在社区和诊所之间建立双向转诊和沟通途径:来自洛杉矶系统知情创新项目的经验

IF 2 4区 医学 Q3 HEALTH POLICY & SERVICES Healthcare-The Journal of Delivery Science and Innovation Pub Date : 2023-03-01 DOI:10.1016/j.hjdsi.2022.100671
Amelia R. DeFosset , Noel C. Barragan , Gabrielle Green , Janina L. Morrison , Tony Kuo
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引用次数: 1

摘要

诊所和社区组织之间的双向沟通和转诊途径可以促进有复杂和重叠健康和社会需求的弱势群体的福祉。虽然BCRP很有前景,但建立它们是复杂的,涉及不同组织环境中的系统和流程变化。迄今为止,很少有模型得到实施或实证检验。本文描述了一个建立BCRP的创新和规划项目,将安全网初级保健诊所的患者与洛杉矶的一套全面的社区健康支持联系起来。在长达一年的过程中,一个多部门团队反复使用数据,以促进学习和改进。该项目经历了三个不同但重叠的阶段:(1)发现、(2)系统映射和(3)BCRP重新设计和测试,这些阶段通过频繁的协作会议进行协调。通过使用逐步系统知情的方法来收集和检查数据,团队能够产生新的变革想法,消除假设,并做出透明和知情的决策。至关重要的是,既要让了解“实地”实践现实的内部合作伙伴参与,也要让外部利益攸关方从新的角度参与,以确定机会并确定改进议程。这些努力是实施可持续BCRP的第一步,也是实现其动态弥合社区诊所鸿沟和改善人口健康的全部潜力的第一步。其他司法管辖区可以学习和调整洛杉矶使用的实用数据驱动方法,以建立将在其独特背景下彻底实施、持续实施和优化的BCRP。
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Building bi-directional referral and communication pathways across the community-clinic divide: Experiences from a systems-informed innovation project in Los Angeles

Bi-directional communication and referral pathways (BCRPs) between clinics and community-based organizations could promote well-being among vulnerable populations with complex and overlapping health and social needs. While BCRPs are promising, establishing them is complex, involving system and process changes across diverse organizational settings. To date, few models have been implemented or empirically tested.

This article describes an innovation and planning project to build a BCRP, linking patients in safety net primary care clinics to a comprehensive suite of community-based health and wellness supports in Los Angeles. During a year-long process, a multi-sector team iteratively engaged data to facilitate learning and improvement. The project proceeded through three distinct, but overlapping, phases: (1) Discovery, (2) Systems Mapping, and (3) BCRP Re-design and Testing, which were coordinated through frequent collaborative meetings. By using a stepwise systems-informed approach to collect and examine data, the team was able to generate new change ideas, dispel assumptions, and make transparent and informed decisions.

It was critical to have engagement from both internal partners with knowledge of “on-the-ground” practice realities, and external stakeholders with the fresh perspective needed to identify opportunities and define an improvement agenda. These efforts represent first steps towards implementing sustainable BCRPs and realizing their full potential to dynamically bridge the community-clinic divide and improve population health. Other jurisdictions can learn from and adapt the practical data-driven approach used in Los Angeles to build BCRPs that will be thoroughly operationalized, consistently implemented, and optimized within their own unique contexts.

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来源期刊
CiteScore
4.90
自引率
0.00%
发文量
37
期刊介绍: HealthCare: The Journal of Delivery Science and Innovation is a quarterly journal. The journal promotes cutting edge research on innovation in healthcare delivery, including improvements in systems, processes, management, and applied information technology. The journal welcomes submissions of original research articles, case studies capturing "policy to practice" or "implementation of best practices", commentaries, and critical reviews of relevant novel programs and products. The scope of the journal includes topics directly related to delivering healthcare, such as: ● Care redesign ● Applied health IT ● Payment innovation ● Managerial innovation ● Quality improvement (QI) research ● New training and education models ● Comparative delivery innovation
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