International Journal of Care Coordination最新文献

Introduction: To explore Norwegian general practitioners' experiences with care coordination in primary health care.

Methods: Qualitative study using data from five focus groups with 32 general practitioners in Norway. We analysed the data using systematic text condensation, a descriptive and explorative method for thematic cross-case analysis of qualitative data.

Results: The general practitioners had different notions of care pathways. They expressed a wish and an obligation to be involved in planning and coordination of primary health-care services, but they experienced organisational and financial barriers that limited their involvement and contribution. General practitioners reported lack of information about and few opportunities for involvement in formal coordination initiatives, and they missed informal arenas for dialogue with other primary health-care professionals. They argued that the general practitioner's role as coordinator should be recognised by other parties and that they needed financial compensation for contributions and attendance in meetings with the municipality.

Discussion: General practitioners need informal arenas for dialogue with other primary health-care professionals and access to relevant information to promote coordinated care. There might be an untapped potential for improving patient care involving general practitioners more in planning and coordinating services at the system level. Financial compensation of general practitioners contribution may promote increased involvement by general practitioners.

Introduction: We aimed to assess changes in care coordination and health insurance coverage among US children with muscular dystrophy.

Methods: We used 2005-2006 and 2009-2010 data from the National Survey of Children with Special Health Care Needs. We examined the distribution of sociodemographic and health characteristics of children with muscular dystrophy by survey cycle. Multivariable regression was used to calculate odds of not receiving effective care coordination, not having adequate health insurance coverage, receiving no help coordinating care, and having problems obtaining referrals in each survey cycle.

Results: In the 2005-2006 and 2009-2010 survey cycles, there were 135 and 117 children with muscular dystrophy (representing 34,672 and 31,169 US children with muscular dystrophy), respectively. The percentage of children with muscular dystrophy who did not receive effective care coordination changed from 59.2% (95% confidence interval (CI), 45.6%-72.7%) in 2005-2006 to 53.4% (95% CI, 38.3%-68.6%) in 2009-2010. The odds of not receiving effective care coordination (adjusted odds ratio (aOR) = 0.77; 95% CI, 0.32-1.89) or having problems obtaining referrals (aOR = 0.52; 95% CI, 0.17-1.59) did not change significantly between the two periods, whereas odds of having inadequate insurance coverage decreased significantly (aOR = 0.41, 95% CI, 0.18-0.93) and odds of not receiving help coordinating care increased significantly (aOR = 4.22, 95% CI, 1.24-14.29) between the two periods.

Conclusion: Our results suggest key health care needs for many families with children with muscular dystrophy have remained unmet for a prolonged period. Although there were significant improvements in health insurance coverage, nearly one-third of children with muscular dystrophy still had inadequate health insurance coverage in 2009-2010; it is likely that this situation has not changed much since then.

It has been 12 years after Porter and Teisberg published their landmark manuscript on "Redefining Health Care." Apart from stressing the need for a fundamental change from fee-for-service to value or outcome-based financing and to a focus on reducing waste, they emphasized the need to work along patient pathways and in Integrated Practice Units to overcome function based and specialist group silos and promote working in multidisciplinary patient-oriented teams. Integrated Practice Units are defined as "organized around the patient and providing the full cycle of care for a medical condition, including patient education, engagement, and follow-up and encompass inpatient, outpatient and rehabilitative care as well as supporting services." Although relatively few papers are published with empirical evidence on Integrated Practice Units development, some providers have impressively developed pathways and integrated care toward alignment with Integrated Practice Units criteria. From the field, we learn that possible advantages lay in improving patient centeredness, breaking through professional boundaries, and reducing waste in unnecessary duplications. A firm body of evidence on the added value of turning pathways into Integrated Practice Units is hard to find and this leaves room for much variation. Although intuitively attractive, this development requires staff efforts and costs and therefore cost-effectiveness and budget impact studies are much needed. Randomized controlled trials may be difficult to realize in organizational research, it is long known that turning to alternative designs such as larger case study series and before-after designs can be helpful. Thus, it can become clear what added value is achievable and how to reach that.