International Journal of Integrated Care最新文献

{"title":"Bridging Perspectives, Building Resilience: Safety-II Guided Reflexive Dialogues Between Care Professionals and Clients as Part of Developing Integrated Maternity Care.","authors":"Sarah R Lips, Jolanda C G Boxem-Tiemessen, Anna M Ligthart, Tjerk Jan Schuitmaker-Warnaar, Martine C de Bruijne, Corine J M Verhoeven, Petra Verdonk, Ank de Jonge","doi":"10.5334/ijic.8588","DOIUrl":"10.5334/ijic.8588","url":null,"abstract":"<p><strong>Background: </strong>Limitations of traditional structures and approaches to further enhance patient safety, satisfaction, and systemic sustainability in healthcare, are becoming increasingly visible. Embedding reflexivity is a proposed strategy to promote progress. We aimed to explore the potential of creating reflexive spaces for promoting integration and client-centeredness in maternity care specifically.</p><p><strong>Methods: </strong>In this participatory action research (PAR), two multidisciplinary and multiorganizational groups of maternity care professionals and clients (n = 28) from two Dutch regions, participated in 'reflexive dialogues'. Cases were discussed from a Safety-II perspective. In total, 22 meetings took place from 2020-2022, mostly online. Additionally, 23 participants were interviewed. Data were audio-recorded, transcribed, and thematically analyzed.</p><p><strong>Findings: </strong>Participants were generally positive about the reflexive dialogues and Safety-II approach. They felt both safe and challenged to critically reflect on their own and each other's care practices. Exchanging perspectives, experiences, and approaches fostered trust, well-being, and repertoire, and through this, resilience.</p><p><strong>Conclusions: </strong>By structurally stimulating, facilitating, and embedding Safety-II guided reflexive dialogues between professionals and clients from multiple organizations and disciplines, healthcare leaders could promote resilience and reinforce the transformation towards integrated, relation-centered maternity care.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"24 4","pages":"4"},"PeriodicalIF":2.6,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11505032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conditions and Co-production of Integrated Care for Patients with Multimorbidity.","authors":"Kirstine Skov Benthien, Nina Gøtzsche, Louise Meinertz Jakobsen, Michaela Schiøtz","doi":"10.5334/ijic.7648","DOIUrl":"10.5334/ijic.7648","url":null,"abstract":"<p><strong>Introduction: </strong>People with multimorbidity can experience fragmented healthcare and burden of treatment and the evidence-base for integrated care in multimorbidity is weak. The aim of this study was to develop a model for integrated care for patients with multimorbidity: The Primary Organization and Relations-Team (PORT).</p><p><strong>Description: </strong>The PORT prototype was formed using a co-production approach including workshops with healthcare professionals from hospital, general practice and municipalities, and interviews with patients with multimorbidity. The qualitative data were analyzed with systematic text condensation. During the co-production phase, 38 persons were interviewed or participated in workshops. Four themes emerged as central for integrated care for patients with multimorbidity: Information sharing, decision making across sectors, healthcare fragmentation, and patient-centeredness. A prototype aimed at these themes was developed and included continuous information sharing and case management by a joint specialty clinic, a total healthcare plan, and systematic needs assessment.</p><p><strong>Discussion: </strong>The results and PORT prototype were developed through a comprehensive co-production process and the results and model may be transferred to other healthcare systems that are divided into sectors.</p><p><strong>Conclusion: </strong>Integrated multimorbidity care may be met through continuous information sharing, case management by a joint specialty clinic, a total healthcare plan, and systematic needs assessment.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"24 4","pages":"3"},"PeriodicalIF":2.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring the Maturity of Integrated Care in Singapore with the SCIROCCO Exchange Tool.","authors":"Angeline Woon Kee Lim, Clive Tan, Jason Chin Huat Yap","doi":"10.5334/ijic.7747","DOIUrl":"10.5334/ijic.7747","url":null,"abstract":"<p><strong>Background: </strong>How have we progressed and where are the gaps of integrated care in Singapore? Social-health care provision in the context of an ageing population is critical in the city-state's management of the unprecedented demand as the proportion of seniors with multiple complex medical needs have almost doubled in the past decade.</p><p><strong>Objective: </strong>This study measures the maturity level of Singapore's integrated care, identifies key gaps and discusses their implications using the SCIROCCO Exchange tool, an online self-assessment tool consisting of the 12 dimensions necessary for the provision of integrated care.</p><p><strong>Methods: </strong>A three-step mixed method Delphi study was used to derive expert consensus. Participants across the social-healthcare sector as well as representatives from all three public healthcare delivery networks with at least five years of experience were included. Participants rated each of the twelve dimensions of the SCIROCCO Exchange tool on a six-point ordinal scale and provided justifications for each rating. Criteria from the RAND UCLA appropriateness method and thematic analysis were adopted for the analysis.</p><p><strong>Results: </strong>All participants completed the study. The study found five dimensions in the \"Initial\" maturity level and five dimensions in the \"Progressing\" maturity level. There were two dimensions which were \"Uncertain\" because of split responses, possibly due to their differing vantage points and conceptualisations of integrated care. The overall medians were plotted on a spider diagram. The absence of a systematic approach for integrated care was the most common subtheme across all dimensions. This is foundational for integrated care as this would enable stakeholders across health and social care to identify with a common goal.</p><p><strong>Implications: </strong>The findings emphasise the imperative to reshape social-health care delivery by focusing on foundational dimensions (such as structure, governance and citizen empowerment) to enable progress in other dimensions. Following the conclusion of this study, Singapore initiated a primary care reform with the launch of Healthier SG in July 2023. Future research may wish to explore the impact of Healthier SG on maturity of integrated care in Singapore.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"24 4","pages":"2"},"PeriodicalIF":2.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Healthcare Integration: An Integrated Palliative Care System in Spain.","authors":"Meritxell Mondejar-Pont, Laura Rota-Musoll, Xavier Gómez-Batiste, Anna Ramon-Aribau","doi":"10.5334/ijic.8613","DOIUrl":"10.5334/ijic.8613","url":null,"abstract":"<p><strong>Introduction: </strong>This study explored the Osona palliative care system, recognized internationally for its good results in managing the chronic patient. The literature notices a gap of models that evaluate integration in healthcare systems. This study assesses the degree of integration of the Osona palliative care system, as well it implements a model that evaluates integration.</p><p><strong>Methods: </strong>This research used a qualitative methodology, involving a case study design with three study phases. The first phase involved reviewing primary sources, followed by conducting interviews. The final phase entailed comparing the findings with a theoretical model to analyse and validate the results.</p><p><strong>Results: </strong>The study found the integrative elements that the Osona system includes such as: multidisciplinary teams, leadership and a palliative care system that is cost-efficient. It also found aspects to improve including collaboration, continuity of care, early patient identification and lack of funding.</p><p><strong>Discussion: </strong>Our findings suggest that the Osona system has made significant progress toward integration, even though it continues the path of ongoing development in integrated care.</p><p><strong>Conclusion: </strong>This research found that the Osona palliative care system includes many integrating aspects such as multidisciplinary teams, leadership and the system's cost-efficiency. Nevertheless, some aspects need changes such as continuity of care, collaboration, enhanced early patient identification and increase funding. Furthermore, this study provides an example of how to assess integration in a system.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"24 4","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rutgers Integrated Care Evaluation (RICE) Research Framework: An Innovative and Rigorous Set of Methods to Evaluate Integrated Care Programs.","authors":"Jamey J Lister, Holly H Lister, Kristen G Powell, Shannon P Cheung, N Andrew Peterson, Anna Marie Toto, Stephanie C Marcello","doi":"10.5334/ijic.7715","DOIUrl":"https://doi.org/10.5334/ijic.7715","url":null,"abstract":"<p><strong>Introduction: </strong>Integrated care programs that prioritize comprehensive service delivery for behavioural health and medical conditions have the potential to improve patient outcomes. Few programs, however, use data-driven methods to guide program evaluation and implementation, limiting their effectiveness, as well as the scope of findings in the research literature.</p><p><strong>Purpose: </strong>To address these gaps, we describe an innovative and rigorous evaluative research framework: the Rutgers Integrated Care Evaluation (RICE) Research Framework, designed to be tailorable across conditions and care settings.</p><p><strong>Method: </strong>The RICE Research Framework is guided by two core concepts: (1) an approach built on engaging as equal partners and (2) data source triangulation. For the former, the approach relies on multiple teams (Project, Clinical Site, Evaluation, and Consumer) working in collaboration. While teams have specific roles, all teams engage frequently as equal partners to facilitate performance and advance research deliverables. For the latter, we provide a template with recommended primary and secondary data sources with areas of focus, applicable methods, and samples. These sources, when used in combination, can guide implementation, advance replicability, develop/refine health care programs, and foster dissemination of scientific findings.</p><p><strong>Conclusions: </strong>We recommend clinicians and scientists implement the RICE Research Framework to enhance their integrated care programs.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"24 3","pages":"22"},"PeriodicalIF":2.6,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11428653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagining Day Rehabilitation For Frailty and Neurodegenerative Conditions through the integrated Rehabilitation and EnAblement Program (iREAP).","authors":"Genevieve Maiden, Annabel Kingsford, Audrey P Wang, Anh R Tran-Nam, Julia Nelson","doi":"10.5334/ijic.8066","DOIUrl":"10.5334/ijic.8066","url":null,"abstract":"<p><strong>Background: </strong>integrated Rehabilitation and EnAblement Program (iREAP) is an innovative redesign of the traditional day rehabilitation model, providing an anticipatory, early assessment and intervention program that manages care of community-dwelling older people with complex needs. It coordinates access to disciplines across medical, allied health and nursing, with a self-management focus, partnering with primary health in an integrated approach.</p><p><strong>Objective: </strong>This observational study reviews the effectiveness of iREAP on frailty, patient activation, quality of life and physical outcome measures on older people at risk of, or experiencing falls and frailty, or with neurodegenerative conditions, including Parkinson's Disease.</p><p><strong>Methods: </strong>99 participants completed the eight-week multidisciplinary program. Patient outcome measures included Rockwood Clinical Frailty Scale, quality of life measures, Patient Activation Measure, Timed Up and Go, 6 Minute Walk Test and Berg Balance Scale.</p><p><strong>Results: </strong>On completion of iREAP, participants displayed improvements in their Rockwood Clinical Frailty Scores (mildly frail to vulnerable), 'patient activation' (55.08 to 60.61), quality of life (Parkinson's Disease Questionnaire-39, 49.93 to 47.16; WHO Quality of Life - Bref physical domain, 21 to 22.7) and physical measures including balance (44 to 49/56 Berg Balance scale) and mobility (294 m to 336 m, 6-minute walk test). Falls were not reduced at twelve months post-program (3.40 to 2.01).</p><p><strong>Conclusion: </strong>iREAP is an interdisciplinary, early assessment and intervention program with the potential to reverse frailty and improve quality of life for complex older patients. This paper offers a platform for future research, given the paucity of evidence reviewing the efficacy of integrated anticipatory models of care in older adults with complex needs.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"24 3","pages":"21"},"PeriodicalIF":2.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11414462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated Diagnosis in Africa's Low- and Middle-Income Countries: What Is It, What Works, and for Whom? A Realist Synthesis.","authors":"Gamuchirai Gwaza, Annette Plüddemann, Marcy McCall, Carl Heneghan","doi":"10.5334/ijic.7788","DOIUrl":"https://doi.org/10.5334/ijic.7788","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Integrated diagnosis can improve health outcomes and patient experiences through early diagnosis and identification of cases that could otherwise be overlooked. Although existing research highlight the feasibility of integrated diagnosis across various conditions, a significant evidence gap remains regarding its direct impact on patient experiences and health outcomes. This review explores the conceptualizations of integrated diagnosis by different stakeholders along the healthcare pathway and examines the necessary contexts and mechanisms crucial for its effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study adopts a realist methodology to explore integrated diagnosis. Using a systematic approach, the research aims to collect, assess, and synthesize existing evidence on integrated diagnosis, guided by a program theory developed through literature review and expert consultations. Primary studies and reviews related to integrated diagnosis, multi-disease testing, or integrated healthcare with a diagnostic focus were sourced from major databases and global health organization websites. The collected evidence was used to construct and refine the evolving theoretical framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study identified three models of integrated diagnosis interventions: individual/human resource integration, facility or mobile-based integration, and technology integration. Successful implementation of these models relies on understanding the values and perceptions of both healthcare workers and patients/clients. This research emphasizes a holistic approach that considers all elements within the health system and underscores their interdependence. Using the WHO health systems framework to contextualise factors, the study positions diagnosis as an integral component of the broader health ecosystem. A key finding of the research is the importance of addressing the barriers and facilitators of integrated diagnosis interventions. This includes policy frameworks, diagnostic tools, funding mechanisms, treatment pathways, and human resource issues. Improving patient experiences requires cultivating positive relationships with healthcare workers ensuring elements such as respect, confidentiality, accessibility, and timeliness of services are prioritised.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion and conclusion: &lt;/strong&gt;The diverse conceptualisations of integrated diagnosis highlight the importance of clear definitions for each intervention. This clarity is essential for transferring lessons learned, comparing programs, and effectively measuring results. The success of integrated diagnosis is not a one-size-fits-all scenario; decisions regarding the approach, conditions to be integrated, and timing of integration must be guided by local contexts to ensure sustainable outcomes. The review findings suggest that integrated diagnosis may be suitable at the primary care level in LMICs under specific circumstances. Successful impleme","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"24 3","pages":"20"},"PeriodicalIF":2.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11396343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scale-Up of Integrated Care Interventions for Chronic Diseases in Diverse Settings.","authors":"Grace Marie Ku, Zalika Klemenc-Ketiš, Antonija Poplas-Susič, Roy Remmen, Wim Van Damme, Edwin Wouters, Josefien Van Olmen, Kerstin Klipstein-Grobusch","doi":"10.5334/ijic.8981","DOIUrl":"https://doi.org/10.5334/ijic.8981","url":null,"abstract":"","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"24 3","pages":"19"},"PeriodicalIF":2.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11396081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Strengths and Weaknesses for Implementing a Place-Based Model of Care for Older People on the Central Coast, Australia: Results of a Pilot Project Using the Population Health Management Maturity Index (PHM-MI) Tool.","authors":"Anna Francisca Teresia Maria van Ede, Nicholas Goodwin, Marc Abraham Bruijnzeels, Katharina Viktoria Stein","doi":"10.5334/ijic.8575","DOIUrl":"10.5334/ijic.8575","url":null,"abstract":"<p><strong>Introduction: </strong>Population health management is increasingly being used to support place-based models of care. This case study provides an account of the use of the Population Health Management - Maturity Index (PHM-MI) tool to inform the future development of a neighbourhood model of care for older people in the Central Coast region of Australia.</p><p><strong>Description: </strong>The PHM-MI tool comprises a set of six evidence-informed elements known to be important in enabling PHM in practice. As part of a joint strategic needs assessment, 17 selected stakeholders from key regional organizations were invited to undertake the PHM-MI tool survey. Three follow-up workshops were held to interpret the results and determine priority actions.</p><p><strong>Discussion: </strong>The PHM-MI scores revealed that the overall maturity of the Central Coast to successfully deliver PHM was low across all six elements, findings that were corroborated through participant workshops. Systemic fragmentations, most pertinently of funding and regulation, incentivised silo-based working. The need to formalise and strengthen regional collaborations, enable data integration, find creative ways to use existing funding streams, and promote community engagement were highlighted as core priorities.</p><p><strong>Conclusion: </strong>Using the PHM-MI tool was enabled by it being embedded within a pre-existing regional strategic process. The results were used to inform future regional priorities. The PHM-MI tool has the potential for use across regional or national contexts.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"24 3","pages":"18"},"PeriodicalIF":2.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Integrated Care World is a Stage: Applying Goffman's Theory of Dramaturgy to the Activities of Integrated Care.","authors":"Carolyn Steele Gray, James Shaw, G Ross Baker, Kerry Kuluski, Walter P Wodchis","doi":"10.5334/ijic.8639","DOIUrl":"10.5334/ijic.8639","url":null,"abstract":"<p><p>Among the challenges in delivering integrated health and social care services is the need to attend to the coordination of tasks, roles, activities, and operations, while considering how these efforts are experienced by patients, carers and communities. The literature has noted an important disconnect between how providers and leaders view their efforts to coordinate service delivery, and how patients perceive these efforts on the receiving end. Our team has provided guidance to integrated care efforts in Ontario, Canada by drawing on Goffman's theory of Dramaturgy to help classify the actions of integrated care delivery as linked to the roles individuals play in the delivery of care. Using this framing helps to uncover how \"backstage\" processes (such as team-functioning, funding models, and digital infrastructures) create a necessary foundation on which \"frontstage\" actions (or performances) can be effectively delivered.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"24 3","pages":"17"},"PeriodicalIF":2.6,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}