation modeling) of surveys involving 2431 nurses on inpatient wards in acute hospitals and 4312 nurses working in nursing homes or home nursing. Results: Dissatisfaction was widespread with the use of patients’ homes the first days after hospital discharge. Among nurses working in hospitals, 38% were commonly or very commonly disagreeing with the use of the patient’s home after hospital discharge, 25% among home nurses, and 18% among nurses in nursing homes. Home nurses were more prone to oppose the use of patients’ homes if they also experienced that their service had inadequate staffing or inadequate medical equipment. Conclusions: This research indicates conflicting priorities between the bureaucracy and nurses involved in actual work with older patients. From the nurses’ perspective, the municipalities’ administration was offering too few older patients short-term-stay in an intermediate care institution as part of the clinical pathway from hospital to home. However, providing more recourses to home nursing would improve their ability to provide sufficient care to older patients discharged from hospital.
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Veronese N, Vianello S, Danesin C, Tudor F, Pozzobon G, Pilotto A. Multidimensional Prognostic Index and Mortality in Intermediate Care Facilities: A Retrospective Study. J Clin Med 2021; 10:2632. [PMID: 34203781 PMCID: PMC8232637 DOI: 10.3390/jcm10122632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Multidimensional prognostic index (MPI) is a frailty assessment tool used for stratifying prognosis in older hospitalized people, but data regarding older people admitted to intermediate care facilities (ICFs) are missing. The aim of this study is to evaluate whether MPI can predict mortality in older patients admitted to the ICFs. MPI was calculated using different domains explored by a standard comprehensive geriatric assessment and categorized into tertiles (MPI-1 ≤ 0.20, MPI-2 0.20-0.34, MPI-3 > 0.34). A Cox's regression analysis, taking mortality as the outcome, was used, reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs). In total, 653 older patients were enrolled (mean age: 82 years, 59.1% females). Patients in MPI-2 (HR = 3.66; 95%CI: 2.45-5.47) and MPI-3 (HR = 6.22; 95%CI: 4.22-9.16) experienced a higher risk of mortality, compared to MPI-1. The accuracy of MPI in predicting mortality was good (area under the curve (AUC) = 0.74, 95%CI: 0.70-0.78). In conclusion, our study showed that prognostic stratification, as assessed by the MPI, was associated with a significantly different risk of mortality in older patients admitted to the ICFs, indicating the necessity of using a CGA-based tool for better managing older people in this setting as well.
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Affiliation(s)
- Nicola Veronese
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
- Geriatrics Section, Department of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Stefano Vianello
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Claudia Danesin
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Florina Tudor
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Gianfranco Pozzobon
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, 16128 Genova, Italy;
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70121 Bari, Italy
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Barriers and Facilitators in the Uptake of Integrated Care Pathways for Older Patients by Healthcare Professionals: A Qualitative Analysis of the French National "Health Pathway of Seniors for Preserved Autonomy" Pilot Program: Barriers and Facilitators for Adhesion of Healthcare Professionals in Integrated Care for Older Patients: A Qualitative Assessment Based on the French National Experiment: 'Health Pathway of Seniors for Preserved Autonomy' (PAERPA). Int J Integr Care 2021; 21:7. [PMID: 33976596 PMCID: PMC8064286 DOI: 10.5334/ijic.5483] [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: 11/25/2022] Open
Abstract
Introduction: Integrated care is a particularly promising approach in geriatrics – a field in which the medical, psychological and social issues are often complex. The uptake of integrated care by healthcare professionals (HCPs) is essential but varies markedly. The objective of the present study of healthcare professionals was to identify barriers to and facilitators of commitment to integrated care for seniors. Methods: We performed a two-step, qualitative study, comprising (i) six qualitative, semi-directive series of interviews with HCPs (hospital practitioners, family physicians, nurses and pharmacists) who agreed or disagreed to take part in the French national “Health Pathway of Seniors for Preserved Autonomy” (PAERPA) pilot program; and (ii) an analysis of the pooled results, in order to identify common concerns among the healthcare professionals. Results: We identified four key “barrier” and “facilitator” topics shared by HCPs who had committed to the pilot program and those who had not: (i) awareness of and/or interest in geriatric medicine and team working, (ii) the presence of a care coordinator; (iii) the provision of information about the program and about the patient, and communication between HCPs, and (iv) personal benefits for the HCPs and the patients. Key conclusions: The four key topics identified in this large qualitative study of several healthcare professions should be considered during the design and dissemination of integrated care pathways for older patients.
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Landeiro F, Roberts K, Gray AM, Leal J. Delayed Hospital Discharges of Older Patients: A Systematic Review on Prevalence and Costs. THE GERONTOLOGIST 2019; 59:e86-e97. [PMID: 28535285 DOI: 10.1093/geront/gnx028] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY To determine the prevalence of delayed discharges of elderly inpatients and associated costs. DESIGN AND METHODS We searched Medline, Embase, Global Health, CAB Abstracts, Econlit, Web of Knowledge, EBSCO - CINAHL, The Cochrane Library, Health Management Information Consortium, and SCIE - Social Care Online for evidence published between 1990 and 2015 on number of days or proportion of delayed discharges for elderly inpatients in acute hospitals. Descriptive and regression analyses were conducted. Data on proportions of delayed discharges were pooled using a random effects logistic model and the association of relevant factors was assessed. Mean costs of delayed discharge were calculated in USD adjusted for Purchasing Power Parity (PPP). RESULTS Of 64 studies included, 52 (81.3%) reported delayed discharges as proportions of total hospital stay and 9 (14.1%) estimated the respective costs for these delays. Proportions of delayed discharges varied widely, from 1.6% to 91.3% with a weighted mean of 22.8%. This variation was also seen in studies from the same country, for example, in the United Kingdom, they ranged between 1.6% and 60.0%. No factor was found to be significantly associated with delays. The mean costs of delayed discharge also varied widely (between 142 and 31,935 USD PPP adjusted), reflecting the variability in mean days of delay per patient. IMPLICATIONS Delayed discharges occur in most countries and the associated costs are significant. However, the variability in prevalence of delayed discharges and available data on costs limit our knowledge of the full impact of delayed discharges. A standardization of methods is necessary to allow comparisons to be made, and additional studies are required-preferably by disease area-to determine the postdischarge needs of specific patient groups and the estimated costs of delays.
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Affiliation(s)
- Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Kenny Roberts
- Department of Physiology, Anatomy and Genetics, University of Oxford, UK
| | - Alastair Mcintosh Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - José Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
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Kvæl LAH, Debesay J, Langaas A, Bye A, Bergland A. A Concept Analysis of Patient Participation in Intermediate Care. PATIENT EDUCATION AND COUNSELING 2018; 101:1337-1350. [PMID: 29551564 DOI: 10.1016/j.pec.2018.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/01/2018] [Accepted: 03/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Although the concept of patient participation has been discussed for a number of years, there is still no clear definition of what constitutes the multidimensional concept, and the application of the concept in an intermediate care (IC) context lacks clarity. Therefore this paper seeks to identify and explore the attributes of the concept, to elaborate ways of understanding the concept of patient participation for geriatric patients in the context of IC. METHODS Walker and Avant's model of Concept analysis [1] based on a literature review. RESULTS Patient participation in the context of IC can be defined as a dynamic process emphasizing the person as a whole, focusing on the establishment of multiple alliances that facilitate individualized information and knowledge exchange, and ensuring a reciprocal engagement in activities within flexible and interactive/dynamic organizational structures. CONCLUSION Patient participation in IC means involving patients and their relatives in holistic interdisciplinary collaborative decision-making. The results highlight the complexity of patient participation and contribute to a greater understanding of the influence of organizational structure and management. PRACTICAL IMPLICATIONS The present study may provide a practical framework for researchers, policy makers and health professionals to facilitate patient participation in IC services.
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Affiliation(s)
- Linda Aimée Hartford Kvæl
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Physiotherapy, Oslo, Norway.
| | - Jonas Debesay
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway
| | - Anne Langaas
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Physiotherapy, Oslo, Norway
| | - Asta Bye
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway; Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Astrid Bergland
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Physiotherapy, Oslo, Norway
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Integrated Care Approaches Used for Transitions from Hospital to Community Care: A Scoping Review. Can J Aging 2018; 37:145-170. [PMID: 29631639 DOI: 10.1017/s0714980818000065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
ABSTRACTIntegrated care is a promising approach for improving care transitions for older adults, but this concept is inconsistently defined and applied. This scoping review describes the size and nature of literature on integrated care initiatives for transitions from hospital to community care for older adults (aged 65 and older) and how this literature conceptualizes integrated care. A systematic search of literature from the past 10 years yielded 899 documents that were screened for inclusion by two reviewers. Of the 48 included documents, there were 26 journal articles and 22 grey literature documents. Analysis included descriptive statistics and a content analysis approach to summarize features of the integrated care initiatives. Results suggest that clinical and service delivery integration is being targeted rather than integration of funding, administration, and/or organization. To promote international comparison of integrated care initiatives aiming to improve care transitions, detailed descriptions of organizational context are also needed.
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Harvey D, Foster M, Strivens E, Quigley R. Improving care coordination for community-dwelling older Australians: a longitudinal qualitative study. AUST HEALTH REV 2017; 41:144-150. [PMID: 27333204 DOI: 10.1071/ah16054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/21/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to describe the care transition experiences of older people who transfer between subacute and primary care, and to identify factors that influence these experiences. A further aim of the study was to identify ways to enhance the Geriatric Evaluation and Management (GEM) model of care and improve local coordination of services for older people. Methods The present study was an exploratory, longitudinal case study involving repeat interviews with 19 patients and carers, patient chart audits and three focus groups with service providers. Interview transcripts were coded and synthesised to identify recurring themes. Results Patients and carers experienced care transitions as dislocating and unpredictable within a complex and turbulent service context. The experience was characterised by precarious self-management in the community, floundering with unmet needs and holistic care within the GEM service. Patient and carer attitudes to seeking help, quality and timeliness of communication and information exchange, and system pressure affected care transition experiences. Conclusion Further policy and practice attention, including embedding early intervention and prevention, strengthening links between levels of care by building on existing programs and educative and self-help initiatives for patients and carers is recommended to improve care transition experiences and optimise the impact of the GEM model of care. What is known about the topic? Older people with complex care needs experience frequent care transitions because of fluctuating health and fragmentation of aged care services in Australia. The GEM model of care promotes multidisciplinary, coordinated care to improve care transitions and outcomes for older people with complex care needs. What does this paper add? The present study highlights the crucial role of the GEM service, but found there is a lack of systemised linkages within and across levels of care that disrupts coordinated care and affects care transition experiences. There are underutilised opportunities for early intervention and prevention across the system, including the emergency department and general practice. What are the implications for practitioners? Comprehensive screening, assessment and intervention in primary and acute care, formalised transition processes and enhanced support for patients and carers to access timely, appropriate care is required to achieve quality, coordinated care transitions for older people.
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Affiliation(s)
- Desley Harvey
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
| | - Michele Foster
- School of Social Work and Human Services, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia. Email
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
| | - Rachel Quigley
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
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Bångsbo A, Dunér A, Dahlin-Ivanoff S, Lidén E. Collaboration in discharge planning in relation to an implicit framework. Appl Nurs Res 2017; 36:57-62. [PMID: 28720240 DOI: 10.1016/j.apnr.2017.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/31/2017] [Accepted: 05/27/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Angela Bångsbo
- Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, Arvid Wallgrens Backe hus 2, Box 455, 405 30 Göteborg, Sweden; Sahlgrenska Academy, Centre of Ageing and Health, University of Gothenburg, 405 30 Göteborg, Sweden; R & D Sjuhärad Välfärd, University of Borås, 501 90 Borås, Sweden.
| | - Anna Dunér
- Department of Social Work, University of Gothenburg, Sprängkullsgat. 23, Box 720, 405 30 Göteborg, Sweden; Sahlgrenska Academy, Centre of Ageing and Health, University of Gothenburg, 405 30 Göteborg, Sweden
| | - Synneve Dahlin-Ivanoff
- Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, Arvid Wallgrens Backe hus 2, Box 455, 405 30 Göteborg, Sweden; Sahlgrenska Academy, Centre of Ageing and Health, University of Gothenburg, 405 30 Göteborg, Sweden
| | - Eva Lidén
- Sahlgrenska Academy, Centre of Ageing and Health, University of Gothenburg, 405 30 Göteborg, Sweden; Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Arvid Wallgrens Backe hus 1, Box 457, 405 30 Göteborg, Sweden
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Pitchforth E, Nolte E, Corbett J, Miani C, Winpenny E, van Teijlingen E, Elmore N, King S, Ball S, Miler J, Ling T. Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05190] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Emma Pitchforth
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Ellen Nolte
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and London School of Hygiene & Tropical Medicine, London, UK
| | - Jennie Corbett
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Céline Miani
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Eleanor Winpenny
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Edwin van Teijlingen
- Department of Human Sciences and Public Health, University of Bournemouth, Bournemouth, UK
| | - Natasha Elmore
- Cambridge Centre for Health Services Research (CCHSR), Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Sarah Ball
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Joanna Miler
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Tom Ling
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
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Busetto L, Kiselev J, Luijkx KG, Steinhagen-Thiessen E, Vrijhoef HJM. Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved. BMC Health Serv Res 2017; 17:180. [PMID: 28270122 PMCID: PMC5341181 DOI: 10.1186/s12913-017-2105-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 02/21/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Many health systems have implemented integrated care as an alternative approach to health care delivery that is more appropriate for patients with complex, long-term needs. The objective of this article was to analyse the implementation of integrated care at a German geriatric hospital and explore whether the use of a "context-mechanisms-outcomes"-based model provides insights into when and why beneficial outcomes can be achieved. METHODS We conducted 15 semi-structured interviews with health professionals employed at the hospital. The data were qualitatively analysed using a "context-mechanisms-outcomes"-based model. Specifically, mechanisms were defined as the different components of the integrated care intervention and categorised according to Wagner's Chronic Care Model (CCM). Context was understood as the setting in which the mechanisms are brought into practice and described by the barriers and facilitators encountered in the implementation process. These were categorised according to the six levels of Grol and Wensing's Implementation Model (IM): innovation, individual professional, patient, social context, organisational context and economic and political context. Outcomes were defined as the effects triggered by mechanisms and context, and categorised according to the six dimensions of quality of care as defined by the World Health Organization, namely effectiveness, efficiency, accessibility, patient-centeredness, equity and safety. RESULTS The integrated care intervention consisted of three main components: a specific reimbursement system ("early complex geriatric rehabilitation"), multidisciplinary cooperation, and comprehensive geriatric assessments. The inflexibility of the reimbursement system regarding the obligatory number of treatment sessions contributed to over-, under- and misuse of services. Multidisciplinary cooperation was impeded by a high workload, which contributed to waste in workflows. The comprehensive geriatric assessments were complemented with information provided by family members, which contributed to decreased likelihood of adverse events. CONCLUSIONS We recommend an increased focus on trying to understand how intervention components interact with context factors and, combined, lead to positive and/or negative outcomes.
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Affiliation(s)
- Loraine Busetto
- Tranzo Scientific Center for Care and Welfare, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
| | - Jörn Kiselev
- Geriatrics Research Group, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katrien Ger Luijkx
- Tranzo Scientific Center for Care and Welfare, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
| | | | - Hubertus Johannes Maria Vrijhoef
- Tranzo Scientific Center for Care and Welfare, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
- Panaxea B.V., Amsterdam, The Netherlands
- Department of Patient & Care, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
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Winpenny EM, Corbett J, Miani C, King S, Pitchforth E, Ling T, van Teijlingen E, Nolte E. Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models. Int J Integr Care 2016; 16:13. [PMID: 28316553 PMCID: PMC5354221 DOI: 10.5334/ijic.2463] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/24/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries. METHODS We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis. RESULTS 75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs), nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists. CONCLUSIONS Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care.
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Affiliation(s)
- Eleanor M. Winpenny
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Jennie Corbett
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Celine Miani
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Sarah King
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Emma Pitchforth
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Tom Ling
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Edwin van Teijlingen
- Bournemouth House B112c, 19 Christchurch Road, Bournemouth, BH1 3LH, United Kingdom
| | - Ellen Nolte
- London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom
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Adamson E, Pow J, Houston F, Redpath P. Exploring the experiences of patients attending day hospitals in the rural Scotland: capturing the patient's voice. J Clin Nurs 2016; 26:3044-3055. [PMID: 27865022 DOI: 10.1111/jocn.13651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To understand the meaning of person-centred compassionate care for people attending day hospitals in rural Scotland. BACKGROUND Increasing numbers of older people are living with chronic conditions and require support to live at home. Intermediate care services such as day hospitals can enable this. Much previous research about day hospitals focused on organisational aspects of care. This study set out to capture the voice of the patient using this service. DESIGN A descriptive qualitative study. METHODS Individual interviews were undertaken in participant's homes using emotional touchpoints as prompts to help patients discuss their experience of care within a day hospital (n = 15). Data were analysed using thematic analysis. RESULTS Four main themes were identified from the data: Relationships, Feeling Valued, Expectations and Perceived Benefits. The findings showed that relationships with staff and other patients were important. The patients also wanted to feel valued, and helping others was part of this. The patients had clear expectations of the service but had an acute awareness of the benefits of attending the day hospital such as coordination of their care. Overall, the patients were highly satisfied, felt that care was person-centred and recognised the advantages of remaining close to home. CONCLUSIONS At a time when enabling health and social care integration is a priority, this study provides insight into the patient perspective of intermediate care. The findings reveal what matters to patients cared for in the community and how this service can respond to this. RELEVANCE TO CLINICAL PRACTICE This study provides insight for healthcare practitioners caring for patients in the community and those responsible for planning and resourcing this service. It should also start a dialogue about how these services could be used more.
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Affiliation(s)
- Elizabeth Adamson
- School of Health and Social care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
| | - Janette Pow
- School of Health & Social care, Sighthill Campus, Edinburgh Napier University, Edinburgh, UK
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Strengthening patient safety in transitions of care: an emerging role for local medical centres in Norway. BMC Health Serv Res 2016; 16:452. [PMID: 27576322 PMCID: PMC5006451 DOI: 10.1186/s12913-016-1708-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 08/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Patient safety has gained less attention in primary care in comparison to specialised care. We explore how local medical centres (LMCs) can play a role in strengthening patient safety, both locally and in transitions between care levels. LMCs represent a form of intermediate care organisation in Norway that is increasingly used as a strategy for integrated care policies. The analysis is based on institutional theory and general safety theories. Methods A qualitative design was applied, involving 20 interviews of nursing home managers, managers at local medical centres and administrative personnel. Results The LMCs mediate important information between care levels, partly by means of workarounds, but also as a result of having access to the different information and communications technology (ICT) systems in use. Their knowledge of local conditions is found to be a key asset. LMCs are providers of competence and training for the local level, as well as serving as quality assurers. Conclusions As a growing organisational form in Norway, LMCs have to legitimise their role in the health care system. They represent an asset to the local level in terms of information, competence and quality assurance. As they have overlapping competencies, tasks and responsibilities with other parts of the health care system, they add to organisational redundancy and strengthen patient safety.
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Interorganizational Collaboration in Transitional Care - A Study of a Post-Discharge Programme for Elderly Patients. Int J Integr Care 2016; 16:11. [PMID: 27616966 PMCID: PMC5015536 DOI: 10.5334/ijic.2226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction and aim: This article reports a study of a
post-discharge programme for elderly patients in Norway. It took place in an
intermediate ward for transitional care and was based on collaboration between a
municipality and a hospital, which was part of a health enterprise. The aim of
the study was to analyse the collaboration and its possible effects on the
quality of patient care, and the economic efficiency of the project for the
organizations involved. Methodology: A mixed-methods approach, consisting of interviews,
questionnaires and analyses of official documents and statistics. Results: The collaboration was working well on the top level of the
organizations, but was more problematic on the operative level. However, there
were clear signs of improvement. The patients who received transitional care
were more satisfied with their stay at the ward than their previous stay at the
hospital. They were discharged to their homes more often and perceived to have a
higher level of functioning than the hospital patients. Average costs per
patient were also lower in the ward than in the hospital departments. Conclusion: The collaboration had mainly positive impacts on the
quality of patient care and the economic efficiency of elderly care in the
municipality. However, the board of the health enterprise decided to close down
the intermediate ward.
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Lim SY, Jarvenpaa SL, Lanham HJ. Barriers to Interorganizational Knowledge Transfer in Post-Hospital Care Transitions: Review and Directions for Information Systems Research. J MANAGE INFORM SYST 2015. [DOI: 10.1080/07421222.2015.1095013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dahl U, Steinsbekk A, Johnsen R. Effectiveness of an intermediate care hospital on readmissions, mortality, activities of daily living and use of health care services among hospitalized adults aged 60 years and older--a controlled observational study. BMC Health Serv Res 2015; 15:351. [PMID: 26315779 PMCID: PMC4552456 DOI: 10.1186/s12913-015-1022-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 08/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intermediate care is a health care model developed to optimize the coordination of health care services and functional independence. In Central Norway, an intermediate care hospital (ICH) was established in a municipality to improve hospital discharge and follow-up among elderly patients with chronic conditions and comprehensive care needs. The aim of this study was to investigate the effectiveness of hospital discharges to a municipality with an ICH compared to discharges to a municipality without an ICH. METHODS This was a non-randomized controlled observational study of hospitalized patients aged 60 years and older from two municipalities. Patients (n = 328) admitted to a general hospital from February 2010 through September 2011 were included in the study and followed for 12 months. The data were analyzed using descriptive statistics, analysis of covariance (ANCOVA) and Cox proportional hazard regression. RESULTS Each patient discharged from the general hospital to the municipality with an ICH had a shorter length of stay and used on average 4.2 (p = 0.046) fewer hospital days during 1 year compared to patients from the municipality without an ICH. Otherwise, no statistical significant differences were found between the municipalities in terms of hospital readmissions, admissions, mortality, activities of daily living, primary health care utilization or total care days. A post hoc analysis of patients discharged to the ICH compared to the municipality without an ICH, showed that the ICH patients were older and frailer, but the outcome was similar to the main analysis. CONCLUSIONS Having an ICH in the municipality facilitated shorter length of hospital stay and kept the risk of readmissions, mortality and post-hospitalization care needs at the same level as without an ICH.
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Affiliation(s)
- Unni Dahl
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Post box 8905 Medisinsk teknisk forskningssenter, 7491, Trondheim, Norway.
- Central Norway Health Authority, 7500, Stjørdal, Norway.
| | - Aslak Steinsbekk
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Post box 8905 Medisinsk teknisk forskningssenter, 7491, Trondheim, Norway.
| | - Roar Johnsen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Post box 8905 Medisinsk teknisk forskningssenter, 7491, Trondheim, Norway.
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Dahl U, Johnsen R, Sætre R, Steinsbekk A. The influence of an intermediate care hospital on health care utilization among elderly patients--a retrospective comparative cohort study. BMC Health Serv Res 2015; 15:48. [PMID: 25638151 PMCID: PMC4323014 DOI: 10.1186/s12913-015-0708-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/19/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND An intermediate care hospital (ICH) was established in a municipality in Central Norway in 2007 to improve the coordination of services and follow-up among elderly and chronically ill patients after hospital discharge. The aim of this study was to compare health care utilization by elderly patients in a municipality with an ICH to that of elderly patients in a municipality without an ICH. METHODS This study was a retrospective comparative cohort study of all hospitalized patients aged 60 years or older in two municipalities. The data were collected from the national register of hospital use from 2005 to 2012, and from the local general hospital and two primary health care service providers from 2008 to 2012 (approx. 1,250 patients per follow-up year). The data were analyzed using descriptive statistics and analysis of covariance (ANCOVA). RESULTS The length of hospital stay decreased from the time the ICH was introduced and remained between 10% and 22% lower than the length of hospital stay in the comparative municipality for the next five years. No differences in the number of readmissions or admissions during one year follow-up after the index stay at the local general hospital or changes in primary health care utilization were observed. In the year after hospital discharge, the municipality with an ICH offered more hour-based care to elderly patients living at home (estimated mean = 234 [95% CI 215-252] versus 175 [95% CI 154-196] hours per person and year), while the comparative municipality had a higher utilization of long-term stays in nursing homes (estimated mean = 33.3 [95% CI 29.0-37.7] versus 21.9 [95% CI 18.0-25.7] days per person and year). CONCLUSIONS This study indicates that the introduction of an ICH rapidly reduces the length of hospital stay without exposing patients to an increased health risk. The ICH appears to operate as an extension of the general hospital, with only a minor impact on the pattern of primary health care utilization.
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Affiliation(s)
- Unni Dahl
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
- Central Norway Health Authority, 7500, Stjørdal, Norway.
| | - Roar Johnsen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
| | - Rune Sætre
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
| | - Aslak Steinsbekk
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
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