International Journal of Care Coordination最新文献_第10页

Care coordination: Complicated or complex? 护理协调:复杂还是复杂?

IF 1.4 Q4 NURSING

International Journal of Care Coordination

Pub Date : 2019-03-20 DOI: 10.1177/2053434519840817

H. Vrijhoef

引用次数: 2

Exploring the effect of streamlining multidisciplinary care pathways on orbital trauma outcomes at a regional referral centre 在区域转诊中心探索简化多学科护理途径对眼眶创伤结果的影响

IF 1.4 Q4 NURSING

International Journal of Care Coordination

Pub Date : 2019-03-20 DOI: 10.1177/2053434519836431

M. Gillam, N. Mandal, V. Lee, V. Vora, M. Perry

Introduction Complex orbital fractures require multi-specialty input. The United Kingdom currently has no agreed best practice guidelines. A systematic review and meta-analysis found a significantly increased adverse outcome of persistent diplopia in patients operated on more than 14 days after initial injury. At our tertiary centre, we felt patient outcomes may be affected by investigative and referral pathway limitations so evaluated to assess and attempt to improve these. Methods This was a two-stage service evaluation study of all orbital trauma patients requiring specialist oculoplastic and orbital input. The initial phase included all orbital trauma patients referred to our department in April–November 2014. We assessed relevant key performance indicators and then implemented changes to our referral system, educated referring departments and formed a multidisciplinary team clinic to manage complex trauma. We then re-evaluated, collecting data on all patients referred March–May 2015. Results Most patients were male and victims of assault. Following intervention, there was a significant reduction in the injury to eye clinic review time (3.45 weeks to 2.22 weeks, p = 0.01) and multidisciplinary team review time (3.86 weeks to 2.71 weeks, p = 0.04). Injury to discharge time was significantly reduced from 6.15 weeks to 3.36 weeks (p = 0.002). Discussion Our study shows that a multidisciplinary team approach and structured pathways can improve assessment and intervention times for orbital trauma patients. This may have a beneficial effect on patient outcomes. In the absence of guidelines in the United Kingdom, we believe similar improvements could be implemented by other national centres and outcomes evaluated to assist future guidance formation.

复杂的眼眶骨折需要多专业的介入。英国目前没有商定的最佳实践指导方针。一项系统回顾和荟萃分析发现，在初次损伤后超过14天手术的患者，持续性复视的不良后果显著增加。在我们的三级中心，我们认为患者的结果可能会受到调查和转诊途径限制的影响，因此评估并试图改善这些。方法对所有需要眼科整形和眶内输入的眶外伤患者进行两阶段的服务评估研究。初始阶段包括2014年4 - 11月至我科就诊的所有眶外伤患者。我们评估了相关的关键绩效指标，然后对我们的转诊系统进行了改革，对转诊部门进行了培训，并组建了一个多学科团队诊所来处理复杂的创伤。然后我们重新评估，收集2015年3月至5月转诊的所有患者的数据。结果患者以男性为主，多为性侵受害者。干预后，损伤眼门诊复查时间(3.45周至2.22周，p = 0.01)和多学科小组复查时间(3.86周至2.71周，p = 0.04)显著减少。损伤至出院时间由6.15周显著缩短至3.36周(p = 0.002)。我们的研究表明，多学科团队方法和结构化路径可以改善眶外伤患者的评估和干预时间。这可能对患者的预后有有益的影响。在英国缺乏指导方针的情况下，我们认为其他国家中心可以实施类似的改进，并评估结果，以协助未来指导方针的形成。

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引用次数: 1

Integrated healthcare models for rheumatoid arthritis: A descriptive systematic review 类风湿关节炎的综合医疗模式:一项描述性系统综述

IF 1.4 Q4 NURSING

International Journal of Care Coordination

Pub Date : 2019-03-20 DOI: 10.1177/2053434519836425

V. Vodopivec, H. Vrijhoef

Introduction Integrated people-centred care is a modern approach for addressing healthcare issues related to demographic changes, increasing prevalence of chronic diseases, and restricted resources. By providing an overview of integrated care models for patients with rheumatoid arthritis, we aimed to offer insight into the strategies and interventions that are being used for designing and implementing integrated models of care for this patient group, and their outcomes. Methods We conducted a systematic literature search of peer-reviewed literature available in English and published between 2013 and 2018, using three databases: Cochrane, PubMed and EMBASE. We analysed the publications based on the Framework on integrated people-centred health services and the Triple/Quadruple Aim framework. Results We identified 1271 records. After screening, 50 articles met the criteria for inclusion in the review. Approaches for improving patient empowerment, engagement and experience of care were most prevalent in the identified care profiles. Similarly, frequently reported outcomes were related to improvements in patients’ experience of care and their health status. Most of the studies we reviewed did not demonstrate notable improvements from the perspective of cost-effectiveness or benefits for the healthcare workforce. Conclusions Our findings suggest that for rheumatoid arthritis, integrated care is in the early stages of development. Strategies focusing on patient outcomes and patient satisfaction were found to be prioritised. Future initiatives aiming to redesign rheumatology care should adopt systems thinking perspective to better address all of the building blocks of people-centred integrated care.

以人为本的综合护理是解决与人口变化、慢性病日益流行和资源有限有关的保健问题的一种现代方法。通过对类风湿关节炎患者综合护理模式的概述，我们旨在深入了解用于设计和实施该患者群体综合护理模式的策略和干预措施及其结果。方法采用Cochrane、PubMed和EMBASE三个数据库，对2013年至2018年间发表的同行评议的英文文献进行了系统的文献检索。我们根据《以人为本的综合卫生服务框架》和《三重/四重目标框架》分析了出版物。结果共鉴定出1271条记录。经筛选，50篇文章符合纳入本综述的标准。在确定的护理概况中，改善患者赋权、参与和护理经验的方法最为普遍。同样，经常报告的结果与患者护理体验和健康状况的改善有关。我们回顾的大多数研究都没有从成本效益或医疗保健工作人员利益的角度显示出显著的改进。结论:我们的研究结果表明，对于类风湿性关节炎，综合护理尚处于发展的早期阶段。关注患者结果和患者满意度的策略被发现是优先考虑的。未来旨在重新设计风湿病护理的举措应采用系统思维的观点，以更好地解决以人为中心的综合护理的所有组成部分。

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引用次数: 2

Patient centeredness: The perspectives of uninsured primary care patients in the United States 以患者为中心：美国未参保初级保健患者的观点

IF 1.4 Q4 NURSING

International Journal of Care Coordination

Pub Date : 2019-03-01 DOI: 10.1177/2053434519836424

A. Kamimura, Shannon Weaver, B. Armenta, Bethany Gull, Jeanie Ashby

Introduction Patient-centered care has become increasingly important within the United States (US) healthcare system. Given that patient-centered care predicts patient satisfaction, health outcomes, and cost-effectiveness, it is of the utmost importance to study patient-centered care from the perspectives of marginalized populations including minorities, immigrants, and other underserved populations. The purpose of this study is to examine factors that affect underserved primary care patients’ perceptions of patient centeredness. Methods The data were cross-sectional and collected in Fall 2016. Free clinic patients (N = 723) completed a self-administered survey, which measures patient centeredness, patient involvement in care, and clinical empathy. Validated measures were part of the survey, and the internal consistency of scales was tested. The general linear model was performed to predict factors associated with patients’ perceptions of patient centeredness. Results Higher levels of perceived patient involvement in care and higher levels of perceived empathy in consultation are related to higher levels of patient centeredness. While better physical health is associated with higher levels of perceived empathy in consultation, high levels of emotional health and depression are not. Conclusions Patients’ perceptions of involvement and empathy are important factors for patient-centered care, although this study did not show causal directions among variables. Based on the findings of this study, it is recommended that future studies should focus on the following three points: (1) to develop and evaluate trainings for providers, (2) develop education classes for patients who utilize free clinics, (3) analyze how these programs affect patient-centered care and health outcomes.

引言在美国医疗体系中，以患者为中心的护理变得越来越重要。鉴于以患者为中心的护理可以预测患者满意度、健康结果和成本效益，从边缘化人群（包括少数民族、移民和其他服务不足人群）的角度研究以患者为核心的护理至关重要。本研究的目的是检验影响服务不足的初级保健患者对以患者为中心的看法的因素。方法采用横断面数据，于2016年秋季收集。免费门诊患者（N = 723）完成了一项自我管理的调查，该调查衡量了以患者为中心、患者参与护理和临床同理心。经验证的措施是调查的一部分，并对量表的内部一致性进行了测试。采用一般线性模型来预测与患者对以患者为中心的认知相关的因素。结果患者在护理中的参与程度越高，在咨询中的同理心水平越高，与以患者为中心的程度越高有关。虽然更好的身体健康与咨询中更高水平的同理心有关，但高水平的情绪健康和抑郁则不然。结论患者的参与感和同理心是以患者为中心的护理的重要因素，尽管本研究没有显示变量之间的因果关系。根据这项研究的结果，建议未来的研究应重点关注以下三点：（1）为提供者制定和评估培训，（2）为使用免费诊所的患者制定教育课程，（3）分析这些项目如何影响以患者为中心的护理和健康结果。

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引用次数: 9

Competence needs of integrated care in the transition of health care and social services in Finland 芬兰保健和社会服务转型中综合护理的能力需求

IF 1.4 Q4 NURSING

International Journal of Care Coordination

Pub Date : 2019-02-14 DOI: 10.1177/2053434519828302

Olli Nummela, Soile Juujärvi, T. Sinervo

Introduction This study investigates future integrated care competencies among workforce in health and social service sectors in the context of the national health and social services reform in Finland. Methods The sample was drawn from the registers of competent workforce in the social and health sectors in Finland in three different forerunner areas. Eight working sectors were identified. A total of 1943 participants represented a 16% of the sample (N = 12,250). Factor analyses were conducted on ratings from the COPE scale measuring integrated care competences. Logistic regression analyses were used to examine the associations between background variables and competence factors. Results The present study identifies three factors about the competences of future integrated care competencies. The factors were client-oriented needs assessment, holistic service guidance, and ensuring service path. The sectors of services for older people and administration indicated the highest level of competence needs, whereas the sector of social services indicated the lowest level. Variations between sectors and background variables are remarkable. Discussion The study points out three dimensions of generic competence needs perceived by employees that are required to secure client-oriented integrated care processes in the future. New competencies and targeted processes in organizations and between sectors are crucial in developing the quality and effectiveness of integrated care by improving future care processes. Professional education and training should advance the learning of generic competences shared by all professionals and sectors in accomplishing integrated care.

本研究在芬兰国家卫生和社会服务改革的背景下，调查了卫生和社会服务部门劳动力未来的综合护理能力。方法从芬兰三个不同的先行领域的社会和卫生部门的合格劳动力登记册中抽取样本。确定了八个工作部门。1943名参与者共占样本的16% (N = 12,250)。对综合护理能力的COPE量表评分进行因素分析。运用逻辑回归分析检验背景变量与能力因子之间的关系。结果本研究确定了未来综合护理能力的三个因素。以客户为导向的需求评估、整体服务引导和确保服务路径。老年人服务部门和行政部门显示出最高水平的能力需求，而社会服务部门则显示出最低水平的能力需求。行业和背景变量之间的差异是显著的。该研究指出了员工感知到的三个通用能力需求维度，这些需求是确保未来以客户为导向的综合护理流程所必需的。组织和部门之间的新能力和有针对性的流程对于通过改进未来的护理流程来发展综合护理的质量和有效性至关重要。专业教育和培训应促进所有专业人员和部门在实现综合护理方面共享的一般能力的学习。

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引用次数: 17

ICP Reviewer’s List 2018 2018年ICP审查员名单

IF 1.4 Q4 NURSING

International Journal of Care Coordination

Pub Date : 2019-01-01 DOI: 10.1177/2053434519841148

Busetto, Loraine, Dessers, Ezra, Grooten, Liset, Guldemond, Nick, Linden, Ariel, Murray Cramm, Jan, Steinsbekk, Aslak, Wessling

引用次数: 0

Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach? 老年复杂患者综合护理模式的有效性和成本效益:一篇叙述性综述。难道我们不需要一种基于价值的方法吗?

IF 1.4 Q4 NURSING

International Journal of Care Coordination

Pub Date : 2018-12-01 DOI: 10.1177/2053434518817019

M. Marino, A. D. de Belvis, M. Tanzariello, E. Dotti, S. Bucci, M. Colotto, W. Ricciardi, S. Boccia

Introduction The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centeredness of care. We conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods MEDLINE, Scopus and EBSCO were searched. We reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilization outcomes, cost and cost-effectiveness). Results Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilization rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalized on a large scale. Discussion We found out a favourable impact of integrated care models/methods on health outcomes, care utilization and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. Thus, we propose a value-based framework for the evaluation of these services.

对具有复杂健康和社会需求的患者的管理是医疗保健系统面临的主要挑战之一。综合护理似乎对这一问题作出了回应，护理系统组成部分、专业人员和服务提供者的协作和整合努力旨在提高护理的效率、适当性和以人为本。我们进行了一项叙述性回顾，以分析针对此类老年患者管理的综合护理模式的有效性和成本效益的现有证据。方法检索MEDLINE、Scopus、EBSCO。我们根据PRISMA清单报告了这篇叙述性评论。对于纳入的研究，它们必须:(i)通过实施实验或示范项目参考综合护理模式;(ii)重点关注年龄≥65岁、有复杂健康和社会需求而非特定疾病的体弱老年人;(iii)评估有效性及/或成本及/或成本效益;报告数量数据(例如保健成果、利用成果、成本和成本效益)。结果纳入文献30篇，确定13种综合护理模式。确定了病例管理、老年评估和多学科团队的共同特征。对医疗设施的利用率产生了有利影响，但对成本产生了好坏参半的影响。由于护理专业人员和提供者之间的合作，以社区为基础和具有成本效益的综合老年人护理系统的发展是可能的，从而对保健和有效的资源管理产生相关影响。成功或失败的因素并不总是独特和可识别的，但这些模式显然存在着成功和大规模推广的潜力。我们发现了综合护理模式/方法对健康结果、护理利用和成本的有利影响。选定的干预措施可能在社区一级实施，重点是在护理的连续性方面对患者进行管理。因此，我们提出了一个基于价值的框架来评估这些服务。

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引用次数: 19

General practitioners' perspectives on care coordination in primary health care: A qualitative study. 全科医生对初级卫生保健护理协调的看法:一项定性研究。

IF 1.4 Q4 NURSING

International Journal of Care Coordination

Pub Date : 2018-12-01 Epub Date: 2018-12-14 DOI: 10.1177/2053434518816792

Ane Drougge Vassbotn, Hege Sjøvik, Trond Tjerbo, Jan Frich, Ivan Spehar

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.

前言:探讨挪威全科医生在初级卫生保健护理协调方面的经验。方法:定性研究使用来自挪威5个焦点小组的32名全科医生的数据。我们使用系统的文本浓缩分析数据，这是一种描述性和探索性的方法，用于定性数据的专题跨案例分析。结果:全科医生对护理路径的认识存在差异。他们表示希望并有义务参与初级保健服务的规划和协调，但他们遇到了组织和财政障碍，限制了他们的参与和贡献。全科医生报告说，他们缺乏关于正式协调倡议的信息，参与的机会也很少，而且他们错过了与其他初级保健专业人员进行对话的非正式场所。他们认为，全科医生作为协调者的角色应该得到其他各方的认可，他们需要对贡献和出席市政当局会议给予经济补偿。讨论:全科医生需要非正式场所与其他初级保健专业人员进行对话，并获得相关信息，以促进协调一致的护理。让全科医生更多地参与系统层面的规划和协调服务，改善患者护理可能存在未开发的潜力。全科医生贡献的经济补偿可能会促进全科医生的参与。

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引用次数: 10

Implant Files sets our health care systems back at square one Implant Files让我们的医疗保健系统重回正轨

IF 1.4 Q4 NURSING

International Journal of Care Coordination

Pub Date : 2018-12-01 DOI: 10.1177/2053434518820607

H. Vrijhoef

引用次数: 0

Changes in care coordination and health insurance in the population of US children with muscular dystrophy, 2005-2006 and 2009-2010. 2005-2006年和2009-2010年美国肌肉萎缩症儿童人口护理协调和健康保险的变化。

IF 1.4 Q4 NURSING

International Journal of Care Coordination

Pub Date : 2018-12-01 Epub Date: 2018-12-14 DOI: 10.1177/2053434518818448

Jaimie Z Shing, Tiebin Liu, Rodolfo Valdez

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.

我们的目的是评估美国肌肉萎缩症儿童护理协调和健康保险覆盖率的变化。方法:我们使用2005-2006年和2009-2010年全国特殊卫生保健需要儿童调查的数据。采用调查周期法对肌萎缩症患儿的社会人口分布及健康特征进行了分析。使用多变量回归来计算在每个调查周期中没有得到有效的护理协调、没有足够的健康保险覆盖、没有得到帮助协调护理和有问题获得转诊的几率。结果:在2005-2006年和2009-2010年的调查周期中，分别有135名和117名肌肉萎缩症儿童(分别代表34,672名和31,169名美国肌肉萎缩症儿童)。肌肉萎缩症患儿未接受有效护理协调的比例从2005-2006年的59.2%(95%可信区间(CI)， 45.6%-72.7%)变为2009-2010年的53.4% (95% CI, 38.3%-68.6%)。未接受有效护理配合的几率(调整优势比(aOR) = 0.77;95% CI, 0.32-1.89)或难以获得转诊(aOR = 0.52;95% CI, 0.17-1.59)在两个时期之间没有显著变化，而保险覆盖面不足的几率显著降低(aOR = 0.41, 95% CI, 0.18-0.93)，未得到帮助协调护理的几率显著增加(aOR = 4.22, 95% CI, 1.24-14.29)。结论:我们的研究结果表明，许多有肌肉萎缩症儿童的家庭的关键卫生保健需求在很长一段时间内仍未得到满足。尽管医疗保险覆盖面有了显著改善，但2009-2010年，近三分之一的肌肉萎缩症儿童的医疗保险覆盖面仍然不足;从那时起，这种情况很可能没有太大变化。

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引用次数: 2