Pub Date : 2020-03-01DOI: 10.1177/2053434519896523
E. Dessers, B. Mohr
The vast majority of research and efforts towards greater care coordination have taken place at the level of single, sovereign organizations, or at the level of networks formed to address the need for cross-organizational collaboration. The recently emerging ecosystem level of analysis and intervention is still under-researched, with few if any available innovation practices that match the complexity experienced at the level of care ecosystems. Beginning with the challenge of care coordination, we discuss what care ecosystems are and how they can be defined and describe the possibilities and opportunities that come when viewing care coordination through an ecosystem lens. We underpin our plea for an ecosystem approach to health and social care coordination with seven lessons, which we draw from an extensive study of 15 care ecosystem cases from seven different countries. We end the paper with an appeal for further research in this promising field.
{"title":"An ecosystem perspective on care coordination: Lessons from the field","authors":"E. Dessers, B. Mohr","doi":"10.1177/2053434519896523","DOIUrl":"https://doi.org/10.1177/2053434519896523","url":null,"abstract":"The vast majority of research and efforts towards greater care coordination have taken place at the level of single, sovereign organizations, or at the level of networks formed to address the need for cross-organizational collaboration. The recently emerging ecosystem level of analysis and intervention is still under-researched, with few if any available innovation practices that match the complexity experienced at the level of care ecosystems. Beginning with the challenge of care coordination, we discuss what care ecosystems are and how they can be defined and describe the possibilities and opportunities that come when viewing care coordination through an ecosystem lens. We underpin our plea for an ecosystem approach to health and social care coordination with seven lessons, which we draw from an extensive study of 15 care ecosystem cases from seven different countries. We end the paper with an appeal for further research in this promising field.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":"23 1","pages":"5 - 8"},"PeriodicalIF":1.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434519896523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46464567","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 : 2020-03-01DOI: 10.1177/2053434520913206
Vivian L Towe, L. Bogart, R. McBain, Lisa Wagner, Clare Stevens, S. Fischer, S. MacCarthy
Introduction Housing is a determinant of HIV-related medical outcomes. Care coordination has been successfully used to treat patients with HIV and can be improved through electronic exchange of patient data, including housing data. Methods Primary data were collected from four sites across the U.S., each comprising partnerships between local HIV medical and housing providers. Between March 2017 and May 2018, we conducted a mixed-methods evaluation, focusing on preparatory activities, implementation of tasks related to data integration, and service coordination. Nineteen focus group discussions were conducted with providers, organizational leaders, and clients. Ten interviews were conducted with data system vendors and administrators. Site visits, logs, and progress reports provided information about data integration progress and other activities. Results Key activities included changes to client consent, setting up data use agreements, and planning with data system vendors. Sites selected one of three models: one-way data transmission between two systems, bidirectional transmission between two systems, and integration into one data system. Focus group discussion themes included: challenges of using existing data systems; concerns about the burden of learning a new data system; and potential benefits to providers and client, such as having more time to spend delivering client services. Discussion Using health information technologies to share data has widespread support, but uptake is still met with resistance from end users. The additional level of complexity differentiating this study from others is the exchange of data between service providers and care providers, but sites were able to accomplish this goal by navigating extensive barriers.
{"title":"Mixed-methods study of integration of housing and medical data systems for enhanced service coordination of people with HIV","authors":"Vivian L Towe, L. Bogart, R. McBain, Lisa Wagner, Clare Stevens, S. Fischer, S. MacCarthy","doi":"10.1177/2053434520913206","DOIUrl":"https://doi.org/10.1177/2053434520913206","url":null,"abstract":"Introduction Housing is a determinant of HIV-related medical outcomes. Care coordination has been successfully used to treat patients with HIV and can be improved through electronic exchange of patient data, including housing data. Methods Primary data were collected from four sites across the U.S., each comprising partnerships between local HIV medical and housing providers. Between March 2017 and May 2018, we conducted a mixed-methods evaluation, focusing on preparatory activities, implementation of tasks related to data integration, and service coordination. Nineteen focus group discussions were conducted with providers, organizational leaders, and clients. Ten interviews were conducted with data system vendors and administrators. Site visits, logs, and progress reports provided information about data integration progress and other activities. Results Key activities included changes to client consent, setting up data use agreements, and planning with data system vendors. Sites selected one of three models: one-way data transmission between two systems, bidirectional transmission between two systems, and integration into one data system. Focus group discussion themes included: challenges of using existing data systems; concerns about the burden of learning a new data system; and potential benefits to providers and client, such as having more time to spend delivering client services. Discussion Using health information technologies to share data has widespread support, but uptake is still met with resistance from end users. The additional level of complexity differentiating this study from others is the exchange of data between service providers and care providers, but sites were able to accomplish this goal by navigating extensive barriers.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":"23 1","pages":"43 - 51"},"PeriodicalIF":1.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434520913206","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42224783","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 : 2020-03-01DOI: 10.1177/2053434520913578
S. Tončinić, R. de Wildt-Liesveld, H. Vrijhoef
Introduction Engaging public and patients in the decision-making processes is on the agenda of many healthcare systems towards sustainable healthcare delivery. While many engagement initiatives are performed face-to-face, an increasing number is conducted online. An example of the latter is the Dutch digital platform Gezonde Mening that engages patients, healthcare professionals and other stakeholders in the co-creation of healthcare innovations. This study aimed to evaluate the effectiveness of stakeholder engagement performed on Gezonde Mening by focusing on the process of planning, execution and transition of engagement activities. Methods A mixed-methods study was performed by conducting eight semi-structured interviews with developers and funders of Gezonde Mening and an assessment of the psychometric properties of two questionnaires administrated via Gezonde Mening to seek stakeholders’ inputs. While the interviews were analysed deductively and inductively, data from the assessment of psychometric properties were analysed in a descriptive quantitative manner. Data were interpreted through triangulation. Results Assessment of the planning of stakeholder engagement identified needs for having more stakeholders on the platform to enable subgroup analysis and robust insights. Moreover, questionnaires administered by Gezonde Mening showed low validity and reliability. Assessment of the execution of stakeholder engagement indicated that stakeholders are sufficiently informed about engagement. Assessment of the transition of engagement activities showed needs to provide direct results to stakeholders and allow their evaluation of the platform. Conclusion Gezonde Mening digital platform facilitates communication between innovators and stakeholders during engagement activities. However, the study identified room for improvement regarding the planning and transition activities.
{"title":"Evaluation of a digital platform that engages stakeholders in the co-creation of healthcare innovations: A mixed-methods study","authors":"S. Tončinić, R. de Wildt-Liesveld, H. Vrijhoef","doi":"10.1177/2053434520913578","DOIUrl":"https://doi.org/10.1177/2053434520913578","url":null,"abstract":"Introduction Engaging public and patients in the decision-making processes is on the agenda of many healthcare systems towards sustainable healthcare delivery. While many engagement initiatives are performed face-to-face, an increasing number is conducted online. An example of the latter is the Dutch digital platform Gezonde Mening that engages patients, healthcare professionals and other stakeholders in the co-creation of healthcare innovations. This study aimed to evaluate the effectiveness of stakeholder engagement performed on Gezonde Mening by focusing on the process of planning, execution and transition of engagement activities. Methods A mixed-methods study was performed by conducting eight semi-structured interviews with developers and funders of Gezonde Mening and an assessment of the psychometric properties of two questionnaires administrated via Gezonde Mening to seek stakeholders’ inputs. While the interviews were analysed deductively and inductively, data from the assessment of psychometric properties were analysed in a descriptive quantitative manner. Data were interpreted through triangulation. Results Assessment of the planning of stakeholder engagement identified needs for having more stakeholders on the platform to enable subgroup analysis and robust insights. Moreover, questionnaires administered by Gezonde Mening showed low validity and reliability. Assessment of the execution of stakeholder engagement indicated that stakeholders are sufficiently informed about engagement. Assessment of the transition of engagement activities showed needs to provide direct results to stakeholders and allow their evaluation of the platform. Conclusion Gezonde Mening digital platform facilitates communication between innovators and stakeholders during engagement activities. However, the study identified room for improvement regarding the planning and transition activities.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":"23 1","pages":"33 - 42"},"PeriodicalIF":1.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434520913578","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45884932","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 : 2020-03-01DOI: 10.1177/2053434520907743
V. Petit-Steeghs, T. Schuitmaker-Warnaar, Ciska A Pruijssers, Gerard van Oortmerssen, J. Broerse
Introduction Care Pathway Management intends to enhance the quality of care by restructuring care services. As recipients of care, patients have relevant experiential knowledge on the provision of care, but they are rarely involved in Care Pathway Management due to various barriers. This study aims to acquire insights into how patients can be meaningfully involved in Care Pathway Management. Methods A case study was conducted to assess the implementation of patient involvement in the co-creation of the care pathways of Soft Tissue Sarcoma and Gastrointestinal Stromal Tumour at Erasmus MC Cancer Institute (the Netherlands), using the Interactive Learning and Action methodology. Within the pathways, seven patients and eight health professionals were involved. To overcome expected and encountered barriers to involving patients, reflection was stimulated on the care pathways and the development process. Qualitative data were collected via interviews, participatory observations and informal conversations. For analysis, a patient involvement evaluation framework and criteria for knowledge co-creation were used. Results Patients indicated specific improvements for current pathways regarding communication, the assistance of a nurse and integrated care. However, the co-creation process encountered several barriers, including limited opportunities to overcome patients’ knowledge gap on medical care services, limited time and uncertainties about responsibilities. Moreover, participatory reflection to enhance the co-creation process was constrained by power imbalances between patients and health professionals and health professionals’ restricted perceptions of their role. Discussion To enhance the meaningful involvement of patients in Care Pathway Management, constraints in joint reflection on the co-creation process must be overcome.
护理路径管理旨在通过重组护理服务来提高护理质量。作为护理的接受者，患者对护理的提供有相关的经验知识，但由于各种障碍，他们很少参与护理路径管理。本研究旨在了解患者如何能够有意义地参与护理路径管理。方法采用交互式学习和行动方法，对荷兰伊拉斯谟MC癌症研究所(Erasmus MC Cancer Institute)患者参与共同创建软组织肉瘤和胃肠道间质瘤护理途径的实施情况进行了案例研究。在这些途径中，有7名病人和8名保健专业人员参与。为了克服预期和遇到的障碍，使患者参与进来，对护理途径和发展过程进行了反思。定性数据通过访谈、参与性观察和非正式谈话收集。为了进行分析，使用了患者参与评估框架和知识共同创造的标准。结果患者在沟通、护士协助和综合护理方面有明显改善。然而，共同创造过程遇到了一些障碍，包括克服患者在医疗保健服务方面的知识差距的机会有限、时间有限以及责任不确定。此外，促进共同创造过程的参与性反思受到患者和卫生专业人员之间权力不平衡以及卫生专业人员对其角色的有限认识的制约。为了加强患者对护理路径管理的有意义的参与，必须克服共同创造过程中共同反思的限制。
{"title":"A qualitative research on co-creating care pathways for Sarcoma and GIST by stimulating reflection","authors":"V. Petit-Steeghs, T. Schuitmaker-Warnaar, Ciska A Pruijssers, Gerard van Oortmerssen, J. Broerse","doi":"10.1177/2053434520907743","DOIUrl":"https://doi.org/10.1177/2053434520907743","url":null,"abstract":"Introduction Care Pathway Management intends to enhance the quality of care by restructuring care services. As recipients of care, patients have relevant experiential knowledge on the provision of care, but they are rarely involved in Care Pathway Management due to various barriers. This study aims to acquire insights into how patients can be meaningfully involved in Care Pathway Management. Methods A case study was conducted to assess the implementation of patient involvement in the co-creation of the care pathways of Soft Tissue Sarcoma and Gastrointestinal Stromal Tumour at Erasmus MC Cancer Institute (the Netherlands), using the Interactive Learning and Action methodology. Within the pathways, seven patients and eight health professionals were involved. To overcome expected and encountered barriers to involving patients, reflection was stimulated on the care pathways and the development process. Qualitative data were collected via interviews, participatory observations and informal conversations. For analysis, a patient involvement evaluation framework and criteria for knowledge co-creation were used. Results Patients indicated specific improvements for current pathways regarding communication, the assistance of a nurse and integrated care. However, the co-creation process encountered several barriers, including limited opportunities to overcome patients’ knowledge gap on medical care services, limited time and uncertainties about responsibilities. Moreover, participatory reflection to enhance the co-creation process was constrained by power imbalances between patients and health professionals and health professionals’ restricted perceptions of their role. Discussion To enhance the meaningful involvement of patients in Care Pathway Management, constraints in joint reflection on the co-creation process must be overcome.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":"23 1","pages":"24 - 32"},"PeriodicalIF":1.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434520907743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43256451","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 : 2020-03-01DOI: 10.1177/2053434520914813
H. Vrijhoef
The above title sums up what the Camden programme has showed us when one offers a care coordination programme to people with complex needs. This ‘superutilizer’ intervention, which aimed to reduce spending and to improve health care quality among patients with very high use of health care services, did not result in lower readmission rates among patients randomly assigned to the five-year lasting programme than among those who received usual care. Despite the evaluation of the Camden programme did not tell why the results are disappointing, some experts did when asked for their opinion. First, care coordination should no longer be offered as a one size fits all programme to those in need. Second, care coordination for patients with very high use of health care services should go beyond health care to include other critical needs, including housing and legal support. Third, offering care coordination without fixing the system that causes fragmentation from the start is unsustainable. And finally, not preventing people to develop super complex needs is not only ethically debatable but also puts an unnecessary burden on a system and makes it even more hard to provide support to the individuals under that system. Not mentioned but certainly useful to consider, is the active involve of end-users of care coordination programmes from start till finish. The why-question remains highly relevant when developing, testing, evaluation, and implementing care coordination programmes. This issue of the International Journal of Care Coordination offers a most interesting mix of papers dealing with this question from different angles. In light of the above, the discussion and opinion papers by Dessers and Mohr and Kumpunen et al. are highly useful to perhaps recalibrate our expectations and mindset about how to develop, evaluate and implement care coordination in real life settings. Dessers and Mohr first discuss what care ecosystems are and how they can be defined before they describe the possibilities and opportunities that come when viewing care coordination through an ecosystem lens. Moreover, they draw their lessons from an extensive study of 15 care ecosystem cases from seven different countries. In explaining why integrated care initiatives do not always live up to their expectations, Kumpunen et al. tested three different hypotheses among 50 experts: (1) problems with the model; (2) problems of implementation; (3) problems of evaluation. The experts did not rule out any of the three hypotheses. Given that evaluating integrated care is a skilled task, an advisory service is recommended to support local systems planning evaluations. The study by Prusaczyk et al. reports distinct patterns in the delivery of transitional care for patients with and without dementia and explains that in developing effective interventions for dementia patients and increasing intervention uptake, one needs to understand the current delivery process of transitional care. To assess
{"title":"Care coordination is necessary but insufficient to fix the health care of these patients","authors":"H. Vrijhoef","doi":"10.1177/2053434520914813","DOIUrl":"https://doi.org/10.1177/2053434520914813","url":null,"abstract":"The above title sums up what the Camden programme has showed us when one offers a care coordination programme to people with complex needs. This ‘superutilizer’ intervention, which aimed to reduce spending and to improve health care quality among patients with very high use of health care services, did not result in lower readmission rates among patients randomly assigned to the five-year lasting programme than among those who received usual care. Despite the evaluation of the Camden programme did not tell why the results are disappointing, some experts did when asked for their opinion. First, care coordination should no longer be offered as a one size fits all programme to those in need. Second, care coordination for patients with very high use of health care services should go beyond health care to include other critical needs, including housing and legal support. Third, offering care coordination without fixing the system that causes fragmentation from the start is unsustainable. And finally, not preventing people to develop super complex needs is not only ethically debatable but also puts an unnecessary burden on a system and makes it even more hard to provide support to the individuals under that system. Not mentioned but certainly useful to consider, is the active involve of end-users of care coordination programmes from start till finish. The why-question remains highly relevant when developing, testing, evaluation, and implementing care coordination programmes. This issue of the International Journal of Care Coordination offers a most interesting mix of papers dealing with this question from different angles. In light of the above, the discussion and opinion papers by Dessers and Mohr and Kumpunen et al. are highly useful to perhaps recalibrate our expectations and mindset about how to develop, evaluate and implement care coordination in real life settings. Dessers and Mohr first discuss what care ecosystems are and how they can be defined before they describe the possibilities and opportunities that come when viewing care coordination through an ecosystem lens. Moreover, they draw their lessons from an extensive study of 15 care ecosystem cases from seven different countries. In explaining why integrated care initiatives do not always live up to their expectations, Kumpunen et al. tested three different hypotheses among 50 experts: (1) problems with the model; (2) problems of implementation; (3) problems of evaluation. The experts did not rule out any of the three hypotheses. Given that evaluating integrated care is a skilled task, an advisory service is recommended to support local systems planning evaluations. The study by Prusaczyk et al. reports distinct patterns in the delivery of transitional care for patients with and without dementia and explains that in developing effective interventions for dementia patients and increasing intervention uptake, one needs to understand the current delivery process of transitional care. To assess ","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":"23 1","pages":"3 - 4"},"PeriodicalIF":1.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434520914813","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41603644","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 : 2020-03-01DOI: 10.1177/2053434520908122
B. Prusaczyk, Vanessa D. Fabbre, N. Morrow-Howell, E. Proctor
Introduction There are numerous effective transitional care interventions yet they are not routinely implemented. Furthermore, few interventions exist for older adults with dementia. A first step in developing effective interventions for dementia patients and increasing intervention uptake for all patients is to understand the current delivery process of transitional care. Methods A mixed methods study using an explanatory multiphase design was conducted. Guided by provider interviews, medical charts were reviewed to collect information on the day-to-day transitional care being delivered to older adults. Then providers were interviewed again to assess the accuracy of those results and provide context. Results The medical charts of 210 older adults (126 with dementia and 84 without) were reviewed and nine providers representing various professional roles including social work, nursing, and case management were interviewed. Social workers and case managers were primarily involved in discharge planning, communicating with providers outside the hospital, advanced care planning, providing social and community supports, and making follow-up appointments. Registered nurses were the primary providers of patient education and medication safety while physicians were primarily involved in ensuring that necessary information was available in the discharge summary and that it was available in the chart. Discussion This study found distinct patterns in the delivery of transitional care, including the unique roles nursing, social work, and case management have in the process. Furthermore, these patterns were found to differ between patients with and without dementia. These findings are both consistent and inconsistent with the existing literature on transitional care interventions.
{"title":"Understanding transitional care provided to older adults with and without dementia: A mixed methods study","authors":"B. Prusaczyk, Vanessa D. Fabbre, N. Morrow-Howell, E. Proctor","doi":"10.1177/2053434520908122","DOIUrl":"https://doi.org/10.1177/2053434520908122","url":null,"abstract":"Introduction There are numerous effective transitional care interventions yet they are not routinely implemented. Furthermore, few interventions exist for older adults with dementia. A first step in developing effective interventions for dementia patients and increasing intervention uptake for all patients is to understand the current delivery process of transitional care. Methods A mixed methods study using an explanatory multiphase design was conducted. Guided by provider interviews, medical charts were reviewed to collect information on the day-to-day transitional care being delivered to older adults. Then providers were interviewed again to assess the accuracy of those results and provide context. Results The medical charts of 210 older adults (126 with dementia and 84 without) were reviewed and nine providers representing various professional roles including social work, nursing, and case management were interviewed. Social workers and case managers were primarily involved in discharge planning, communicating with providers outside the hospital, advanced care planning, providing social and community supports, and making follow-up appointments. Registered nurses were the primary providers of patient education and medication safety while physicians were primarily involved in ensuring that necessary information was available in the discharge summary and that it was available in the chart. Discussion This study found distinct patterns in the delivery of transitional care, including the unique roles nursing, social work, and case management have in the process. Furthermore, these patterns were found to differ between patients with and without dementia. These findings are both consistent and inconsistent with the existing literature on transitional care interventions.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":"23 1","pages":"14 - 23"},"PeriodicalIF":1.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434520908122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45158635","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 : 2019-09-01DOI: 10.1177/2053434519890050
L. Ørtenblad, N. Nissen
Introduction General practitioners’ management of multimorbid patients is mostly described as a burden, although it is also indicated that fundamental characteristics of general practice are well-suited to accommodate appropriate management of multimorbidity. However, little is known about actual practices among general practitioners. This study explores general practitioners’ management of their multimorbid patients. Methods A qualitative methodological design using participant observation and interviews. Interpretive description was used as the analytical framework. The study took place in a provincial town in Denmark. Three general practices with a total of 12 general practitioners participated. Results ‘Multimorbidity’ as general terminology does not reflect the practice of the general practitioners. Their approach is based on the functional capacity of individual patients. The heterogeneity of the group was classified into three categories determining the general practitioners’ approach: the well-functioning patients, the surprising patients and the fragile patients. Three core characteristics were identified as pivotal for the general practitioners’ approach: holistic view of the patient’s situation, patient-centred focus and coordinator and facilitator. These are fundamental characteristics of general practice, but become especially significant because they accommodate the complexity and heterogeneity of multimorbid patients. Discussion This study expands the subject field by exploring the general practitioners’ actual practices, thereby providing new perspectives into features that support appropriate management of multimorbid patients. General practitioners balance administrative and clinical regulations in their considerations of accommodating the heterogeneity and complexity of multimorbid patients. This suggests that better possibilities must be provided to realize the fundamental characteristics of general practice to support their management of multimorbid patients.
{"title":"General practitioners’ considerations of and experiences with multimorbidity patients: A qualitative study","authors":"L. Ørtenblad, N. Nissen","doi":"10.1177/2053434519890050","DOIUrl":"https://doi.org/10.1177/2053434519890050","url":null,"abstract":"Introduction General practitioners’ management of multimorbid patients is mostly described as a burden, although it is also indicated that fundamental characteristics of general practice are well-suited to accommodate appropriate management of multimorbidity. However, little is known about actual practices among general practitioners. This study explores general practitioners’ management of their multimorbid patients. Methods A qualitative methodological design using participant observation and interviews. Interpretive description was used as the analytical framework. The study took place in a provincial town in Denmark. Three general practices with a total of 12 general practitioners participated. Results ‘Multimorbidity’ as general terminology does not reflect the practice of the general practitioners. Their approach is based on the functional capacity of individual patients. The heterogeneity of the group was classified into three categories determining the general practitioners’ approach: the well-functioning patients, the surprising patients and the fragile patients. Three core characteristics were identified as pivotal for the general practitioners’ approach: holistic view of the patient’s situation, patient-centred focus and coordinator and facilitator. These are fundamental characteristics of general practice, but become especially significant because they accommodate the complexity and heterogeneity of multimorbid patients. Discussion This study expands the subject field by exploring the general practitioners’ actual practices, thereby providing new perspectives into features that support appropriate management of multimorbid patients. General practitioners balance administrative and clinical regulations in their considerations of accommodating the heterogeneity and complexity of multimorbid patients. This suggests that better possibilities must be provided to realize the fundamental characteristics of general practice to support their management of multimorbid patients.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":"22 1","pages":"117 - 126"},"PeriodicalIF":1.4,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434519890050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47734262","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 : 2019-09-01DOI: 10.1177/2053434519893659
Vini Singh, M. Pinkett-Davis, Luther G. Kalb, G. Azad, J. Neely, R. Landa
Introduction Parents of children with autism spectrum disorder often experience high levels of stress and challenges when organizing medical and behavioral services for their child. Care coordination could alleviate these challenges, however little is known about the effectiveness of this service. This study examined the need, feasibility, and acceptability of a care coordination program. Methods Families of 176 children with autism, seen at a multidisciplinary autism clinic in the United States, participated in a prospective observational study. Families received a three-month structured care coordination program and completed pre- and post-program questionnaires that probed parents’ beliefs about the need and acceptability of the program through structured and open-ended questions. Results Most (≥90%) parents reported both a need for care coordination and satisfaction with the program. Qualitative themes identified valuable aspects and ways to improve the program. Discussion Parents raising a child with autism spectrum disorder experience an unmet need for care coordination. When provided, parents’ demonstrated high uptake of service and high levels of satisfaction with the program.
{"title":"A preliminary study of care coordination services within a specialized outpatient setting for youth with autism spectrum disorder","authors":"Vini Singh, M. Pinkett-Davis, Luther G. Kalb, G. Azad, J. Neely, R. Landa","doi":"10.1177/2053434519893659","DOIUrl":"https://doi.org/10.1177/2053434519893659","url":null,"abstract":"Introduction Parents of children with autism spectrum disorder often experience high levels of stress and challenges when organizing medical and behavioral services for their child. Care coordination could alleviate these challenges, however little is known about the effectiveness of this service. This study examined the need, feasibility, and acceptability of a care coordination program. Methods Families of 176 children with autism, seen at a multidisciplinary autism clinic in the United States, participated in a prospective observational study. Families received a three-month structured care coordination program and completed pre- and post-program questionnaires that probed parents’ beliefs about the need and acceptability of the program through structured and open-ended questions. Results Most (≥90%) parents reported both a need for care coordination and satisfaction with the program. Qualitative themes identified valuable aspects and ways to improve the program. Discussion Parents raising a child with autism spectrum disorder experience an unmet need for care coordination. When provided, parents’ demonstrated high uptake of service and high levels of satisfaction with the program.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":"22 1","pages":"109 - 116"},"PeriodicalIF":1.4,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434519893659","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42035748","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 : 2019-09-01DOI: 10.1177/2053434519892469
Andrés Daniel Gallego-Ardila, Á. M. Pinzón-Rondón, A. Mogollón-Pérez, C. Cardozo, I. Vargas, M. Vázquez
Introduction Care coordination is a priority concern for healthcare systems. In Colombia, there is a lack of information on the topic. This study analysed how doctors of two Bogotá’s public healthcare networks perceived coordination between healthcare levels and what factors are associated with their perception. Methods A cross-sectional study using the COORDENA-CO questionnaire to a sample of 363 doctors (network-1 = 181; network-2 = 182) in 2015. The questionnaire asks about types and dimensions of care coordination: information and clinical management, with items in a Likert scale, as well as conditions regarding health system, organisational and doctors’ conditions. Descriptive statistics and logistic regression analysis were performed. Results The doctors’ perception of a high level of coordination did not exceed 25.4%. On coordination of information, limited transfer of clinical information was found. Concerning clinical management, there were limited care coherence, deficits in patient follow-up and lengthy waiting times for specialised care. A high perception of coordination were associated with being female, being over 50 years old, being a specialist, having less than one year’s working experience, working less than 20 h per week at the centre, forming part of network-1, having time available for performing coordination tasks, having job satisfaction and not identifying limitations imposed by healthcare insurers. Discussion There was limited perception of coordination, in its different dimensions and types with some differences between networks. The results support the importance of guaranteeing job satisfaction, ensuring sufficient time to coordination-related activities and intervening in the restrictions imposed by healthcare insurers to improve care coordination.
{"title":"Care coordination in two of Bogota’s public healthcare networks: A cross-sectional study among doctors","authors":"Andrés Daniel Gallego-Ardila, Á. M. Pinzón-Rondón, A. Mogollón-Pérez, C. Cardozo, I. Vargas, M. Vázquez","doi":"10.1177/2053434519892469","DOIUrl":"https://doi.org/10.1177/2053434519892469","url":null,"abstract":"Introduction Care coordination is a priority concern for healthcare systems. In Colombia, there is a lack of information on the topic. This study analysed how doctors of two Bogotá’s public healthcare networks perceived coordination between healthcare levels and what factors are associated with their perception. Methods A cross-sectional study using the COORDENA-CO questionnaire to a sample of 363 doctors (network-1 = 181; network-2 = 182) in 2015. The questionnaire asks about types and dimensions of care coordination: information and clinical management, with items in a Likert scale, as well as conditions regarding health system, organisational and doctors’ conditions. Descriptive statistics and logistic regression analysis were performed. Results The doctors’ perception of a high level of coordination did not exceed 25.4%. On coordination of information, limited transfer of clinical information was found. Concerning clinical management, there were limited care coherence, deficits in patient follow-up and lengthy waiting times for specialised care. A high perception of coordination were associated with being female, being over 50 years old, being a specialist, having less than one year’s working experience, working less than 20 h per week at the centre, forming part of network-1, having time available for performing coordination tasks, having job satisfaction and not identifying limitations imposed by healthcare insurers. Discussion There was limited perception of coordination, in its different dimensions and types with some differences between networks. The results support the importance of guaranteeing job satisfaction, ensuring sufficient time to coordination-related activities and intervening in the restrictions imposed by healthcare insurers to improve care coordination.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":"22 1","pages":"127 - 139"},"PeriodicalIF":1.4,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434519892469","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49214524","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 : 2019-09-01DOI: 10.1177/2053434519895423
J. Symons, Julie Jamison, Jane Dening, L. Murray, Sue Pearson
Introduction Contemporary rehabilitation change relies on effective collaboration and ongoing social interactions among stakeholders. The study objective was to explore the influence of the selected change framework and underlying social interactions during a care coordination improvement project. Methods A qualitative study collected data from 35 employees in a community physical rehabilitation service. Participants were not only undergoing change to improve client care coordination but were also facilitating the change processes themselves. Symbolic interactionism guided the research design, and data were collected using interviews and observation. Blumer’s six root beliefs were used for deductive data analysis and provided the framework for the findings. Results Findings highlight that the perceptions of the selected change framework were mixed yet dynamic, with modification occurring via social interaction. Elements of Kotter’s eight steps, lean thinking, and transformational change models were trialed. Implementation of the change processes required formal and informal group social interactions. Participants’ different outlooks explained their mixed response to the change processes. Participants who supported the implemented changes believed the processes and outcomes were clear, appropriate, and inclusive. Time, energy, and positive social interactions enabled employees to drive change, with more of these resources desired to refine the vision, problem-solve implementation, and further improve care coordination. Discussion This study enhances the understanding of how employees and the community physical rehabilitation service shaped each other during the change processes. The focus on social interactions highlights the slow rate of improved care coordination and need for increased resources and/or duration for successful change.
{"title":"Improving care coordination in community physical rehabilitation: A qualitative study of the change framework","authors":"J. Symons, Julie Jamison, Jane Dening, L. Murray, Sue Pearson","doi":"10.1177/2053434519895423","DOIUrl":"https://doi.org/10.1177/2053434519895423","url":null,"abstract":"Introduction Contemporary rehabilitation change relies on effective collaboration and ongoing social interactions among stakeholders. The study objective was to explore the influence of the selected change framework and underlying social interactions during a care coordination improvement project. Methods A qualitative study collected data from 35 employees in a community physical rehabilitation service. Participants were not only undergoing change to improve client care coordination but were also facilitating the change processes themselves. Symbolic interactionism guided the research design, and data were collected using interviews and observation. Blumer’s six root beliefs were used for deductive data analysis and provided the framework for the findings. Results Findings highlight that the perceptions of the selected change framework were mixed yet dynamic, with modification occurring via social interaction. Elements of Kotter’s eight steps, lean thinking, and transformational change models were trialed. Implementation of the change processes required formal and informal group social interactions. Participants’ different outlooks explained their mixed response to the change processes. Participants who supported the implemented changes believed the processes and outcomes were clear, appropriate, and inclusive. Time, energy, and positive social interactions enabled employees to drive change, with more of these resources desired to refine the vision, problem-solve implementation, and further improve care coordination. Discussion This study enhances the understanding of how employees and the community physical rehabilitation service shaped each other during the change processes. The focus on social interactions highlights the slow rate of improved care coordination and need for increased resources and/or duration for successful change.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":"22 1","pages":"140 - 147"},"PeriodicalIF":1.4,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434519895423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65486844","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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