Care Coordination Research Articles

Epilepsy care pathway: The Finnish model

AbstractObjectiveIntegrated care pathways are essential for consistent, effective epilepsy care, offering equal access and quality regardless of socioeconomic status. They must align with the WHO Global Action Plan on Epilepsy, ensuring best practices and cost‐effective management. We describe the Finnish national epilepsy care pathway, which includes multiple levels of care, from initial diagnosis to long‐term care for all types of epilepsy, with a specific focus on rare and complex cases integrated with the European Reference Network (ERN) for Rare and Complex Epilepsies EpiCARE.MethodsIn 2017, the Finnish government nominated Kuopio University Hospital to coordinate diagnostics and care for severe epilepsy in Finland. A national multidisciplinary consensus panel, including specialists from both adult and pediatric neurology departments across all five Finnish university hospitals and from the patient organization, was established. The resulting pathway was adopted into the current Finnish evidence‐based current care guidelines for epilepsy.ResultsThe Finnish epilepsy care pathway focuses on timely referrals, continuity of care and enhanced communication between healthcare providers at different levels of care. Patient involvement is assured with an individualized digital application offering secure online messaging, a seizure calendar, and remote visits. The pathway enhances virtual consultations and includes regular national diagnostic multidisciplinary meetings for severe epilepsies before selected cases are consulted in ERN EpiCARE meetings.SignificanceThis Finnish model for epilepsy care provides a streamlined, multidisciplinary approach to diagnosis and treatment and combines modern digital tools, data sharing, and peer support. This pathway can serve to model how integrated healthcare systems can effectively manage complex conditions.Plain Language SummaryWe describe the Finnish national epilepsy care pathway, which includes multiple levels of care, from initial diagnosis to long‐term care for all types of epilepsy, with a specific focus on rare and complex cases integrated with the European Reference Network (ERN) for Rare and Complex Epilepsies EpiCARE. Finnish model for epilepsy care provides a streamlined, multidisciplinary approach to diagnosis and long‐term treatment of epilepsy. The pathway enhances virtual consultations and includes national and European‐level diagnostic multidisciplinary meetings for severe epilepsies. To improve outcomes, we emphasize the use of modern digital tools, data sharing, and peer support.

Intersectional stigma among Latino MSM and HIV prevention: barriers to HIV prevention and strategies to overcome the barriers

ABSTRACT Latino men, especially Latino men who have sex with men (LMSM), experience disparities in HIV prevention. Lack of attention to key barriers to care, such as stigma, result in inequitable access to HIV prevention and care for LMSM. This paper describes how intersectional stigma and related factors act as barriers to HIV prevention among Latino men and proposes strategies to overcome these barriers. Qualitative data were collected via in-depth interviews (n = 15) with Latino men about HIV prevention services, mobile outreach, peer navigation and care coordination, and analyzed using rapid qualitative methods. Three key themes emerged: (1) HIV stigma as a barrier to HIV testing, (2) sexual minority stigma as a barrier to accessing HIV prevention services and (3) strategies for stigma reduction, such as confidentiality, comprehensive education about HIV and prevention, and empathy and warmth from staff/care providers. Identified stigmas were intersectional. Addressing and reducing stigma is critical to engaging Latino men in HIV prevention and care, and requires strategies sensitive to the Latino cultural context and community.

Family Resilience in Care Coordination Technologies: Designing for Families as Adaptive Systems

When a child is admitted to the hospital with a critical illness, their family must adapt and manage care and stress. CSCW researchers have shown the potential for collaborative technologies to support and augment care collaboration between patients and caregivers. However, as a field CSCW lacks a holistic, theory-driven understanding of how collaborative technologies might best augment and support the family caregiving circle as a socio-technical system. In this paper, we report findings from interviews with 14 parents of children with cancer admitted for extended hospitalizations. We use the resilience-based Family Adaptive Systems framework from family therapy as a lens to characterize their challenges and practices across four key subsystems: Emotion, Control, Meaning, and Maintenance. Then, we introduce a fifth system-the Information system-and draw on our empirical findings to suggest theory-driven opportunities for designing future collaborative technology to augment collaborative caregiving and enhance family resilience.

Priorities to Support Care Partners of People Living With Dementia: Results of a Modified Delphi Process.

Objective: To determine priorities for services and policies that better support care partners of people living with dementia. Methods: A modified Delphi process engaged participants from organizations serving people living with dementia and care partners, focusing on historically and currently underserved communities. Eight thematic areas were identified. Participants (N = 40) responded to three surveys, generating ideas, rating each, and ranking priorities. Results: Each survey received 13-17 responses. Top ranked ideas were arrayed across six thematic areas: care partner supports; programs; funding; information; care coordination; and workforce development. Discussion: The Delphi process empowered participants to share knowledge, and respected their opinions. Anonymity removed power imbalances. The survey iterations blended qualitative and quantitative approaches, and built consensus. The Delphi invited the voices of diverse participants; all voices were weighed equally. This process could be extended to efforts to further engage dementia care partners, helping to value their voices in decision-making for services and policies.

Cost-effectiveness and cost-utility analysis of a nurse-led, transitional care model to improve care coordination for patients with cardiovascular diseases: results from the "Cardiolotse" study.

To assess the 12-month cost-effectiveness of the nurse-led transitional care program "Cardiolotse" (CL) for patients with cardiovascular diseases compared to usual care (UC). A cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) were conducted from the perspective of statutory health insurance (SHI), covering a time horizon of 12 months. Analyzed outcomes included the number of rehospitalizations and health-related quality of life (HRQoL). Total costs comprised program costs and the utilization of healthcare resources. Point estimates are presented as incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs). Sensitivity and subgroup analyses were conducted to illustrate uncertainty and provide insights into the impact mechanisms of the CL program. The study population consisted of 2550 patients, with 1256 allocated to the intervention group and 1294 to the control group. Patients who received support from CLs experienced fewer rehospitalizations and lower inpatient costs from an SHI perspective, compared to the UC group. HRQoL assessments indicated higher utility values for CL patients at the 12-month follow-up. Total program costs amounted to €1454.65 per patient. The CEA and CUA demonstrate that the CL program is dominant compared to UC from the SHI perspective. Our study shows that the CL program not only reduces the number of rehospitalizations and costs but increases HRQoL, resulting in a dominant ICER and ICUR. Further research is necessary to evaluate longer periods of time, different levels of care intensity, and perspectives of different healthcare stakeholders. German Clinical Trial Register DRKS00020424, 2020-06-18, retrospectively registered.

Facilitated Advance Care Planning Interventions: A Narrative Review.

Introduction: Multiple interventions have been designed to employ facilitators to address gaps in Advance Care Planning (ACP). Objective: To collect and review available evidence related to facilitated ACP interventions. Methods/Design: Narrative review using a previously described framework for scoping reviews. We searched PubMed using structured criteria and report synthesized themes detailing the design, target populations, methods, and outcome measurements for interventions in which a facilitator-who may or may not be clinical staff-engaged a patient and/or a patient's caregiver in some part of the ACP process. Results: Of 1492 articles discovered on our search, 28 met the inclusion criteria. Twelve (42.9%) studies utilized a nurse facilitator, two (7.1%) utilized trained social workers, and one (3.6%) embedded multiple facilitators. The remaining 13 (46.4%) utilized facilitators from other various professional and community backgrounds, such as lay navigators, care coordinators, and peer mentors. Twenty-five (89.2%) studies included patients with serious or chronic illness, at the end-of-life, or having a high risk of need for medical care. Four (14.3%) articles focused on marginalized populations. Intervention settings varied notably across studies. Eighteen (64.3%) integrated interventions into existing clinical workflows. Primary outcomes were measured in one of three ways: documentation in the Electronic Health Record (EHR) (25.0%); questionnaires, scales, patient reports, or non-EHR documentation (64.3%); or multiple measures (10.7%). Twenty-three (82.1%) of the studies were determined a success by study authors. Conclusion: We identified a variety of key characteristics that can be modified to target facilitated ACP interventions towards gaps in current applications of ACP.

The state of patient centered care and associated factors at a large referral hospital in Northwestern Uganda: Perceptions of patients

BackgroundA Patient-Centered Care (PCC) approach to health service delivery is considered one of the essential domains of healthcare quality. This has been shown to improve patient satisfaction with health services and patient outcomes, but it has not been fully embraced in many low and middle income countries. PurposeTo evaluate patients’ perceptions of PCC and identify the factors influencing perceived PCC at a large referral hospital in Northwestern Uganda. Materials and MethodsWe conducted a descriptive cross-sectional correlational study. Four hundred and eighty patients or their attendants participated in the study. Data was collected using an interviewer administered questionnaire. Statistical analysis was applied at univariate, bivariate and multivariate levels using Stata V.14 to assess the state of PCC, patient perceptions and factors associated with perceived PCC. ResultsSixty five percent (64.8 %) of the participants perceived they received PCC. Most of the dimensions of PCC were rated high on a 5-point Likert scale, with respect for patient’s values and preferences ranked highest; mean score of 3.9 (SD = 0.9) and coordination of care ranked lowest, mean of 3.5 (SD = 0.9). Being outpatient, single or never in union had a reduced perception score of PCC. Patients who had heard of PCC had a higher perception of PCC. ConclusionPatient-Centered Care was rate optimally at ARRH. All the PCC dimension was rated highly except coordination of care and information, education and communication which could be improved by building the capacity of health workers in effective communication and coordination of health care services.

Results From Complex Abdominal Reconstruction at Non-Academic Institution can Favorably Compare to Major Academic Centers: An Abdominal Core Health Quality Collaborative Database Review.

Many complex abdominal hernias are referred to tertiary academic institutions for evaluation and treatment. The purpose of this study was to compare clinical outcomes from complex abdominal hernia repairs and abdominal wall reconstructions at a community hospital vs high volume academic centers participating in Abdominal Core Health Quality Collaborative (ACHQC). Patients undergoing elective complex abdominal hernia repair were identified in our community setting and treated between 2016 and 2019. These results were then compared to Academic centers in the ACHQC database. Complex hernia definition was limited to those who have undergone any myofascial advancement procedure for homogeneity. Informed consent was obtained, and study was IRB approved. All data was de-identified. A total of 180 patients underwent complex abdominal hernia repair at our community hospital. The ACHQC database identified 6299 patients meeting criteria at participating academic centers. Demographics were similar between the two groups including hernia grade, size and wound class. Academic centers tended to have patients with previous component separations (25.7% vs 10.6%) and immunosuppressed (7.2% vs 2.8%), while the community hospital patients included more patients with tobacco use (18.9% vs 12.1%) and hypertension (65% vs 54.9%). Operative times were significantly less at the community hospital, patients requiring >240 minutes of time for repair at academic centers (39.6% vs 5%). Postoperatively length of stay was significantly shorter at the community hospital group averaging 3.7days vs academic centers of 6days (P < .05). Although overall complications were less in the community hospital group (26.5% vs 19.4%). Readmission within 30days was nearly twice as frequent in the community hospital group (14.4% vs 7.7%). Community hospitals can provide comparable care and surgical expertise as major academic centers in regard to complex hernias in a large majority of cases. There is a need for dedicated care coordination and continuous review of supporting staff and outcomes is necessary to assure quality care. There is still a need to identify which patients would benefit from treatment at an academic center as opposed to a community hospital in order to maximize patient access and outcomes at both types of hospital setting. Further investigation needs to be performed regarding criteria for which patients should be transferred to academic centers for their complex hernia care. Identifying patients who would benefit from treatment at Academic Centers as opposed to Community hospitals should continue to be investigated.

Process Mining on National Health Care Data for the Discovery of Patient Journeys of Older Adults

ObjectiveUnderstanding the longitudinal patterns of health care utilization among older adults is crucial for designing effective patient journeys and enhancing care coordination across settings. This study aims to uncover the most common patient journeys of older adults. DesignThis explorative study used process mining techniques to analyze national health care data from 2017 to 2019, focusing on patient care journeys of older adults (aged ≥65 years) in the Netherlands. Setting and ParticipantsData were sourced from Statistics Netherlands, encompassing all residents aged ≥65 years as of January 1, 2017. Health care usage declarations from various care settings during 2017-2019 were included. Patient journeys were exclusively selected if their initiation points were certain. MethodsData underwent rigorous preprocessing, merging, and filtering to create a single event log file suitable for process mining. Patients were categorized by age and medication use, and differences in patient journeys were analyzed. Process mining techniques generated visualizations illustrating the connections between care forms and the impact of changes in one form on others. ResultsThe study included 3,177,203 individuals aged 65 years and older, with 44% experiencing 1 or more patient journeys totaling 2,469,663 journeys in 2017-2019. Most care journeys for older adults were simple and short. The top 10 most frequent journeys had 4 or fewer care forms, with 95% of journeys for the 65+ population and 90% for the 85+ population having 4 or fewer care transitions. Long-term care forms, such as home care, personal care, and long-term care, accounted for the majority of time spent in the system. Conclusions and ImplicationsThis pioneering study used process mining to show that most older adults tend to have a straightforward health care need, often involving the emergency department and hospitalizations. However, a smaller group among the population requires more complex and prolonged care, especially in the 85+ population. Reducing the number of transitions for this population, although impacting fewer people, might result in a larger effect on the overall system.

Telehealth innovations for cardiovascular disease management

Telehealth innovations and wearable technologies are revolutionizing the management of cardiovascular diseases (CVD), providing patients with more accessible and continuous care. The integration of remote monitoring tools and mobile health applications allows for real-time tracking of vital signs, such as heart rate, blood pressure, and oxygen levels, enabling early detection of abnormalities and timely medical interventions. These technologies empower patients to actively participate in their own health management, encouraging adherence to prescribed lifestyle changes, such as increased physical activity and improved dietary habits, which are essential for preventing and controlling CVD. Wearable devices, such as smartwatches and fitness trackers, play a critical role in the continuous monitoring of cardiovascular health. Combined with telehealth platforms, they offer personalized insights and facilitate communication between patients and healthcare providers, enhancing care coordination. This leads to improved patient outcomes, particularly in managing chronic conditions like hypertension and heart failure, where early intervention is key to preventing complications. Additionally, telehealth solutions reduce the need for frequent in-person visits, cutting healthcare costs and making care more convenient and accessible for patients in remote or underserved areas. As telehealth and wearable technologies continue to advance, they hold the potential to further transform cardiovascular care, contributing to more efficient healthcare delivery and better management of cardiovascular risk factors.

A Qualitative Study of Patient and Interprofessional Healthcare Team Member Experiences of Bedside Interdisciplinary Rounds at a VA: Language, Teamwork, and Trust.

Patient and interprofessional healthcare team member experiences of bedside interdisciplinary rounds (BIDR) are generally positive. Overall, there is large heterogeneity in existingBIDR frameworks, and best practices have not been defined. Understand patients' and interprofessional healthcare team members' experiences of BIDR. Academic VA Medical Center (VAMC) with daily structured BIDR. Inpatients, nurses, pharmacists, and care coordinators who participated in BIDR. We conducted semi-structured qualitative interviews with study participants about their experiences with BIDR between January and June 2020. All interviews were recorded and professionally transcribed. We used thematic analysis to identify key themes. We interviewed 14 inpatients and 18 interprofessional healthcare team members, including nurses, pharmacists, and care coordinators. Patients participating in BIDR reported positive perceptions of being included in the discussion of their healthcare plans and increased trust in providers; patient discomfort resulted from physician use of technical language and frombeing presented with unclear, vague careplans. Interdisciplinary healthcare team members participating in BIDR reported an increased understanding, respect, and trust for other team members and improved patient care; challenges were posed by lack of supportive structural elements to interprofessional workflow and prolonged physician presentations. BIDR can build trust between patients andhealthcare providers and within the interprofessional team by creating a setting where teamwork interactions can be observed. Based on our findings, we recommend trust-building practices for BIDR, which include sharing BIDR goals with patients, using patient-centered language, creating structures for interprofessional inclusion, defining team roles, using standardized communication, and addressing interprofessional inputs in real time.

Digital health and quality of care in Primary Health Care: an evaluation model

IntroductionThe implementation of technologies in Primary Health Care with monitoring and evaluation of the quality of health care is fundamental to direct the access and quality of health care in the context of the Sustainable Development Goals. Our objective was to develop a model for evaluating digital health interventions in primary care, considering its impact on first contact, longitudinality, integrality and coordination in health.MethodologyThis is an exploratory methodological study of a qualitative nature. This study seeks to explore strategic actors’ perceptions of an evaluation model, and was developed in a process between June 2021 and March 2024. The following stages were followed: Identification of previous models available in the literature, model development, model validation, model update. We performed a nominal group consensus technique online with seven experts. Stages taken to define the design of the model: sending the elaborated model, together with an electronic form with 18 subjective questions, such as brainstorming strategy, for recording impressions, judgment of agreement and suggestions; workshop for discussion by videoconference, at the time the objectives and the model diagram were presented, followed by debate with clarification of doubts and suggestions for clarification of the step-by-step design. After incorporating the suggestions, the model agreed upon in the workshop was subjected to another analysis by the same experts, sent in an online Google document, in which possible inconsistencies between the proposed model and the agreed one were verified, as well as the final agreement on the recommended proposal. At the end of this stage, with synchronous and asynchronous remote procedures, consensus was reached.ResultsThe proposed evaluation model presents as primary categories, structure, process and result. The structure encompasses four indicators, namely, employees; financial resources; infrastructure resources; and regulatory and strategic resources. The process is organized into three dimensions, namely: technical dimension, organizational dimension and relational dimension. The results will be evaluated in products; intermediate results; and impacts (short, medium and long term). The results will be measured by the seven pillars of quality: efficacy, effectiveness, efficiency, optimization, acceptability, legitimacy, equity.ConclusionThis study achieved the goal of developing a model to evaluate digital health interventions in Primary Health Care, helping to identify adequate and useful evaluation methods filling the gap of the lack of quality evaluation standards in the brazilian Digital Health Strategy. It presents an important difference in relation to models from different countries, as it considers the impacts on Primary Health Care quality attributes such as first contact care, longitudinality, integrality and coordination of care. The model will be used by managers and health professionals of Primary Health Care in a case study in Brazil to evaluate the quality of health care. It is expected that the proposed model may be used in other evaluation studies and countries through contextual adaptations.

Provision of Digital Primary Health Care Services: Overview of Reviews.

Digital health is a growing field, and many digital interventions have been implemented on a large scale since the COVID-19 pandemic, mainly in primary health care (PHC). The development of digital health interventions and their application in PHC are encouraged by the World Health Organization. The increased number of published scientific papers on this topic has resulted in an overwhelming amount of information, but there is no overview of reviews to summarize this evidence. This study aims to provide policy makers, health managers, and researchers with a summary of evidence on digital interventions used in PHC. This overview of reviews searched the Web of Science and MEDLINE databases for systematic and scoping reviews on assessments of digital technologies implemented in PHC published from January 2007 to March 2023. Only reviews that addressed digital interventions whose targets were real patients or health care providers (HCPs) were included. A total of 236 records were identified from the search strategy, of which 42 (17.8%) full-text papers were selected for analysis, and 18 (7.6%) reviews met the eligibility criteria. In total, 61% (11/18) of the reviews focused their analysis on specific digital health interventions (client-to-provider telemedicine, provider-to-provider telemedicine, health worker decision support systems, systems for tracking patients' health status, client participation and self-care platforms, and provision of education and training to health workers), and 39% (7/18) of the reviews focused on specific topics related to PHC (preventive care, chronic disease management, behavioral health disorders, the COVID-19 pandemic, multicomponent PHC interventions, and care coordination). Most studies in the included reviews agreed on barriers to implementation, such as software and apps developed without involving end users, the lack of training of HCPs and patients in digital technology use, and the lack of reimbursement and billing strategies for remote consultations. However, they showed several mixed results related to health service quality and patients' clinical conditions and behavior changes. Research in digital health applied to PHC is still concentrated in high-income countries, mainly in North America and Europe. The mixed results related to health service quality and patients' clinical conditions or behavior changes may have been caused by deficiencies in the process of implementing digital interventions. It is necessary to examine the entire impact pathway and the causal relationship among implementation, health service quality, and clinical condition outcomes to support the spread of digital health in PHC settings.

Insurance and Structural Access Quality and Effects on AAA Mortality: A National Healthcare Quality and Disparities Report Analysis.

The National Health care Quality and Disparities Report (NHDQR) presents trends for measures related to access to care, affordable care, care coordination, effective treatment, healthy living, patient safety, and person-centered care. This study aims to determine the significance of insurance quality and access to care on AAA repair outcomes. Data was obtained through the Agency for Health care Research and Quality database from 2016-2020. AAA repair mortality rates per 1000 persons, insurance quality, and structural access were compared between the 31 reportable U.S. states in which data was analyzed using linear regression models and ANOVA. Insurance quality and structural access groups were categorized as weak, average, and strong, based on NHDQR Reports measures. No association was found between access to care and AAA mortality at specific time points (2016 and 2020; P-value = .90 and .29 respectively) and when comparing states that showed improvement from 2016 to 2020 (weak categorization to strong; P value = .27). An association was found between private insurance quality and AAA repair mortality at baseline (2016; P-value = .022) and in those that showed improvement or worsening in private insurance quality over the study period (P-value = .042). Our findings suggest that there is no association between structural access quality and AAA mortality although an association exists between AAA mortality and private insurance quality.

EHealth profile and care coordination of primary care physicians

Abstract Background Digital health or eHealth is a vast field encompassing mobile health (mHealth), health information technology, wearable devices, telehealth, and telemedicine, and is changing the practice of medicine. While it holds promise for enhancing care coordination, its adoption is hindered by various barriers, including at the healthcare professional level. We assessed the eHealth profile of primary care physicians and its relationship with care coordination. Methods As part of the Commonwealth Fund 2022 IHP survey of primary care physicians, 1114 physicians in Switzerland completed a questionnaire on their digital health use, and care coordination practices. Based on their responses, we built a digital health score, summarizing physicians’ use of digital health tools, and a care coordination score. Associations between both scores were assessed using stratified analyses and multiple linear regression. Results Among 1114 participants (46% women, mean age 52), 83% used electronic patient records, 96% used teleconsultations for less than 5% of consultations, and 63% never used connected health tools for the monitoring of patients with chronic diseases. A total of 16% allowed for online appointments, 20% for online medical prescriptions, 52% for communicating electronically lists of medications with other healthcare professionals, and 89% the possibility of e-mail or web communications with the patient. The eHealth score was positively associated with the number of weekly working hours, being an internal medicine specialist or practicing physician, the number of full-time equivalents in the practice, and with being in a group practice setting. The higher the eHealth profile score, the higher was the care coordination score. Conclusions Physicians’ use of digital health tools was positively associated with care coordination. This could underscore the potential benefits of digital health in enhancing collaborative and interprofessional care practices. Key messages • In a large survey of primary care physicians, the use of digital health tools and care coordination were correlated. • Digital health could enhance collaborative and interprofessional care practices.

Review of national rare disease strategies: innovation driving change

Abstract Background A rare disease affects fewer than 5 in 10,000 people. More than 6,000 known rare diseases affect up to 6% of the European population. A national rare disease strategy sets out a country’s plan to reduce disease burden and improve quality of care for people with rare diseases. This review, requested by the Department of Health in Ireland to inform a new national strategy, described national rare disease strategies in 13 selected countries. Methods Strategies published from 2013 to 2023 were identified via online searches for Austria, Australia, Denmark, England, Finland, France, Germany, Ireland, the Netherlands, Northern Ireland, Portugal, Scotland and Wales. National representatives were contacted to confirm the identified resources. Data were extracted for the domains of: aims, priorities, implementation, governance and funding models. Descriptive analysis and narrative synthesis was undertaken. Results Improving treatment and coordination of care was a common overall aim. Priorities noted in all strategies were: screening and diagnosis; access to healthcare and coordination of services; rare disease research; and patient representation and empowerment. Implementation details varied to reflect the national context and time of strategy development. More recently-developed strategies included more precise actions and greater emphasis on innovations in genomics than older strategies. Strategies were developed, implemented, monitored and evaluated via combinations of newly-established bodies and or existing health authorities. Six countries did not specify a funding model or dedicated budget for strategy implementation. Conclusions National rare disease strategy contents and implementation approaches varied between countries and reflected innovations over time. This review will inform the development of Ireland’s new national rare disease strategy. Key messages • This review provided insights into national rare disease strategies over a 10-year period. • The findings will inform strategy development in Ireland, and are relevant to other countries.

10.X.2. Strengthening primary health care through best practice transfer: the CIRCE-JA approach

Abstract Primary health care (PHC) is a fundamental component of resilient, strong, and sustainable health systems. The main aim of PHC is to address people’s health in a high-quality comprehensive system approach, ensuring person-centred and integrated care across their lifespan, which includes their physical, mental and social well-being. Following the COVID-19 pandemic, health systems’ strengthening has become a global public health and European public health priority, and an overarching objective of the EU4Health programme. In Feb 2023, the three-year Joint Action on the transfer of best praCtices In pRimary CarE (CIRCE-JA) was launched. Its overall objective is to effectively transfer and implement six identified PHC best practices (BPs) across EU Member States (MS), with scientifically robust evidence-based approach, to ensure sound transferability methodology. Critically, it aims to increase MS capacity to deploy innovative care models in PHC and to effectively support health system transformation at this level of care. CIRCE-JA is a collaborative effort with 14 MS participating, bringing together 48 entities, to initially transfer the identified BPs into 42 new implementation sites, whilst at the same time generate all the necessary tools to facilitate uptake and evidence-informed decision-making across all MS. This implementation is based on the alignment of key BP characteristics to meet the local healthcare needs and priorities and match them with national and regional policies. It aims to facilitate integration of public health priorities to PHC practice, and to support the reorganization of services, for strong health promotion focus, synergies with community care, and better coordination of care. During this session key aspects will be discussed using the Pecha Kucha style, to inform the audience about current progress and CIRCE-JA using short stories, also on EU policies and priorities, and the EU4Health support for PHC and public health integration. What is urgently needed at EU-level when it comes to health systems’ strengthening in the post-COVID-19 period and why is PHC critical in this respect? How can the CIRCE-JA developments inform the ongoing transfer and future efforts for the selected BPs in terms of a robust scientifically evidence-based approach? How does the policy dialogue CIRCE-JA is establishing locally, nationally, regionally, supports not only the JA’s sustainability, but all future implementation efforts for PHC? Finally, a brief interaction with the audience will take a place to allow attendees to discuss on key priorities and challenges in their own settings and practice, including the barriers and difficulties that they have initially identifies in the implementation efforts. The output of this interaction will also inform the initial steps towards the establishment of the final deliverable of CIRCE-JA, i.e., the European Primary Healthcare Observatory, to sit on the European Commission’s Health Policy Platform. Key messages • Health systems’ strengthening necessitates strong PHC. CIRCE-JA delivers state-of-the-art tools and brokers policy dialogue to achieve it across Europe. • Several barriers and issues that facilitate the transferring process have been identified in the first implementation of this European initiative. Speakers/Panelists Christos Lionis CSFM &amp; HSR-PH Lab, Faculty of Medicine, University of Crete, Heraklion, Greece Ana M Carriazo Regional Ministry of Health and Families of Andalusia, Seville, Spain Alice Borghini National Agency for Regional Health Services AGENAS, Rome, Italy Radivoje Pribakovic NIJZ, Ljubljana, Slovenia

Healthcare in police custody: a conceptual framework for measuring and improving quality of care

Abstract Background Individuals in police custody are often in poor (mental) health and can be in need of medical attention. The delivery of primary healthcare in police custody differs from other custodial and non-custodial settings, due to its short-term character and the reliance on custody officers and healthcare professionals to access care. Therefore, medical care for detainees in police custody requires its own standards and indicators to measure the quality of care. We aimed to develop a conceptual framework for (actionable) indicators to measure the quality of care for people detained in short-term police custody settings in the Netherlands. Methods We conducted a scoping review and consulted with experts. The scoping review involved Embase, Medline, PsycINFO, CINAHL, Criminal Justice Abstracts, PiCarta and Cochrane, and was supplemented with grey literature searches. We consulted twenty-seven stakeholders with a wide variety of expertise in the field of healthcare in police custody to discuss and validate the conceptual framework. Results The conceptual framework consists of 14 domains of structures (e.g. staff and facilities), processes (e.g. triage and coordination of care) and outcomes (e.g. effectiveness and satisfaction) that need to be considered when developing quality indicators for the healthcare provision in police custody. The scoping review yielded 68 publications providing information on common health issues and recommendations related to quality assurance or improvement. Conclusions The conceptual framework will guide the development of (actionable) quality indicators, which will be evaluated on relevance and measurability. These are crucial for monitoring care quality and enhancing a learning health systems approach. This study fills a gap in the existing scientific literature by shedding light on the factors contributing to the quality of primary healthcare provision for people detained in short-term custody settings. Key messages • The conceptual framework guides the development of (actionable) quality indicators for healthcare in police custody. • This study contributes to the creation of a learning health system for healthcare in short-term police custody settings.

Exploring methodologies and frameworks for best practice transfer at the primary care level

Abstract Background In Feb 2023, the EU’s Joint Action on the transfer of best praCtices In pRimary CarE (CIRCE-JA) was launched with the objective of effectively transferring and implementing six best practices (BPs) among Member States (MS). Transferability from one primary care (PC) setting to another can be challenging given organizational, legal, cultural, social, economic, and environmental factors, requiring robust a methodological framework to guide the transfer process. A scoping review was conducted to identify conceptual models and methodological frameworks for context-relevant and evidence-informed BP transfer in PC settings. Methods The study aimed to identify models or frameworks to guide BP transfer in PC settings, whilst maximizing transferability. The JBI methodology was used, and an extensive search was conducted in PubMed (time limit: Jan ‘13-May ‘23). All publications of original research, systematic reviews, and text and opinion papers in English were eligible for inclusion. Key exclusion criteria were set, i.e., intervention type, level of care and reporting quality. The search was supplemented by gray literature review. Results From a total of 369 publications, 9 met eligibility criteria, reporting on 10 conceptual and methodological models/framework largely varying. These included transfer models applicable to all BPs as well as elements specific to some BPs, i.e., addressing integration, patient-centered care, care coordination, and health promotion. Strengths and weaknesses were identified for all. Conclusions Transferability of health interventions is complex, requiring systematic consideration of setting and intervention characteristics to inform and support local adaptation, implementation, and decision-making. Key elements identified can support the CIRCE-JA BP transfer and are largely relevant for further BP transfer across PC settings in EU MS, incl. for local adaptation, stakeholder engagement and effective implementation monitoring. Key messages • Innovative BPs are successfully deployed in many EU MS. To best support transformation for strong EU primary care and resilient health systems, it is important to ensure evidence-informed BP transfer. • This review reports on the selection of appropriate frameworks and models, and key elements thereof, to allow successful transfer of CIRCE-JA BPs and other BP transfer across PC settings in Europe.

The state of primary health care systems in ten high-income countries

Abstract Primary care systems in high-income countries perform comparatively better than the U.S. system in large part due to decades of investment, an adequate workforce supply, and universal healthcare. This research identifies successes and areas of improvement of 10 high-performing primary care systems in four areas of care: 1) access, 2) continuity, 3) comprehensiveness, 4) and coordination. Cross-national comparisons using primary data from the 2022 CMWF International Health Policy Survey of Primary Care Physicians (N ranged from 321-2,092) and the 2023 CMWF International Health Policy Survey on the General Population (N ranged from 750-4,820). Countries included: Australia, Canada, France, Germany, Netherlands, New Zealand, Sweden, Switzerland, the U.K., and the U.S. • More than 90% of adults in all surveyed countries reported having a regular primary care doctor except Sweden, the U.S., and Canada. • Less than 5% of physicians reported high telehealth use in their patient encounters, except for in the U.K. and New Zealand where over 10% reported high use. • Over a quarter of physicians in the U.S., Germany, and France report screening patients for social needs, compared to just 8% in the Netherlands. • Care coordination with social services was a major challenge in all surveyed countries, with over 75% of physicians in the U.K., Australia, and France reporting major challenges. Primary care systems in 10 other high-income countries outperform the U.S. system, particularly when it comes to access to care and care continuity. Policy options to consider for U.S. policymakers include narrowing the wage gap between generalist and specialist physicians and rewarding and holding providers accountable for continuity of care. On the other hand, countries like Sweden and the Netherlands can learn from the U.S. on how to adequately coordinate care between primary care physicians, specialists, and hospitals. Key messages • Investment in primary care yields better health outcomes, greater equity and lower costs. • Many high-income countries in Europe have high performing primary care systems, something the U.S. system can learn from.