Pub Date : 2022-08-29DOI: 10.1177/20534345221121068
IJ Sumpter, SM Phillips, GS Magwood
Introduction Fragmented care overwhelmingly affects populations with multimorbid chronic conditions, like systemic lupus erythematosus (SLE). However, strategies to mitigate care fragmentation typically focus on singular disease frameworks with insufficient evidence regarding approaches for individuals with two or more concurrent chronic conditions (multimorbidity). This review explores the literature to identify the (C)ontextual influences, underlying (M)echanisms, and associated (O)utcomes of fragmented care prevention in SLE and other multimorbid conditions. Methods A realist review was applied to systematically examine literature, including the search of >1300 published articles focused on SLE and multimorbidity, continuity of care, and approaches to mitigate fragmented care. The analysis was guided by care continuity elements and organized by fragmented care concepts explicated by the MacColl Institute for Healthcare Innovations Care Coordination Model and further grouped for context–mechanism–outcome (CMO) configurations. Results Fourteen articles met inclusion/exclusion criteria and were included in the sample to illustrate the relationship between C-M-O for approaches focused on fragmented care prevention. Favorable outcomes in mechanisms that produced positive responses to resources relevant to fragmented care prevention included 1) opportunities for exposure and negotiation within professional teams, 2) structured health education, role clarity, and access to adherence services for patients, and 3) awareness of workflow waste and use of clinical algorithms. Discussion Review findings suggest using a multidimensional approach to mitigate fragmented care in SLE and other multimorbid conditions. Multidimensional approaches should focus on shared decision-making, social support, social–cultural–economic factors, patient engagement, and technological infrastructure to support the complex care needs of the multimorbid patient.
{"title":"Approaches to reducing fragmented care in systemic lupus erythematosus (SLE) and other multimorbid conditions: A realist review","authors":"IJ Sumpter, SM Phillips, GS Magwood","doi":"10.1177/20534345221121068","DOIUrl":"https://doi.org/10.1177/20534345221121068","url":null,"abstract":"Introduction Fragmented care overwhelmingly affects populations with multimorbid chronic conditions, like systemic lupus erythematosus (SLE). However, strategies to mitigate care fragmentation typically focus on singular disease frameworks with insufficient evidence regarding approaches for individuals with two or more concurrent chronic conditions (multimorbidity). This review explores the literature to identify the (C)ontextual influences, underlying (M)echanisms, and associated (O)utcomes of fragmented care prevention in SLE and other multimorbid conditions. Methods A realist review was applied to systematically examine literature, including the search of >1300 published articles focused on SLE and multimorbidity, continuity of care, and approaches to mitigate fragmented care. The analysis was guided by care continuity elements and organized by fragmented care concepts explicated by the MacColl Institute for Healthcare Innovations Care Coordination Model and further grouped for context–mechanism–outcome (CMO) configurations. Results Fourteen articles met inclusion/exclusion criteria and were included in the sample to illustrate the relationship between C-M-O for approaches focused on fragmented care prevention. Favorable outcomes in mechanisms that produced positive responses to resources relevant to fragmented care prevention included 1) opportunities for exposure and negotiation within professional teams, 2) structured health education, role clarity, and access to adherence services for patients, and 3) awareness of workflow waste and use of clinical algorithms. Discussion Review findings suggest using a multidimensional approach to mitigate fragmented care in SLE and other multimorbid conditions. Multidimensional approaches should focus on shared decision-making, social support, social–cultural–economic factors, patient engagement, and technological infrastructure to support the complex care needs of the multimorbid patient.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42842993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-22DOI: 10.1177/20534345221121067
M. Karimollahi, M. Abazari, Z. Tazakori, N. Ramazanzadeh
Introduction Providing care for patients by family caregivers causes in several consequences known as “Caregiving Burden”, which affects the caregiver's health and the whole family process, considered in holistic healthcare/nursing. This study aimed to evaluate the caregiving burden and social support in family caregivers of patients with cancer and their influencing factors in a local area in Iran. Methods In this cross-sectional study, 190 family members of patients with cancer were studied through convenient sampling method. Data were collected using demographic data sheet enriched with Karnofsky Performance Status Scale and Katz Index of Independence in Activities of Daily Living (ADL), and Zarit Burden Inventory and Medical Outcomes Social Support Survey questionnaires. Results The results indicated intermediate performance status and moderate independence in ADL in patients. The mean score of caregiving burden was 43.95 ± 17.48 which indicates moderate to severe burden. The average social support in the caregivers was 60.25 ± 23.81% which shows above the average social support. Both performance status and dependence in ADL of patient had statistically significant effect on the caregiving burden in caregivers. Also a statistically significant negative relationship was observed between caregiving burden and social support in primary family caregivers of patients with cancer. Discussion Considering the increasing importance of primary care provided by families, developing strategies for providing caregiver's needs through family care in cancer nursing is essential. So supporting caregivers through family nursing in holistic healthcare by providing social support, can play a significant role in reducing caregiving burden in healthcare services considering the qualified holistic healthcare/nursing.
{"title":"Caregiving burden and social support in family caregivers of patients with cancer: A cross-sectional study","authors":"M. Karimollahi, M. Abazari, Z. Tazakori, N. Ramazanzadeh","doi":"10.1177/20534345221121067","DOIUrl":"https://doi.org/10.1177/20534345221121067","url":null,"abstract":"Introduction Providing care for patients by family caregivers causes in several consequences known as “Caregiving Burden”, which affects the caregiver's health and the whole family process, considered in holistic healthcare/nursing. This study aimed to evaluate the caregiving burden and social support in family caregivers of patients with cancer and their influencing factors in a local area in Iran. Methods In this cross-sectional study, 190 family members of patients with cancer were studied through convenient sampling method. Data were collected using demographic data sheet enriched with Karnofsky Performance Status Scale and Katz Index of Independence in Activities of Daily Living (ADL), and Zarit Burden Inventory and Medical Outcomes Social Support Survey questionnaires. Results The results indicated intermediate performance status and moderate independence in ADL in patients. The mean score of caregiving burden was 43.95 ± 17.48 which indicates moderate to severe burden. The average social support in the caregivers was 60.25 ± 23.81% which shows above the average social support. Both performance status and dependence in ADL of patient had statistically significant effect on the caregiving burden in caregivers. Also a statistically significant negative relationship was observed between caregiving burden and social support in primary family caregivers of patients with cancer. Discussion Considering the increasing importance of primary care provided by families, developing strategies for providing caregiver's needs through family care in cancer nursing is essential. So supporting caregivers through family nursing in holistic healthcare by providing social support, can play a significant role in reducing caregiving burden in healthcare services considering the qualified holistic healthcare/nursing.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44422727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-08DOI: 10.1177/20534345221117920
Juliëtte A Beuken, Mara E J Bouwmans, D. Dolmans, Steven PA Hornstra, Lina Vogt, D. Verstegen
Introduction In European border regions, healthcare providers join forces to make full use of the potential of healthcare. Trainees need to be aware of the challenges and opportunities of cross-border healthcare. To increase such awareness, a workshop was designed, implemented and evaluated. The workshop was entitled ‘Creating cross-border collaborators’ and combined elements of contextual, collaborative and reflective learning. The aim of the study was to understand how this workshop enhanced trainees’ awareness of challenges and opportunities of cross-border healthcare. Methods Using a mixed-methods approach, focus-group interviews (QUAL) were held with trainees (N = 16) and trainees (N = 13) completed a survey (QUAN) about their workshop experiences. The workshop was held three times for three different groups of trainees. Results Quantitative analysis (of surveys) demonstrated increased self-reported awareness of cross-border healthcare. All learning principles contributed to this awareness, however reflective learning slightly less. Qualitative analysis (of focus-group interviews) unearthed the following four themes: (1) Attention to cross-border healthcare fostered awareness of its complexity; (2) real-life examples stimulated recognition of challenges and opportunities; (3) discussions in interdisciplinary and international groups helped to see different perspectives; and (4) reflection made trainees think about their own role and perspective. Quantitative and qualitative data are strongly cohered. Conclusion According to participating trainees, a workshop with elements of contextual, collaborative and reflective learning did improve trainee awareness of cross-border healthcare. This study highlights that theoretical insights into learning can and should inform the design and evaluation of workshops.
{"title":"Design, implementation and evaluation of a postgraduate workshop on cross-border healthcare in Europe – Mixed methods research","authors":"Juliëtte A Beuken, Mara E J Bouwmans, D. Dolmans, Steven PA Hornstra, Lina Vogt, D. Verstegen","doi":"10.1177/20534345221117920","DOIUrl":"https://doi.org/10.1177/20534345221117920","url":null,"abstract":"Introduction In European border regions, healthcare providers join forces to make full use of the potential of healthcare. Trainees need to be aware of the challenges and opportunities of cross-border healthcare. To increase such awareness, a workshop was designed, implemented and evaluated. The workshop was entitled ‘Creating cross-border collaborators’ and combined elements of contextual, collaborative and reflective learning. The aim of the study was to understand how this workshop enhanced trainees’ awareness of challenges and opportunities of cross-border healthcare. Methods Using a mixed-methods approach, focus-group interviews (QUAL) were held with trainees (N = 16) and trainees (N = 13) completed a survey (QUAN) about their workshop experiences. The workshop was held three times for three different groups of trainees. Results Quantitative analysis (of surveys) demonstrated increased self-reported awareness of cross-border healthcare. All learning principles contributed to this awareness, however reflective learning slightly less. Qualitative analysis (of focus-group interviews) unearthed the following four themes: (1) Attention to cross-border healthcare fostered awareness of its complexity; (2) real-life examples stimulated recognition of challenges and opportunities; (3) discussions in interdisciplinary and international groups helped to see different perspectives; and (4) reflection made trainees think about their own role and perspective. Quantitative and qualitative data are strongly cohered. Conclusion According to participating trainees, a workshop with elements of contextual, collaborative and reflective learning did improve trainee awareness of cross-border healthcare. This study highlights that theoretical insights into learning can and should inform the design and evaluation of workshops.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45668650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1177/20534345221112978
H. Vrijhoef
In December 2021 the European Commission has launched the “Healthier Together – EU Non-Communicable Disease Initiative” to support EU countries in reducing the human and financial burden on non-communicable diseases (NCDs). It does so by reinforcing and supporting policy implementation and effective action of EU countries’ health authorities and stakeholders in five strands: (a) a horizontal strand on shared health determinants, focussing on population-level health promotion and disease prevention of NCDs (completing the actions of Europe’s Beating Cancer Plan); (b) diabetes; (c) cardiovascular diseases; (d) chronic respiratory diseases; and (e) mental health and neurological diseases. In June 2022 the European Commission published, what is referred to as, an ‘open document’ or a ‘toolkit’ to guide and coordinate action on NCDs, and to identify and create windows of opportunity for high-impact actions to be implemented across countries for the years 2022–2027. Inputs for the document are obtained via a co-creation process involving numerous stakeholders. The document or toolkit is a rich source of what is referred to as ‘possible priority areas’ which are translated into ‘collaborative actions’. In addition to the five strands, an integrated and coordinated approach composed of transversal actions is suggested because major NCDs share many risk factors which could be addressed more effectively and efficiently by the suggested approach. As part of the integrated approach, ‘health system redesign to deliver person-centred and integrated care’ is endorsed as a priority area by 16 EU countries. Interestingly, this priority area is endorsed by 1 EU country for diabetes, 10 EU countries for mental health and neurological diseases, and remains unmentioned for cardiovascular diseases and chronic respiratory diseases. Since the process to develop the tool is ongoing and with the tool reflecting an intermediate state, it is too early to draw conclusions at this moment. However, one wonders whymore countries endorse a systems’ approach for mental health and neurological diseases than for other NCDs. And, related to this, does endorsement reflect activity or lack of activity in a specific area? In the document, the European Commission repeatedly invites EU countries to comment on the suggested work packages and their content. For readers of the International Journal of Care Coordination, the “Healthier Together” initiative and accompanying reports and tools should have your attention, at the very least The first paper in this issue of the International Journal of Care Coordination reports on how community health workers can maximize the impact of their services on highrisk adult clients to help mitigate their risk and overcome barriers to controlling chronic diseases. In doing, so Chiyaka et al. make use of observational data from participants of the Northwest Ohio Pathways Community model. In times when health services delivery is shifting in favour of tele
{"title":"Healthier together","authors":"H. Vrijhoef","doi":"10.1177/20534345221112978","DOIUrl":"https://doi.org/10.1177/20534345221112978","url":null,"abstract":"In December 2021 the European Commission has launched the “Healthier Together – EU Non-Communicable Disease Initiative” to support EU countries in reducing the human and financial burden on non-communicable diseases (NCDs). It does so by reinforcing and supporting policy implementation and effective action of EU countries’ health authorities and stakeholders in five strands: (a) a horizontal strand on shared health determinants, focussing on population-level health promotion and disease prevention of NCDs (completing the actions of Europe’s Beating Cancer Plan); (b) diabetes; (c) cardiovascular diseases; (d) chronic respiratory diseases; and (e) mental health and neurological diseases. In June 2022 the European Commission published, what is referred to as, an ‘open document’ or a ‘toolkit’ to guide and coordinate action on NCDs, and to identify and create windows of opportunity for high-impact actions to be implemented across countries for the years 2022–2027. Inputs for the document are obtained via a co-creation process involving numerous stakeholders. The document or toolkit is a rich source of what is referred to as ‘possible priority areas’ which are translated into ‘collaborative actions’. In addition to the five strands, an integrated and coordinated approach composed of transversal actions is suggested because major NCDs share many risk factors which could be addressed more effectively and efficiently by the suggested approach. As part of the integrated approach, ‘health system redesign to deliver person-centred and integrated care’ is endorsed as a priority area by 16 EU countries. Interestingly, this priority area is endorsed by 1 EU country for diabetes, 10 EU countries for mental health and neurological diseases, and remains unmentioned for cardiovascular diseases and chronic respiratory diseases. Since the process to develop the tool is ongoing and with the tool reflecting an intermediate state, it is too early to draw conclusions at this moment. However, one wonders whymore countries endorse a systems’ approach for mental health and neurological diseases than for other NCDs. And, related to this, does endorsement reflect activity or lack of activity in a specific area? In the document, the European Commission repeatedly invites EU countries to comment on the suggested work packages and their content. For readers of the International Journal of Care Coordination, the “Healthier Together” initiative and accompanying reports and tools should have your attention, at the very least The first paper in this issue of the International Journal of Care Coordination reports on how community health workers can maximize the impact of their services on highrisk adult clients to help mitigate their risk and overcome barriers to controlling chronic diseases. In doing, so Chiyaka et al. make use of observational data from participants of the Northwest Ohio Pathways Community model. In times when health services delivery is shifting in favour of tele","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45833286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1177/20534345221109429
K. Katona, M. D. Menting, Y. Pisters
Abstract Introduction The care for many patients with diabetes mellitus type 2 in the Netherlands, is contracted by a local care group. The healthcare providers, who collectively shape a care group, provide protocolled diabetes care. Differences exist between care groups in terms of their organizational and financial arrangements. These differences may result in variation in outcomes. The aim of this study is to assess whether variation in healthcare costs, diabetes complications and related hospital admissions on the level of care groups exist. Methods A quantitative cohort study was conducted. Patients who used diabetes medication (more than 180 days of defined daily doses per year) for the first time between the years 2014 and 2019 were included. Data were extracted from health insurance claims between 2014 and 2019. Generalized linear mixed models were used to analyse patient variation in healthcare costs (two and six years follow-up), diabetes-related complications and hospital admission days. Intraclass correlation coefficients were calculated to estimate the amount of variation that was attributable to the care groups. Results A large variation in outcome variables was observed between patients and a small variation between care groups. The intraclass correlation coefficient for long-term costs was 0.4%; for short-term costs between 0.1% and 0.3%; for complications 1% and for hospital days 4%. Discussion A large variation between patients with diabetes mellitus type 2 exists in terms of their healthcare costs and complications. In our study, care groups accounted minimally for this variation. A generalized linear mixed model in combination with year cohorts is a tool to study variations in the long-term outcomes of integrated care initiatives.
{"title":"Assessment of variation in long-term outcomes of integrated care initiatives in Dutch health care","authors":"K. Katona, M. D. Menting, Y. Pisters","doi":"10.1177/20534345221109429","DOIUrl":"https://doi.org/10.1177/20534345221109429","url":null,"abstract":"Abstract Introduction The care for many patients with diabetes mellitus type 2 in the Netherlands, is contracted by a local care group. The healthcare providers, who collectively shape a care group, provide protocolled diabetes care. Differences exist between care groups in terms of their organizational and financial arrangements. These differences may result in variation in outcomes. The aim of this study is to assess whether variation in healthcare costs, diabetes complications and related hospital admissions on the level of care groups exist. Methods A quantitative cohort study was conducted. Patients who used diabetes medication (more than 180 days of defined daily doses per year) for the first time between the years 2014 and 2019 were included. Data were extracted from health insurance claims between 2014 and 2019. Generalized linear mixed models were used to analyse patient variation in healthcare costs (two and six years follow-up), diabetes-related complications and hospital admission days. Intraclass correlation coefficients were calculated to estimate the amount of variation that was attributable to the care groups. Results A large variation in outcome variables was observed between patients and a small variation between care groups. The intraclass correlation coefficient for long-term costs was 0.4%; for short-term costs between 0.1% and 0.3%; for complications 1% and for hospital days 4%. Discussion A large variation between patients with diabetes mellitus type 2 exists in terms of their healthcare costs and complications. In our study, care groups accounted minimally for this variation. A generalized linear mixed model in combination with year cohorts is a tool to study variations in the long-term outcomes of integrated care initiatives.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46441765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1177/20534345221111004
Danny T. Y. Wu, Paul Murdock, Scott Vennemeyer, Janie M Mynatt, Ming-Yuan Chih
Introduction Inpatient care coordinators (ICCs) in the United States play a critical role in case management and care transition. ICCs spend a large amount of time in chart review and documentation through electronic health record (EHR) systems. However, significant knowledge gaps exist regarding their workflow barriers and their use of health information technology (Health IT). Using only quantitative or quantitative methods does not provide a comprehensive picture about ICC’s workflow due to its complex and dynamic nature. This work aimed to address this gap by conducting a mixed-methods study to understand the workflow of ICCs and identifying challenges in care deliver and documentation activities. Methods The study adopted a concurrent triangulation design including qualitative interviews with 12 ICC staff members in the United States followed by extraction of their EHR event logs for one month. The qualitative interview data were analyzed thematically, and the log data were analyzed statistically. The results were triangulated and interpreted. Results Three major workflow barriers faced by ICCs were identified: long travel time, heavy documentation load, and suboptimal communication. The event logs provided empirical evidence to support the workflow barriers identified in the interviews, especially in travel time and documentation load. Discussion ICC workflow has several inefficiencies. The study generated four design considerations to develop a Health IT solution: Mobility, EHR integration, Team-based Communication, and User Adoption to improve workflow efficiency and care coordination. Using a mixed-methods approach is effective and efficient in collecting and analyzing clinical workflow.
{"title":"Challenges in inpatient care coordinators’ clinical workflow and opportunities in designing a health IT solution: A mixed methods study","authors":"Danny T. Y. Wu, Paul Murdock, Scott Vennemeyer, Janie M Mynatt, Ming-Yuan Chih","doi":"10.1177/20534345221111004","DOIUrl":"https://doi.org/10.1177/20534345221111004","url":null,"abstract":"Introduction Inpatient care coordinators (ICCs) in the United States play a critical role in case management and care transition. ICCs spend a large amount of time in chart review and documentation through electronic health record (EHR) systems. However, significant knowledge gaps exist regarding their workflow barriers and their use of health information technology (Health IT). Using only quantitative or quantitative methods does not provide a comprehensive picture about ICC’s workflow due to its complex and dynamic nature. This work aimed to address this gap by conducting a mixed-methods study to understand the workflow of ICCs and identifying challenges in care deliver and documentation activities. Methods The study adopted a concurrent triangulation design including qualitative interviews with 12 ICC staff members in the United States followed by extraction of their EHR event logs for one month. The qualitative interview data were analyzed thematically, and the log data were analyzed statistically. The results were triangulated and interpreted. Results Three major workflow barriers faced by ICCs were identified: long travel time, heavy documentation load, and suboptimal communication. The event logs provided empirical evidence to support the workflow barriers identified in the interviews, especially in travel time and documentation load. Discussion ICC workflow has several inefficiencies. The study generated four design considerations to develop a Health IT solution: Mobility, EHR integration, Team-based Communication, and User Adoption to improve workflow efficiency and care coordination. Using a mixed-methods approach is effective and efficient in collecting and analyzing clinical workflow.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43392137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1177/20534345221092512
Ernest Lim, Mumta Kanda, Zena Rodrigues, Rohan Hussain, Vickie Lee
Introduction: To explore patient and clinician perspectives on acute ophthalmology presentations during the COVID pandemic. To ascertain whether the pandemic had differentially impacted access to care based on patient demographics and postcodes.
Methods: A single-centre, cross-sectional prospective study in a busy metropolitan eye casualty between April-June 2020 recording patient demographics, distance travelled to access healthcare, diagnosis and outcome compared to the equivalent period in 2019. A further two-part survey was conducted to explore patient and clinician's perceptions around delays in attendances, views on remote consultation and severity of the condition.
Results: There was a 68% decrease in April 2020 compared to previous year's ED attendance. The diagnosis tended towards more visually significant pathology. From 2019 to 2020, there was a significant decrease in average distance travelled to the eye emergency department (eye ED). working-age adults (18-59) and white patients travelling from very far pre-pandemic contributed most to this change. 513 Patient responses (12%) out of 4433 attendances during the study period were received, 89% (456/513) of the completed surveys also had matching clinician surveys. 29% (149/513) patients felt COVID-19 stopped them from attending earlier. Clinicians thought a video consultation would have been suitable for 40% (182/456) of patients compared to only 13% (58/456) of patients preferring a video consultation.
Discussion: Although our findings were limited by low response rates, COVID-19 may have caused a delay in presentation for emergency eye care. Demographic changes and attitudes towards video consultations have implications for planning of emergency eye care in future pandemics.
{"title":"Patient and clinician perspectives of ophthalmology emergency attendances during the COVID 19 pandemic.","authors":"Ernest Lim, Mumta Kanda, Zena Rodrigues, Rohan Hussain, Vickie Lee","doi":"10.1177/20534345221092512","DOIUrl":"10.1177/20534345221092512","url":null,"abstract":"<p><strong>Introduction: </strong>To explore patient and clinician perspectives on acute ophthalmology presentations during the COVID pandemic. To ascertain whether the pandemic had differentially impacted access to care based on patient demographics and postcodes.</p><p><strong>Methods: </strong>A single-centre, cross-sectional prospective study in a busy metropolitan eye casualty between April-June 2020 recording patient demographics, distance travelled to access healthcare, diagnosis and outcome compared to the equivalent period in 2019. A further two-part survey was conducted to explore patient and clinician's perceptions around delays in attendances, views on remote consultation and severity of the condition.</p><p><strong>Results: </strong>There was a 68% decrease in April 2020 compared to previous year's ED attendance. The diagnosis tended towards more visually significant pathology. From 2019 to 2020, there was a significant decrease in average distance travelled to the eye emergency department (eye ED). working-age adults (18-59) and white patients travelling from very far pre-pandemic contributed most to this change. 513 Patient responses (12%) out of 4433 attendances during the study period were received, 89% (456/513) of the completed surveys also had matching clinician surveys. 29% (149/513) patients felt COVID-19 stopped them from attending earlier. Clinicians thought a video consultation would have been suitable for 40% (182/456) of patients compared to only 13% (58/456) of patients preferring a video consultation.</p><p><strong>Discussion: </strong>Although our findings were limited by low response rates, COVID-19 may have caused a delay in presentation for emergency eye care. Demographic changes and attitudes towards video consultations have implications for planning of emergency eye care in future pandemics.</p>","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9016414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46331976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-14DOI: 10.1177/20534345221092515
Edward T. Chiyaka, B. Lanese, D. Bruckman, M. Redding, Joshua Filla, Pamela Ferguson, John A. Hoornbeek
Introduction Addressing health disparities and barriers to care requires a comprehensive approach that involves participation of health care providers, multiple organizations, and service providers in the communities affected. Given the importance of using community health workers to help address the complex and overlapping medical, social, and behavioral needs of high-risk individuals, it is of utmost importance to understand their impact on health outcomes. This study examines how in-person interaction between community health workers and their clients influence the client's level of risk mitigation achieved through care coordination using the Pathways Community HUB model. Methods The study utilized two years of data extracted from the Care Coordination Systems database for 391 adults who participated in the Northwest Ohio Pathways Community HUB program. Using multinomial logistic regression analysis, we assessed how the interaction between community health workers and adults with chronic diseases who participated in the Northwest Ohio Pathways Community HUB program influenced the successful mitigation of their social, behavioral, and other medical risks over a 2-year period. Results Our findings show that as the number of in-person contacts between the community health worker and the client increased, the likelihood of completing all Pathways increased by 27% when compared to completing less than 50% of the assigned Pathways, after adjusting for potential confounders (odds ratio: 1.27, 95% confidence interval: 1.07−1.52). Discussion Using community health workers as part of care coordination teams may be effective in connecting communities to systems of care, helping individuals manage their health conditions and connecting individuals to needed social services. Their direct in-person interaction with at-risk individuals may increase the extent to which these individuals successfully address risks to their health and well-being.
引言解决健康差距和护理障碍需要一种全面的方法，包括受影响社区的医疗保健提供者、多个组织和服务提供者的参与。鉴于利用社区卫生工作者来帮助解决高危人群复杂和重叠的医疗、社会和行为需求的重要性，了解他们对健康结果的影响至关重要。本研究考察了社区卫生工作者及其客户之间的面对面互动如何影响客户通过使用Pathways community HUB模型的护理协调实现的风险缓解水平。方法该研究使用了从护理协调系统数据库中提取的两年数据，共有391名成年人参加了俄亥俄州西北路径社区HUB项目。使用多项逻辑回归分析，我们评估了社区卫生工作者和参与俄亥俄州西北路径社区HUB计划的慢性病成年人之间的互动如何影响他们在2年内成功缓解社会、行为和其他医疗风险。结果我们的研究结果表明，随着社区卫生工作者和客户之间面对面的接触次数的增加，与完成不到50%的指定路径相比，完成所有路径的可能性增加了27%，讨论将社区卫生工作者作为护理协调团队的一部分，可以有效地将社区与护理系统联系起来，帮助个人管理自己的健康状况，并将个人与所需的社会服务联系起来。他们与高危人群的直接面对面互动可能会增加这些人成功应对健康和福祉风险的程度。
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Pub Date : 2022-01-24DOI: 10.1177/20534345221075661
H. Vrijhoef
Healthcare delivery models are under intensifying pressure as health systems struggle with various challenges including employee burnout, workforce shortages, equipment scarcities, and outdated facilities. The COVID-19 pandemic has magnified the importance of coordination to secure access to and navigation between health services. By facilitating coordination within and between services, the goal is to guide people quickly to the level of care they need and prevent instances of those receiving too much or too little care or no care at all. Further, the COVID-19 pandemic has promoted the use of telehealth and digital services while continued implementation and utilization of modern technological advances are recommended for various target populations. Technology-enabled or digital innovation is accelerating the healthcare delivery models and ecosystems of tomorrow. The main feature of tomorrow’s healthcare delivery models and ecosystems is that these models and systems are about bringing care to the patient, rather than bringing the patient to care. As health care will become further decentralized, coordination is conditional for people to take advantage of the full range of (new) services. Historical review has shown that ill-coordinated or disjoined health initiatives lead to vertical or stand-alone information and communication technology applications that often result in information fragmentation and, consequently, poor delivery of services. To move into the future, healthcare models and ecosystems will need to become smart. They need to become highly technologically advanced and interconnected. Such transformation requires the participation of all stakeholders. Data sharing among all entities is crucial to ensure that patients receive high-quality healthcare efficiently and conveniently. Similar to change management and changes themselves, the best results are to be expected when as much attention is paid to coordination as to what needs to get coordinated. It is then when coordination becomes smart coordination to enable timely, convenient, and efficient patient and provider experiences. In this issue of the International Journal of Care Coordination, Shook et al. address the question of what tools improve care coordination for children with special health care needs. Their scoping review provides useful insights into the potential of telehealth, online health records, care plans, inpatient discharge protocols, family training, and reminders to address gaps impeding pediatric traumatic brain injury care coordination. The same authors also reviewed scientific literature on child and family outcomes when care coordinators are implemented as an intervention to facilitate long-term management of children with special health care needs. They found that utilization of care coordinators in different forms generally resulted in positive outcomes in terms of healthcare utilization, costs of care, disease status, parent and child quality of life, and
{"title":"The future of coordination is smart coordination","authors":"H. Vrijhoef","doi":"10.1177/20534345221075661","DOIUrl":"https://doi.org/10.1177/20534345221075661","url":null,"abstract":"Healthcare delivery models are under intensifying pressure as health systems struggle with various challenges including employee burnout, workforce shortages, equipment scarcities, and outdated facilities. The COVID-19 pandemic has magnified the importance of coordination to secure access to and navigation between health services. By facilitating coordination within and between services, the goal is to guide people quickly to the level of care they need and prevent instances of those receiving too much or too little care or no care at all. Further, the COVID-19 pandemic has promoted the use of telehealth and digital services while continued implementation and utilization of modern technological advances are recommended for various target populations. Technology-enabled or digital innovation is accelerating the healthcare delivery models and ecosystems of tomorrow. The main feature of tomorrow’s healthcare delivery models and ecosystems is that these models and systems are about bringing care to the patient, rather than bringing the patient to care. As health care will become further decentralized, coordination is conditional for people to take advantage of the full range of (new) services. Historical review has shown that ill-coordinated or disjoined health initiatives lead to vertical or stand-alone information and communication technology applications that often result in information fragmentation and, consequently, poor delivery of services. To move into the future, healthcare models and ecosystems will need to become smart. They need to become highly technologically advanced and interconnected. Such transformation requires the participation of all stakeholders. Data sharing among all entities is crucial to ensure that patients receive high-quality healthcare efficiently and conveniently. Similar to change management and changes themselves, the best results are to be expected when as much attention is paid to coordination as to what needs to get coordinated. It is then when coordination becomes smart coordination to enable timely, convenient, and efficient patient and provider experiences. In this issue of the International Journal of Care Coordination, Shook et al. address the question of what tools improve care coordination for children with special health care needs. Their scoping review provides useful insights into the potential of telehealth, online health records, care plans, inpatient discharge protocols, family training, and reminders to address gaps impeding pediatric traumatic brain injury care coordination. The same authors also reviewed scientific literature on child and family outcomes when care coordinators are implemented as an intervention to facilitate long-term management of children with special health care needs. They found that utilization of care coordinators in different forms generally resulted in positive outcomes in terms of healthcare utilization, costs of care, disease status, parent and child quality of life, and ","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46087692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-06DOI: 10.1177/20534345211070647
Cara Palusak, Brandy Shook, S. Davies, Jennifer P. Lundine
Introduction & Importance: Effective, patient-centered care coordination has been shown to improve outcomes for children with special healthcare needs (CSHCN), who often have complex, long-term involvement with multiple service providers. Traumatic brain injury (TBI) can result in long-term physical, intellectual, social, and emotional disabilities that persist long after acute treatment. Yet, even though it is a chronic condition, TBI remains an area with scarce standardization and research surrounding the complex, long-term care coordination need in this population. The purpose of this scoping review is to summarize current research on outcomes in CSHCN after implementation of care coordinators, whether individual or teams, to inform future research for youth with TBI. Methods: OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination and CSHCN. Results: 31 articles met inclusion criteria. Outcomes for children and families were grouped into 5 major categories: healthcare utilization, cost of care, disease status, parent and child quality of life, and healthcare satisfaction and perception of care. Discussion: Implementation of care coordinators, whether in the form of individuals, dyads, or teams, resulted in overall positive outcomes for CSHCN and their families across all 5 major outcome domains. Future research should be focused on the efficacy of care coordinators differing in profession, qualifications, and educational attainment specifically for the unique needs of children with TBI. Additionally, the application of care coordination within medical homes should be further investigated to increase proactive, preventative care of children with TBI and further reduce reactive, need-based treatment only.
{"title":"A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination personnel","authors":"Cara Palusak, Brandy Shook, S. Davies, Jennifer P. Lundine","doi":"10.1177/20534345211070647","DOIUrl":"https://doi.org/10.1177/20534345211070647","url":null,"abstract":"Introduction & Importance: Effective, patient-centered care coordination has been shown to improve outcomes for children with special healthcare needs (CSHCN), who often have complex, long-term involvement with multiple service providers. Traumatic brain injury (TBI) can result in long-term physical, intellectual, social, and emotional disabilities that persist long after acute treatment. Yet, even though it is a chronic condition, TBI remains an area with scarce standardization and research surrounding the complex, long-term care coordination need in this population. The purpose of this scoping review is to summarize current research on outcomes in CSHCN after implementation of care coordinators, whether individual or teams, to inform future research for youth with TBI. Methods: OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination and CSHCN. Results: 31 articles met inclusion criteria. Outcomes for children and families were grouped into 5 major categories: healthcare utilization, cost of care, disease status, parent and child quality of life, and healthcare satisfaction and perception of care. Discussion: Implementation of care coordinators, whether in the form of individuals, dyads, or teams, resulted in overall positive outcomes for CSHCN and their families across all 5 major outcome domains. Future research should be focused on the efficacy of care coordinators differing in profession, qualifications, and educational attainment specifically for the unique needs of children with TBI. Additionally, the application of care coordination within medical homes should be further investigated to increase proactive, preventative care of children with TBI and further reduce reactive, need-based treatment only.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43512852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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