International Journal of Care Coordination最新文献

{"title":"Exploring the effect of streamlining multidisciplinary care pathways on orbital trauma outcomes at a regional referral centre","authors":"M. Gillam, N. Mandal, V. Lee, V. Vora, M. Perry","doi":"10.1177/2053434519836431","DOIUrl":"https://doi.org/10.1177/2053434519836431","url":null,"abstract":"Introduction Complex orbital fractures require multi-specialty input. The United Kingdom currently has no agreed best practice guidelines. A systematic review and meta-analysis found a significantly increased adverse outcome of persistent diplopia in patients operated on more than 14 days after initial injury. At our tertiary centre, we felt patient outcomes may be affected by investigative and referral pathway limitations so evaluated to assess and attempt to improve these. Methods This was a two-stage service evaluation study of all orbital trauma patients requiring specialist oculoplastic and orbital input. The initial phase included all orbital trauma patients referred to our department in April–November 2014. We assessed relevant key performance indicators and then implemented changes to our referral system, educated referring departments and formed a multidisciplinary team clinic to manage complex trauma. We then re-evaluated, collecting data on all patients referred March–May 2015. Results Most patients were male and victims of assault. Following intervention, there was a significant reduction in the injury to eye clinic review time (3.45 weeks to 2.22 weeks, p = 0.01) and multidisciplinary team review time (3.86 weeks to 2.71 weeks, p = 0.04). Injury to discharge time was significantly reduced from 6.15 weeks to 3.36 weeks (p = 0.002). Discussion Our study shows that a multidisciplinary team approach and structured pathways can improve assessment and intervention times for orbital trauma patients. This may have a beneficial effect on patient outcomes. In the absence of guidelines in the United Kingdom, we believe similar improvements could be implemented by other national centres and outcomes evaluated to assist future guidance formation.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434519836431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45095553","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}

{"title":"Integrated healthcare models for rheumatoid arthritis: A descriptive systematic review","authors":"V. Vodopivec, H. Vrijhoef","doi":"10.1177/2053434519836425","DOIUrl":"https://doi.org/10.1177/2053434519836425","url":null,"abstract":"Introduction Integrated people-centred care is a modern approach for addressing healthcare issues related to demographic changes, increasing prevalence of chronic diseases, and restricted resources. By providing an overview of integrated care models for patients with rheumatoid arthritis, we aimed to offer insight into the strategies and interventions that are being used for designing and implementing integrated models of care for this patient group, and their outcomes. Methods We conducted a systematic literature search of peer-reviewed literature available in English and published between 2013 and 2018, using three databases: Cochrane, PubMed and EMBASE. We analysed the publications based on the Framework on integrated people-centred health services and the Triple/Quadruple Aim framework. Results We identified 1271 records. After screening, 50 articles met the criteria for inclusion in the review. Approaches for improving patient empowerment, engagement and experience of care were most prevalent in the identified care profiles. Similarly, frequently reported outcomes were related to improvements in patients’ experience of care and their health status. Most of the studies we reviewed did not demonstrate notable improvements from the perspective of cost-effectiveness or benefits for the healthcare workforce. Conclusions Our findings suggest that for rheumatoid arthritis, integrated care is in the early stages of development. Strategies focusing on patient outcomes and patient satisfaction were found to be prioritised. Future initiatives aiming to redesign rheumatology care should adopt systems thinking perspective to better address all of the building blocks of people-centred integrated care.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434519836425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41831680","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}

{"title":"Patient centeredness: The perspectives of uninsured primary care patients in the United States","authors":"A. Kamimura, Shannon Weaver, B. Armenta, Bethany Gull, Jeanie Ashby","doi":"10.1177/2053434519836424","DOIUrl":"https://doi.org/10.1177/2053434519836424","url":null,"abstract":"Introduction Patient-centered care has become increasingly important within the United States (US) healthcare system. Given that patient-centered care predicts patient satisfaction, health outcomes, and cost-effectiveness, it is of the utmost importance to study patient-centered care from the perspectives of marginalized populations including minorities, immigrants, and other underserved populations. The purpose of this study is to examine factors that affect underserved primary care patients’ perceptions of patient centeredness. Methods The data were cross-sectional and collected in Fall 2016. Free clinic patients (N = 723) completed a self-administered survey, which measures patient centeredness, patient involvement in care, and clinical empathy. Validated measures were part of the survey, and the internal consistency of scales was tested. The general linear model was performed to predict factors associated with patients’ perceptions of patient centeredness. Results Higher levels of perceived patient involvement in care and higher levels of perceived empathy in consultation are related to higher levels of patient centeredness. While better physical health is associated with higher levels of perceived empathy in consultation, high levels of emotional health and depression are not. Conclusions Patients’ perceptions of involvement and empathy are important factors for patient-centered care, although this study did not show causal directions among variables. Based on the findings of this study, it is recommended that future studies should focus on the following three points: (1) to develop and evaluate trainings for providers, (2) develop education classes for patients who utilize free clinics, (3) analyze how these programs affect patient-centered care and health outcomes.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434519836424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46729314","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}

{"title":"Competence needs of integrated care in the transition of health care and social services in Finland","authors":"Olli Nummela, Soile Juujärvi, T. Sinervo","doi":"10.1177/2053434519828302","DOIUrl":"https://doi.org/10.1177/2053434519828302","url":null,"abstract":"Introduction This study investigates future integrated care competencies among workforce in health and social service sectors in the context of the national health and social services reform in Finland. Methods The sample was drawn from the registers of competent workforce in the social and health sectors in Finland in three different forerunner areas. Eight working sectors were identified. A total of 1943 participants represented a 16% of the sample (N = 12,250). Factor analyses were conducted on ratings from the COPE scale measuring integrated care competences. Logistic regression analyses were used to examine the associations between background variables and competence factors. Results The present study identifies three factors about the competences of future integrated care competencies. The factors were client-oriented needs assessment, holistic service guidance, and ensuring service path. The sectors of services for older people and administration indicated the highest level of competence needs, whereas the sector of social services indicated the lowest level. Variations between sectors and background variables are remarkable. Discussion The study points out three dimensions of generic competence needs perceived by employees that are required to secure client-oriented integrated care processes in the future. New competencies and targeted processes in organizations and between sectors are crucial in developing the quality and effectiveness of integrated care by improving future care processes. Professional education and training should advance the learning of generic competences shared by all professionals and sectors in accomplishing integrated care.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2019-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434519828302","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42607922","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}

{"title":"ICP Reviewer’s List 2018","authors":"Busetto, Loraine, Dessers, Ezra, Grooten, Liset, Guldemond, Nick, Linden, Ariel, Murray Cramm, Jan, Steinsbekk, Aslak, Wessling","doi":"10.1177/2053434519841148","DOIUrl":"https://doi.org/10.1177/2053434519841148","url":null,"abstract":"","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434519841148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65486838","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}

{"title":"Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach?","authors":"M. Marino, A. D. de Belvis, M. Tanzariello, E. Dotti, S. Bucci, M. Colotto, W. Ricciardi, S. Boccia","doi":"10.1177/2053434518817019","DOIUrl":"https://doi.org/10.1177/2053434518817019","url":null,"abstract":"Introduction The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centeredness of care. We conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods MEDLINE, Scopus and EBSCO were searched. We reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilization outcomes, cost and cost-effectiveness). Results Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilization rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalized on a large scale. Discussion We found out a favourable impact of integrated care models/methods on health outcomes, care utilization and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. Thus, we propose a value-based framework for the evaluation of these services.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434518817019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42685093","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}

{"title":"General practitioners' perspectives on care coordination in primary health care: A qualitative study.","authors":"Ane Drougge Vassbotn,&nbsp;Hege Sjøvik,&nbsp;Trond Tjerbo,&nbsp;Jan Frich,&nbsp;Ivan Spehar","doi":"10.1177/2053434518816792","DOIUrl":"https://doi.org/10.1177/2053434518816792","url":null,"abstract":"<p><strong>Introduction: </strong>To explore Norwegian general practitioners' experiences with care coordination in primary health care.</p><p><strong>Methods: </strong>Qualitative study using data from five focus groups with 32 general practitioners in Norway. We analysed the data using systematic text condensation, a descriptive and explorative method for thematic cross-case analysis of qualitative data.</p><p><strong>Results: </strong>The general practitioners had different notions of care pathways. They expressed a wish and an obligation to be involved in planning and coordination of primary health-care services, but they experienced organisational and financial barriers that limited their involvement and contribution. General practitioners reported lack of information about and few opportunities for involvement in formal coordination initiatives, and they missed informal arenas for dialogue with other primary health-care professionals. They argued that the general practitioner's role as coordinator should be recognised by other parties and that they needed financial compensation for contributions and attendance in meetings with the municipality.</p><p><strong>Discussion: </strong>General practitioners need informal arenas for dialogue with other primary health-care professionals and access to relevant information to promote coordinated care. There might be an untapped potential for improving patient care involving general practitioners more in planning and coordinating services at the system level. Financial compensation of general practitioners contribution may promote increased involvement by general practitioners.</p>","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434518816792","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36812542","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}

{"title":"Implant Files sets our health care systems back at square one","authors":"H. Vrijhoef","doi":"10.1177/2053434518820607","DOIUrl":"https://doi.org/10.1177/2053434518820607","url":null,"abstract":"","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434518820607","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47622101","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}

{"title":"Changes in care coordination and health insurance in the population of US children with muscular dystrophy, 2005-2006 and 2009-2010.","authors":"Jaimie Z Shing,&nbsp;Tiebin Liu,&nbsp;Rodolfo Valdez","doi":"10.1177/2053434518818448","DOIUrl":"https://doi.org/10.1177/2053434518818448","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to assess changes in care coordination and health insurance coverage among US children with muscular dystrophy.</p><p><strong>Methods: </strong>We used 2005-2006 and 2009-2010 data from the National Survey of Children with Special Health Care Needs. We examined the distribution of sociodemographic and health characteristics of children with muscular dystrophy by survey cycle. Multivariable regression was used to calculate odds of not receiving effective care coordination, not having adequate health insurance coverage, receiving no help coordinating care, and having problems obtaining referrals in each survey cycle.</p><p><strong>Results: </strong>In the 2005-2006 and 2009-2010 survey cycles, there were 135 and 117 children with muscular dystrophy (representing 34,672 and 31,169 US children with muscular dystrophy), respectively. The percentage of children with muscular dystrophy who did not receive effective care coordination changed from 59.2% (95% confidence interval (CI), 45.6%-72.7%) in 2005-2006 to 53.4% (95% CI, 38.3%-68.6%) in 2009-2010. The odds of not receiving effective care coordination (adjusted odds ratio (aOR) = 0.77; 95% CI, 0.32-1.89) or having problems obtaining referrals (aOR = 0.52; 95% CI, 0.17-1.59) did not change significantly between the two periods, whereas odds of having inadequate insurance coverage decreased significantly (aOR = 0.41, 95% CI, 0.18-0.93) and odds of not receiving help coordinating care increased significantly (aOR = 4.22, 95% CI, 1.24-14.29) between the two periods.</p><p><strong>Conclusion: </strong>Our results suggest key health care needs for many families with children with muscular dystrophy have remained unmet for a prolonged period. Although there were significant improvements in health insurance coverage, nearly one-third of children with muscular dystrophy still had inadequate health insurance coverage in 2009-2010; it is likely that this situation has not changed much since then.</p>","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434518818448","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37219212","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}

{"title":"Turning teams and pathways into integrated practice units: Appearance characteristics and added value.","authors":"W H van Harten","doi":"10.1177/2053434518816529","DOIUrl":"10.1177/2053434518816529","url":null,"abstract":"<p><p>It has been 12 years after Porter and Teisberg published their landmark manuscript on \"Redefining Health Care.\" Apart from stressing the need for a fundamental change from fee-for-service to value or outcome-based financing and to a focus on reducing waste, they emphasized the need to work along patient pathways and in Integrated Practice Units to overcome function based and specialist group silos and promote working in multidisciplinary patient-oriented teams. Integrated Practice Units are defined as \"organized around the patient and providing the full cycle of care for a medical condition, including patient education, engagement, and follow-up and encompass inpatient, outpatient and rehabilitative care as well as supporting services.\" Although relatively few papers are published with empirical evidence on Integrated Practice Units development, some providers have impressively developed pathways and integrated care toward alignment with Integrated Practice Units criteria. From the field, we learn that possible advantages lay in improving patient centeredness, breaking through professional boundaries, and reducing waste in unnecessary duplications. A firm body of evidence on the added value of turning pathways into Integrated Practice Units is hard to find and this leaves room for much variation. Although intuitively attractive, this development requires staff efforts and costs and therefore cost-effectiveness and budget impact studies are much needed. Randomized controlled trials may be difficult to realize in organizational research, it is long known that turning to alternative designs such as larger case study series and before-after designs can be helpful. Thus, it can become clear what added value is achievable and how to reach that.</p>","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2053434518816529","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36812541","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}