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Anderson AJ, Noyes K, Hewner S. Expanding the evidence for cross-sector collaboration in implementation science: creating a collaborative, cross-sector, interagency, multidisciplinary team to serve patients experiencing homelessness and medical complexity at hospital discharge. Front Health Serv 2023; 3:1124054. [PMID: 37744643 PMCID: PMC10515621 DOI: 10.3389/frhs.2023.1124054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/21/2023] [Indexed: 09/26/2023]
Abstract
Introduction Patients with medical and social complexity require care administered through cross-sector collaboration (CSC). Due to organizational complexity, biomedical emphasis, and exacerbated needs of patient populations, interventions requiring CSC prove challenging to implement and study. This report discusses challenges and provides strategies for implementation of CSC through a collaborative, cross-sector, interagency, multidisciplinary team model. Methods A collaborative, cross-sector, interagency, multidisciplinary team was formed called the Buffalo City Mission Recuperative Care Collaborative (RCU Collaborative), in Buffalo, NY, to provide care transition support for people experiencing homelessness at acute care hospital discharge through a medical respite program. Utilizing the Expert Recommendations for Implementing Change (ERIC) framework and feedback from cross-sector collaborative team, implementation strategies were drawn from three validated ERIC implementation strategy clusters: 1) Develop stakeholder relationships; 2) Use evaluative and iterative strategies; 3) Change infrastructure. Results Stakeholders identified the following factors as the main barriers: organizational culture clash, disparate visions, and workforce challenges related to COVID-19. Identified facilitators were clear group composition, clinical academic partnerships, and strategic linkages to acute care hospitals. Discussion A CSC interagency multidisciplinary team can facilitate complex care delivery for high-risk populations, such as medical respite care. Implementation planning is critically important when crossing agency boundaries for new multidisciplinary program development. Insights from this project can help to identify and minimize barriers and optimize utilization of facilitators, such as academic partners. Future research will address external organizational influences and emphasize CSC as central to interventions, not simply a domain to consider during implementation.
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Affiliation(s)
- Amanda Joy Anderson
- School of Nursing, State University of New York at Buffalo, Buffalo, NY, United States
| | - Katia Noyes
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, NY, United States
| | - Sharon Hewner
- School of Nursing, State University of New York at Buffalo, Buffalo, NY, United States
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Schneberk T, Bolshakova M, Sloan K, Chang E, Stal J, Dinalo J, Jimenez E, Motala A, Hempel S. Quality Indicators for High-Need Patients: a Systematic Review. J Gen Intern Med 2022; 37:3147-3161. [PMID: 35260956 PMCID: PMC9485370 DOI: 10.1007/s11606-022-07454-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Healthcare systems are increasingly implementing programs for high-need patients, who often have multiple chronic conditions and complex social situations. Little, however, is known about quality indicators that might guide healthcare organizations and providers in improving care for high-need patients. We sought to conduct a systematic review to identify potential quality indicators for high-need patients. METHODS This systematic review (CRD42020215917) searched PubMed, CINAHL, and EMBASE; guideline clearing houses ECRI and GIN; and Google scholar. We included publications suggesting, evaluating, and utilizing indicators to assess quality of care for high-need patients. Critical appraisal of the indicators addressed the development process, endorsement and adoption, and characteristics, such as feasibility. We standardized indicators by patient population subgroups to facilitate comparisons across different indicator groups. RESULTS The search identified 6964 citations. Of these, 1382 publications were obtained as full text, and 53 studies met inclusion criteria. We identified over 1700 quality indicators across studies. Quality indicator characteristics varied widely. The scope of the selected indicators ranged from detailed criterion (e.g., "annual eye exam") to very broad categories (e.g., "care coordination"). Some publications suggested disease condition-specific indicators (e.g., diabetes), some used condition-independent criteria (e.g., "documentation of the medication list in the medical record available to all care agencies"), and some publications used a mixture of indicator types. DISCUSSION We identified and evaluated existing quality indicators for a complex, heterogeneous patient group. Although some quality indicators were not disease-specific, we found very few that accounted for social determinants of health and behavioral factors. More research is needed to develop quality indicators that address patient risk factors.
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Affiliation(s)
- Todd Schneberk
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA.
| | - Maria Bolshakova
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kylie Sloan
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Evelyn Chang
- VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Julia Stal
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer Dinalo
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elvira Jimenez
- VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Aneesa Motala
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Susanne Hempel
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Abstract
Although administrative claims data can be used to identify high-need (HN) Medicare beneficiaries, persistence in HN status among beneficiaries and subsequent variation in outcomes are unknown. We use national-level claims data to classify Fee-for-Service (FFS) Medicare beneficiaries as HN annually among beneficiaries continuously enrolled between 2013 and 2015. To examine persistence of HN status over time, we categorize longitudinal patterns in HN status into being never, newly, transiently, and persistently HN and examine differences in patients' demographic characteristics and outcomes. Among survivors, 23% of beneficiaries were HN at any time-4% persistently HN, 13% transiently HN, and 6% newly HN. While beneficiaries who were persistently HN had higher mortality, utilization, and expenditures, classification as HN at any time was associated with poor outcomes. These findings demonstrate longitudinal variability of HN status among FFS beneficiaries and reveal the pervasiveness of poor outcomes associated with even transitory HN status over time.
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