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Itoh S, Mori T, Jin X, Ito T, Komiyama J, Kuroda N, Uda K, Tsuchiya-Ito R, Wu XV, Kodama K, Takahashi H, Takeda T, Tamiya N. Outcomes of advanced care management in home-based long-term care: A retrospective population-based observational study. Int J Nurs Stud 2024; 158:104862. [PMID: 39098084 DOI: 10.1016/j.ijnurstu.2024.104862] [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: 07/06/2023] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND In home-based long-term care, care management aims to facilitate the independence of community-dwelling older adults and mitigate the escalation of their care needs. We examined the association between the types of care management (advanced vs. conventional) and the progression of care needs among recipients with moderate care needs and compared care services offered in care plans between care management types. METHODS A retrospective, population-based observational study was conducted in Tsukuba City in Japan. The individual-level secondary data from the suburban municipal government was collected between May 2015 and March 2019. The primary outcome was the progression of care-need levels certificated in Japanese long-term care insurance. The exposure variable was advanced care management. First, we conducted propensity-score matching to adjust for differences in recipient characteristics. Second, we performed Kaplan-Meier survival analyses and log-rank tests, with the outcome measure being the progression of care-need levels. Third, Pearson's chi-square tests were performed to compare care services for recipients of advanced vs. conventional care management. RESULTS Of the 1010 long-term care recipients, we selected 856 propensity score-matched recipients receiving advanced or conventional care management. The proportions of four-year cumulative progression-free survival in the groups receiving advanced and conventional care management were 82.2 % and 78.5 %, respectively (p = .69). The proportions of the groups with advanced and conventional care management were 17.1 % and 23.8 % using home-help services (p < .05), and 4.0 % and 8.2 % using community-based day care services (p < .05), respectively. CONCLUSIONS Advanced care management in home-based long-term care was not associated with a slowing of the progression of care needs among older adults with moderate care needs compared with conventional care management. There was a notable discrepancy in the use of care services, with the advanced care management group having lower rates of use of home-help services and community-based day care services compared with the conventional care management group.
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Affiliation(s)
- Sakiko Itoh
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Genome Informatics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan.
| | - Takahiro Mori
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan; Department of General Internal Medicine, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba 286-0124, Japan
| | - Xueying Jin
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan; Department of Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi 474-8511, Japan
| | - Tomoko Ito
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Jun Komiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Naoaki Kuroda
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan; Tsukuba City, 1-1-1 Kenkyu-Gakuen, Tsukuba, Ibaraki 305-8555, Japan; National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Kazuaki Uda
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Rumiko Tsuchiya-Ito
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, 1-21-19 Toranomon, Minato-ku, Tokyo 105-0001, Japan
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore
| | - Kana Kodama
- Department of Medical Informatics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Hideto Takahashi
- Teikyo Heisei University, 4-21-2 Nakano, Nakano, 164-8530, Japan
| | - Toshihiro Takeda
- Department of Medical Informatics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Nanako Tamiya
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
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Macdonald M, Weeks LE, Langman E, Roach S, MacNeil MX, Caruso J, Tricco AC, Pham B, Straus SE, Mishra S, Isaranuwatchai W, Cormack GV, Grossman MR, Yakubovich AR, Mojbafan A, Ignaczak M, Leid C, Watt J, Stevens S, Khan T, Curran JA, Moody E, Rodrigues R. Recent innovations in long-term care coverage and financing: a rapid scoping review. BMJ Open 2024; 14:e077309. [PMID: 38388500 PMCID: PMC10884182 DOI: 10.1136/bmjopen-2023-077309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES To identify, chart and analyse the literature on recent initiatives to improve long-term care (LTC) coverage, financial protection and financial sustainability for persons aged 60 and older. DESIGN Rapid scoping review. DATA SOURCES Four databases and four sources of grey literature were searched for reports published between 2017 and 2022. After using a supervised machine learning tool to rank titles and abstracts, two reviewers independently screened sources against inclusion criteria. ELIGIBILITY CRITERIA Studies published from 2017-2022 in any language that captured recent LTC initiatives for people aged 60 and older, involved evaluation and directly addressed financing were included. DATA EXTRACTION AND ANALYSIS Data were extracted using a form designed to answer the review questions and analysed using descriptive qualitative content analysis, with data categorised according to a prespecified framework to capture the outcomes of interest. RESULTS Of 24 reports, 22 were published in peer-reviewed journals, and two were grey literature sources. Study designs included quasi-experimental study, policy analysis or comparison, qualitative description, comparative case study, cross-sectional study, systematic literature review, economic evaluation and survey. Studies addressed coverage based on the level of disability, income, rural/urban residence, employment and citizenship. Studies also addressed financial protection, including out-of-pocket (OOP) expenditures, copayments and risk of poverty related to costs of care. The reports addressed challenges to financial sustainability such as lack of service coordination and system integration, insufficient economic development and inadequate funding models. CONCLUSIONS Initiatives where LTC insurance is mandatory and accompanied by commensurate funding are situated to facilitate ageing in place. Efforts to expand population coverage are common across the initiatives, with the potential for wider economic benefits. Initiatives that enable older people to access the services needed while avoiding OOP-induced poverty contribute to improved health and well-being. Preserving health in older people longer may alleviate downstream costs and contribute to financial sustainability.
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Affiliation(s)
- Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Erin Langman
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheri Roach
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Morgan X MacNeil
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie Caruso
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea C Tricco
- St. Michael's Hospital Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Epidemiology Division, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ba' Pham
- University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- St. Michael's Hospital Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sujata Mishra
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Mueang Nonthaburi, Nonthaburi, Thailand
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gordon V Cormack
- David R. Cheriton School of Computer Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Maura R Grossman
- David R. Cheriton School of Computer Science, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Osgoode Hall Law School, York University, Toronto, Ontario, Canada
| | - Alexa R Yakubovich
- St. Michael's Hospital Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Affiliate Scientist, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Arezoo Mojbafan
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa Ignaczak
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Caron Leid
- SPOR Evidence Alliance, Toronto, Ontario, Canada
| | | | - Susan Stevens
- Senior Director Continuing Care, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Tayaba Khan
- SPOR Evidence Alliance, Toronto, Ontario, Canada
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elaine Moody
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ricardo Rodrigues
- ISEG Lisbon School of Economics and Management, Universidade de Lisboa, Lisboa, Portugal
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Sudo K, Noda S, Kobayashi J, Wongwatcharapaiboon P, Sakolwasan U, Takahashi K. The role of community nurse in the implementation of health policy for the elderly in Thailand. Glob Health Med 2023; 5:345-353. [PMID: 38162425 PMCID: PMC10730923 DOI: 10.35772/ghm.2023.01032] [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: 03/30/2023] [Revised: 07/23/2023] [Accepted: 09/01/2023] [Indexed: 01/03/2024]
Abstract
In the implementation of the policy for the elderly, the nurses who have the competency to pull out their potential power to continue living with several stakeholders' support are required to provide care in the community. Community nurse in Thailand has the responsibility to deliver adequate medical care and also social care for the elderly. The study aimed to identify the role of community nurse in the implementation of Thai health policy for the elderly. Codes regarding the role of community nurse in the implementation of Thai health policy for the elderly were extracted from descriptive data interviewed with 15 policy implementors in Thailand. The codes were categorized by similarities using thematic analysis. The role of community nurse was 16 categories and 102 codes out of factors promoting implementation of Thai health policy for the elderly, with 27 categories and 416 codes. The main roles were Coordination, Service delivery, and Monitoring and evaluation, composing seven categories and 45 codes, eight categories and 51 codes, and one category and six codes, respectively. It was conspicuous in coordination mechanisms, especially between the organizations and disciplines in providing Primary Health Care. Both health promotion activities and medical treatment were crucial roles for community nurses. The role of community nurse was one of promoting factors of Thai health policy for the elderly. The community nurse acts as a lubricant between the hospital and the community, which means that the community nurse implements seamless service delivery for the elderly integrating medical care and welfare.
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Affiliation(s)
- Kyoko Sudo
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichiro Noda
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Jun Kobayashi
- Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
| | | | | | - Kenzo Takahashi
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
- Department of Pediatrics, Navitas Clinic Kawasaki, Kanagawa, Japan
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Khatri R, Endalamaw A, Erku D, Wolka E, Nigatu F, Zewdie A, Assefa Y. Continuity and care coordination of primary health care: a scoping review. BMC Health Serv Res 2023; 23:750. [PMID: 37443006 DOI: 10.1186/s12913-023-09718-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Healthcare coordination and continuity of care conceptualize all care providers and organizations involved in health care to ensure the right care at the right time. However, systematic evidence synthesis is lacking in the care coordination of health services. This scoping review synthesizes evidence on different levels of care coordination of primary health care (PHC) and primary care. METHODS We conducted a scoping review of published evidence on healthcare coordination. PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science and Google Scholar were searched until 30 November 2022 for studies that describe care coordination/continuity of care in PHC and primary care. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to select studies. We analysed data using a thematic analysis approach and explained themes adopting a multilevel (individual, organizational, and system) analytical framework. RESULTS A total of 56 studies were included in the review. Most studies were from upper-middle-income or high-income countries, primarily focusing on continuity/care coordination in primary care. Ten themes were identified in care coordination in PHC/primary care. Four themes under care coordination at the individual level were the continuity of services, linkage at different stages of health conditions (from health promotion to rehabilitation), health care from a life-course (conception to elderly), and care coordination of health services at places (family to hospitals). Five themes under organizational level care coordination included interprofessional, multidisciplinary services, community collaboration, integrated care, and information in care coordination. Finally, a theme under system-level care coordination was related to service management involving multisectoral coordination within and beyond health systems. CONCLUSIONS Continuity and coordination of care involve healthcare provisions from family to health facility throughout the life-course to provide a range of services. Several issues could influence multilevel care coordination, including at the individual (services or users), organizational (providers), and system (departments and sectors) levels. Health systems should focus on care coordination, ensuring types of care per the healthcare needs at different stages of health conditions by a multidisciplinary team. Coordinating multiple technical and supporting stakeholders and sectors within and beyond health sector is also vital for the continuity of care especially in resource-limited health systems and settings.
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Affiliation(s)
- Resham Khatri
- School of Public Health, the University of Queensland, Brisbane, Australia.
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Aklilu Endalamaw
- School of Public Health, the University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Mount Gravatt, Australia
- Menzies Health Institute Queensland, Griffith University, Mount Gravatt, Australia
| | - Eskinder Wolka
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
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Chen J, Lu C, Huang H, Zhu D, Yang Q, Liu J, Huang Y, Deng A, Han X. Cognitive Computing-Based CDSS in Medical Practice. HEALTH DATA SCIENCE 2021; 2021:9819851. [PMID: 38487503 PMCID: PMC10880153 DOI: 10.34133/2021/9819851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/28/2021] [Indexed: 03/17/2024]
Abstract
Importance. The last decade has witnessed the advances of cognitive computing technologies that learn at scale and reason with purpose in medicine studies. From the diagnosis of diseases till the generation of treatment plans, cognitive computing encompasses both data-driven and knowledge-driven machine intelligence to assist health care roles in clinical decision-making. This review provides a comprehensive perspective from both research and industrial efforts on cognitive computing-based CDSS over the last decade.Highlights. (1) A holistic review of both research papers and industrial practice about cognitive computing-based CDSS is conducted to identify the necessity and the characteristics as well as the general framework of constructing the system. (2) Several of the typical applications of cognitive computing-based CDSS as well as the existing systems in real medical practice are introduced in detail under the general framework. (3) The limitations of the current cognitive computing-based CDSS is discussed that sheds light on the future work in this direction.Conclusion. Different from medical content providers, cognitive computing-based CDSS provides probabilistic clinical decision support by automatically learning and inferencing from medical big data. The characteristics of managing multimodal data and computerizing medical knowledge distinguish cognitive computing-based CDSS from other categories. Given the current status of primary health care like high diagnostic error rate and shortage of medical resources, it is time to introduce cognitive computing-based CDSS to the medical community which is supposed to be more open-minded and embrace the convenience and low cost but high efficiency brought by cognitive computing-based CDSS.
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Affiliation(s)
| | | | | | | | | | | | | | - Aijun Deng
- The Affiliated Hospital of Weifang Medical University, Shandong, China
| | - Xiaoxu Han
- National Clinical Research Center for Laboratory MedicineChina
- The First Affiliated Hospital, China Medical University, Liaoning, China
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