Causes of care discontinuity in chronic outpatient care: A mixed method case study.

IF 1.6 Q3 HEALTH POLICY & SERVICES Health Services Management Research Pub Date : 2024-12-17 DOI:10.1177/09514848241307183

Anu Vehkamäki, Märt Vesinurm, Riina-Riitta Helminen, Olli Halminen, Paul Lillrank

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Abstract

Background: While health systems are primarily designed for acute health issues, managing life-long conditions often results in chronic care discontinuity. This refers to situations where a chronic patient's planned care fails to actualise.

Research design: This study descriptively explores the reasons behind chronic care discontinuity in outpatient care.

Data collection: Data was collected via interviews and a focus group with healthcare professionals, and a patient survey specifically targeting chronic abdominal patients.

Analysis: Using grounded theorising the Discontinuity of Chronic Care (DoCC) framework was developed, to identify and categorise reasons behind chronic care discontinuity.

Results: The framework reveals that reasons for discontinuity can be largely divided into healthcare system related factors-including caregiver, technological, and process challenges-and patient-related factors such as situational and internal psychological challenges.

Conclusions: The DoCC-framework provides a valuable tool for analysing various patient processes, offering healthcare managers insights to improve the management of chronic patient journeys. Additionally, it guides healthcare professionals to better focus their development efforts on challenges they have the capacity to address.

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慢性病门诊护理中断的原因：混合方法案例研究。

背景：虽然卫生系统主要是为急性健康问题设计的，但管理终身疾病往往会导致慢性保健不连续性。这是指慢性病患者的计划护理未能实现的情况。研究设计：本研究描述性地探讨门诊慢性护理不连续背后的原因。数据收集：通过访谈和医疗保健专业人员焦点小组以及专门针对慢性腹部患者的患者调查收集数据。分析：使用扎根理论的慢性护理不连续（DoCC）框架被开发，以确定和分类慢性护理不连续背后的原因。结果：该框架显示，不连续性的原因主要可分为医疗保健系统相关因素（包括护理人员、技术和流程挑战）和患者相关因素（如情境和内部心理挑战）。结论：docc框架为分析各种患者流程提供了一个有价值的工具，为医疗保健管理人员提供了改进慢性患者旅程管理的见解。此外，它还指导医疗保健专业人员更好地将发展工作重点放在他们有能力解决的挑战上。

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来源期刊

Health Services Management Research HEALTH POLICY & SERVICES-

CiteScore

4.00

自引率

4.80%

发文量

期刊介绍： Health Services Management Research (HSMR) is an authoritative international peer-reviewed journal which publishes theoretically and empirically rigorous research on questions of enduring interest to health-care organizations and systems throughout the world. Examining the real issues confronting health services management, it provides an independent view and cutting edge evidence-based research to guide policy-making and management decision-making. HSMR aims to be a forum serving an international community of academics and researchers on the one hand and healthcare managers, executives, policymakers and clinicians and all health professionals on the other. HSMR wants to make a substantial contribution to both research and managerial practice, with particular emphasis placed on publishing studies which offer actionable findings and on promoting knowledge mobilisation toward theoretical advances.