Components Of Care Coordination Research Articles

How external and agency characteristics are related to coordination in homecare – findings of the national multicenter, cross-sectional SPOTnat study

BackgroundHomecare client services are often distributed across several interdependent healthcare providers, making proper care coordination essential. However, as studies exploring care coordination in the homecare setting are scarce, serious knowledge gaps exist regarding how various factors influence coordination in this care sector. To fill such gaps, this study’s central aim was to explore how external factors (i.e., financial and regulatory mechanisms) and homecare agency characteristics (i.e., work environment, workforce, and client characteristics) are related to care coordination in homecare.MethodsThis analysis was part of a national multicentre, cross-sectional study in the Swiss homecare setting that included a stratified random sample of 88 Swiss homecare agencies. Data were collected between January and September 2021 through agency and employee questionnaires. Using our newly developed care coordination framework, COORA, we modelled our variables to assess the relevant components of care coordination on the structural, process, and outcome levels. We conducted both descriptive and multilevel regression analyses—with the latter adjusting for dependencies within agencies—to explore which key factors are associated with coordination.ResultsThe final sample size consisted of 1450 employees of 71 homecare agencies. We found that one explicit coordination mechanism (“communication and information exchange” (beta = 0.10, p <.001)) and four implicit coordination mechanisms—“knowledge of the health system” (beta = -0.07, p <.01), “role clarity” (beta = 0.07, p <.001), “mutual respect and trust” (beta = 0.07, p <.001), and “accountability, predictability, common perspective” (beta = 0.19, p <.001)—were significantly positively associated with employee-perceived coordination. We also found that the effects of agency characteristics and external factors were mediated through coordination processes.ConclusionImplicit coordination mechanisms, which enable and enhance team communication, require closer examination. While developing strategies to strengthen implicit mechanisms, the involvement of the entire care team is vital to create structures (i.e., explicit mechanisms) that enable communication and information exchange. Appropriate coordination processes seem to mitigate the association between staffing and coordination. This suggests that they support coordination even when workload and overtime are higher.

Abstract 12558: Sodium-Glucose Cotransporter-2 Inhibitor Quality Improvement Initiative for Guideline-Directed Medical Therapy in Heart Failure (SQUAD-HF)

Introduction: Despite efforts encouraging SGLT2i prescriptions at discharge for decompensated heart failure (HF), recent data suggest only 1 in 5 patients receive them with a median odds ratio of 2.5 across hospitals. One of the reasons for under prescription of SGLT2i is cost. Aim: We implemented a comprehensive quality improvement initiative, focusing on education and care coordination, at 2 hospitals, to reduce financial barriers to initiation of SGLT2i prior to discharge. Methods: Interventions were implemented between October 2022 and January 2023. The education component of the intervention included providing residents, fellows, and faculty information regarding the latest HF guidelines, drug profile, and insurance coverage of SGLT2i through multiple modalities like grand rounds, posters, memes, and a dedicated website with links to published research. The care-coordination component of the intervention included similar presentations to pharmacists, social workers, and care coordinators. Best practices including cost checking of SGLT2i earlier during inpatient stay were encouraged throughout the study period. Primary outcome was a change in physician-reported financial barriers to prescription of SGLT2i assessed by a 10-item survey before and after the interventions. Results: Pre- and post-intervention surveys were completed by 82 and 56 healthcare providers; 52% were residents, 8% cardiology fellows, 16% internal medicine attendings, 14% cardiology attendings, and 8% cardiology nurse practitioners respectively. Physicians reported an 18.7% reduction in access and affordability barriers to prescribing SGLT2i for patients admitted with HF, from 86.6% to 67.9% (Table 1). Conclusion: Through a comprehensive education initiative and improving care coordination tailored to the health systems, SQUAD-HF reduced physician-reported access and affordability barriers to SGLT2i prescription prior to discharge for patients admitted with HF.

Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why?

Introduction:Healthy Homes and Neighbourhoods (HHAN), an integrated care programme in the Sydney Local Health District (SLHD), seeks to address the needs of disadvantaged families through care coordination, as one of its components. This research aims to determine for whom, when and why the care coordination component of HHAN works, and establish the reported outcomes for clients, service-providers and partner organisations.Methods:Critical realist methodology was utilised to undertake a qualitative evaluation of the impact of care coordination. Purposive sampling was used to select a total of 37 participants for interview, including consumers, service-providers and key stakeholders. Thematic analysis was undertaken to derive the major modes of intervention of HHAN, and data representing these elements was coded and summarised under contexts, mechanisms and outcomes.Results:Analysis indicates that care coordination has a positive impact on clients’ sense of independence, self-awareness and outlook on life. Trust and favourable interpersonal relations were identified as major underlying mechanisms for a successful client-provider working relationship. The identified modes of intervention facilitating positive consumer outcomes included accessibility, flexibility and service navigation. Persistent siloes in health and systemic resistance to collaboration was seen to hinder effective care delivery.Conclusions:This study suggests that a care coordination model may be effective in engaging disadvantaged families in healthcare, assist them in navigating the health system and can lead to beneficial health and social outcomes. Successful implementation of care coordination requires flexible programme design and experienced and skilful clinicians to fulfil the care coordinator role. There is a need to appreciate the negative impact that the complex and siloed health system can have on disadvantaged families.

Development and psychometric evaluation of a questionnaire to measure cancer patients\u2019 perception of care coordination

BackgroundAlthough the importance of care coordination (CC) is well-recognized, cancer patients often receive poorly coordinated care across varied care settings and different oncology providers. Efforts to improve cancer care are hampered by lack of adequate measures. In this two-part, mixed-method study, we describe the development, refinement, and validation of a new care coordination instrument (CCI) designed to assess cancer patients’ perception of CC.MethodsIn Study 1, an initial CCI was developed incorporating questions based on literature review. The items were then modified following four field tests conducted in a large academic hospital with oncology nurses (n = 20) and cancer patients (n = 120). This modified instrument was used to determine whether the CCI was able to distinguish CC between two practices (30 GI and 30 myeloma patients) within the same hospital setting. In Study 2, 68 patients receiving community-based care participated in seven focus groups. Based on these discussions, the CCI items were again refined, and psychometric evaluation was conducted to assess the quality of the instrument.ResultsBased on field tests, 3 domains of the CCI, Communication, Navigation, and Operational, were defined as critical components of CC. The Operational domain evaluates efficiency of care and is unique to this CCI. The field test demonstrated that GI patients reported significantly better CC Overall and for the Communication and Navigation domains (all p < .05). In Study 2, patients expressed concordance with the CCI items and their CC experiences, establishing validity of the CCI. Qualitative analysis of the focus group discussions indicated that the items with the highest frequencies of participants’ comments were related to the concepts of Navigator, Team, Survey, and Communication. Quantitative analysis identified items with a limited response range or high rates of “neutral” responses; accordingly, those items were removed. The final CCI survey is a 29 item, multiple-choice questionnaire with excellent reliability, Cronbach’s α = .922.ConclusionsWe developed a novel, patient-centered tool with excellent psychometric properties that can be utilized across varied practice settings to assess patients’ perception of cancer care coordination.Trial registrationNot required; retrospectively registered ClinicalTrials.gov NCT03594006 20 July 2018.

Development of an evidence-based reference framework for care coordination interventions in France

Abstract Background Today, the high variability of practices, the lack of common definitions and underlying concepts increases the existing difficulty to standardise, to replicate, to transpose and to assess the coordinated care. This heterogeneity makes very difficult the evaluation of performance of care coordination. The aim of the first phase of Epock study is to develop a theoretical framework for care coordination interventions in the French health system that can be used for description, implementation and evaluation of care coordination intervention in any clinical situation. Methods A review of systematic reviews on care coordination interventions was conducted to identify relevant models and constitutive elements of the expected reference framework for care coordination intervention. These elements resulting from the literature review have been grouped by themes, prioritised and selected by a structured consensus method (Nominal Group Technique). Results Four dimensions of care coordination were identified: (a) Underlying conceptual models; (b) Care organization, care and facilitation activities; (c) Actors and tools; and (d) Effects classified according to WHO’s quality of care dimensions. Among these dimensions, 4 to 28 elements have been selected to build the reference components of care coordination in France. Conclusions This first reference framework for care coordination interventions in France will be used during the Epock project phase 2 as a basis for comparing practices observed in oncology. This framework could be used as of now for: practice by helping to develop job descriptions and training programmes for future care coordination professionals; piloting to measure care coordination (by developing indicators for care coordination); and research, to evaluate the impact of care coordination interventions. Key messages Epock is a challenging French national research project for the development of an evidence-based reference framework for cancer care coordination interventions considered as a complex intervention. Epock will provide key elements for cancer care coordination intervention effective implementations and for designing further medico-economic evaluation of cancer care coordination intervention impact.

Asthma care coordination in schools by school nurses: An integrative literature review.

The purpose of this integrative literature review is to document and synthesize the available evidence on school nurse asthma care coordination challenges and explain the components of asthma care coordination/case management at schools. The Whittemore and Knafl guidelines were followed for this integrative literature review. Twelve diverse primary sources-one qualitative study, eight quantitative studies, and three mixed-method studies-were used for the review. Data were analyzed using the matrix method. A total of 12 papers met the inclusion criteria. The initial group categorization was based on variables, patterns, and conceptual classification. Results were divided into two categorizations of asthma care coordination program components and asthma care coordination challenges at schools; subthemes were identified under the categorizations. The results showed that care coordination was key for students with chronic diseases including asthma. Asthma care coordination has many challenges, but school nurses can drive effective asthma care by including the essential components of care coordination. Successful asthma care coordination may prevent health care fragmentation, emergency room visits, hospitalization, and school absenteeism, and can increase asthma knowledge and the quality of life for students and parents.

Mental health and parenting stress in mothers of children with diabetes treated in a patient-centred medical home.

Mothers of children with diabetes are at-risk for experiencing parenting stress and diminished mental/emotional health. To the best of our knowledge, no studies to date have examined whether there are differences in these outcomes between mothers whose diabetic child is managed in a patient-centred medical home or not. The objective of the present study was to assess whether there were differences in mental health and parenting stress among mothers whose diabetic child was managed in a patient-centred medical home or not. Two hundred fifty-three mothers of children with diabetes (mean age = 12.50 years; SD = 3.90) from the 2011-2012 National Survey of Children's Health were included in this study. Hierarchical multiple regression was conducted to determine the amount of variance that having a patient-centred medical home contributed to maternal emotional/mental health and parenting stress. After controlling for child sex, age, race/ethnicity and family poverty level, patient-centred medical home status was associated with better mental health for mothers and less parenting stress. Effective care coordination was the only subcomponent of the patient-centred medical home that significantly contributed to the variance in mother's mental/emotional health and parenting stress. Receiving care in a patient-centred medical home, particularly the care coordination component, may mitigate some of the negative maternal effects of managing a child's diabetes.

Survivorship care models for breast cancer, colorectal cancer, and adolescent and young adult (AYA) cancer survivors: a systematic review.

Well-elucidated survivorship care models are pertinent in the long-term management of cancer survivors. This review aims to update existing literature and evaluate the key components of such models with a focus on breast, colorectal, and adolescent and young adult (AYA) cancer survivors. The PubMed electronic database were searched comprehensively for relevant publications in English through February 2017. Additional manual searches were conducted for reference lists and official guidelines published by oncology societies. Included studies addressed the correct cancer type, elaborated on each model's structure and provided patient-related outcome data to support its model's effectiveness if applicable. Among the 25 included studies, six articles described survivorship models applicable to all cancer types, and the remaining focused on breast cancer (n = 10), colorectal cancer (n = 3), and AYA cancer survivors (n = 6). Shared-care model was largely described for all cancer types whereas multidisciplinary model predominated for AYA cancer survivors. Upon evaluation, these models described the essential components of survivorship care fairly well except for the care coordination component. Also, the definition of time points of care was vague and noncomprehensive. The reviewed survivorship model studies were comprehensive but were limited by a lack of existing rigorous evaluation efforts to assess their effectiveness. This review further provided valuable recommendations for future methodological evaluation of such models. This review has highlighted care coordination as an area for improvement and emphasized the importance of obtaining data on the effectiveness of these survivorship models to ensure satisfactory quality of life and health outcomes.

Validation of New Care Coordination Quality Measures for Children with Medical Complexity

ObjectivesTo validate new caregiver-reported quality measures assessing care coordination services for children with medical complexity (CMC). MethodsA cross-sectional analysis of the associations between 20 newly developed Family Experiences with Coordination of Care (FECC) quality measures and 3 validation measures among 1209 caregivers who responded to a telephone or mailed survey from August to November 2013 in Minnesota and Washington. Validation measures included an access composite, a provider rating item, and a care coordination outcome measure, all derived from Consumer Assessments of Healthcare Providers and Systems (CAHPS) survey items. Multivariate regression was used to examine associations between the 3 validation measures and each of the 20 FECC quality measures. ResultsNineteen of the 20 FECC quality measures were significantly and positively associated with ≥1 of the validation measures. The components of care coordination demonstrating the strongest positive association with provider ratings included: 1) having a care coordinator who was knowledgeable and supportive and advocated for the child's needs (β = 26.4; 95% confidence interval [CI], 20.0–32.8, scaled to reflect change associated with a 0-100 change in the FECC measure score); and 2) receiving a written visit summary that was useful and easy to understand (β = 22.0; 95% CI, 17.1–27.0). ConclusionsNineteen newly developed FECC quality measures demonstrated convergent validity with previously validated CAHPS measures. These new measures are valid for assessing the quality of care coordination services provided to CMC and may be useful for evaluating new models of care focused on improving these services.

Care Coordination Strategies in Reforming Health Care: A Concept Analysis.

With the growing number of individuals with chronic conditions and the associated healthcare costs, there is a need to improve how health care is delivered from an individual provider standpoint as well as a systemwide perspective. Such delivery can be accomplished through improved care coordination. Care coordination is a complex term that encompasses the full array of healthcare delivery activities across all systems of care. This includes organizing the care, improving quality of health care delivered, and achieving cost savings. In working to achieve this goal, the nurse is well suited to provide oversight in this process in assuring that the components of care coordination are conducted efficiently and effectively. While the nurse is the optimal provider for this position, the nurse's defined role in this process is not always clear. This article focuses on the term care coordination, which includes the definitions of care coordination, impact on nursing, attributes, antecedents, consequences, and empirical referents for this term. Care coordination is also differentiated from case management to add clarity to the role.

A needs assessment of health information technology for improving care coordination in three leading patient-centered medical homes.

We investigated ways that patient-centered medical homes (PCMHs) are currently using health information technology (IT) for care coordination and what types of health IT are needed to improve care coordination. A multi-disciplinary team of researchers conducted semi-structured telephone interviews with 28 participants from 3 PCMHs in the United States. Participants included administrators and clinicians from PCMHs, electronic health record (EHR) and health information exchange (HIE) representatives, and policy makers. Participants identified multiple barriers to care coordination using current health IT tools. We identified five areas in which health IT can improve care coordination in PCMHs: 1) monitoring patient populations, 2) notifying clinicians and other staff when specific patients move across care settings, 3) collaborating around patients, 4) reporting activities, and 5) interoperability. To accomplish these tasks, many participants described using homegrown care coordination systems separate from EHRs. The participants in this study have resources, experience, and expertise with using health IT for care coordination, yet they still identified multiple areas for improvement. We hypothesize that focusing health IT development in the five areas we identified can enable more effective care coordination. Key findings from this work are that homegrown systems apart from EHRs are currently used to support care coordination and, also, that reporting tools are key components of care coordination. New health IT that enables monitoring, notifying, collaborating, reporting, and interoperability would enhance care coordination within PCMHs beyond what current health IT enables.

Using Clinical Microsystems to Implement Care Coordination in Primary Care

Objective: Care coordination is a core competency for primary care nurses and an essential element of the Patient Centered Medical Home (PCMH) model. Implementing care coordination in primary care is challenging and requires changes in roles, staffing, and culture. Clinical Microsystems are frontline teams of healthcare staff that, when engaged in quality improvement, can make important contributions towards practice redesign. We used a Microsystem team to develop an effective model to integrate nurse care coordinators into a busy primary care center. Methods: A Clinical Microsystem team, supported by an improvement coach, met weekly for one year to develop and test a new nurse staffing model in a large Federally Qualified Health Center. Intervention uptake and impact on workflow was tracked by direct observation of nurses and by measuring volume of nursing visits and virtual contacts. Nurses in a non-participating site with similar characteristics served as a comparison group. Results: The Microsystem team developed and implemented a new nurse care coordination model for their site. The intervention emphasized patient self-management, independent nursing visits, and hospital and emergency room transition support. The nurse care coordinator in this new role managed 335 patients over a nine-month study period. The nurse in this new role spent 276 minutes over two days of observation engaged in direct care coordination work while two nurses at the comparison site spent only 94 minutes and 149 minutes, respectively, over the same time period. Conclusion: Engaging front line staff is an effective way for organizations to make changes in delivery systems, improve quality and spread innovations. In this study, a Microsystem team developed a model to provide key components of care coordination to support PCMH practice redesign at a large community health center.

Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination.

BackgroundCare pathways are widely used in hospitals for a structured and detailed planning of the care process. There is a growing interest in extending care pathways into primary care to improve quality of care by increasing care coordination. Evidence is sparse about the relationship between care pathways and care coordination.The multi-level framework explores care coordination across organizations and states that (inter)organizational mechanisms have an effect on the relationships between healthcare professionals, resulting in quality and efficiency of care.The aim of this study was to assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary - hospital care continuum.MethodsThis study is an in-depth analysis of five existing local community projects located in four different regions in Flanders (Belgium) to determine whether the available empirical evidence supported or refuted the theoretical expectations from the multi-level framework. Data were gathered using mixed methods, including structured face-to-face interviews, participant observations, documentation and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results.ResultsThe development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, led to the use of existing and newly constructed structures, data monitoring and the development of information tools. The construction and use of these inter-organizational mechanisms had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other’s roles, expectations and competences and building qualitative relationships.ConclusionCare pathways across the primary-hospital care continuum enhance the components of care coordination.

Medical Home and Out-of-Pocket Medical Costs for Children With Special Health Care Needs

We examined key factors that affect out-of-pocket medical expenditures per $1000 of household income for children with special health care needs (CSHCN) with a broad range of conditions, controlling for insurance type and concentrating on the potentially moderating role of the medical home. A Heckman selection model was used to estimate whether the medical home influenced out-of-pocket medical costs per $1000 of household income for children covered by either private or public health insurance. Data from the 2005-2006 National Survey of CSHCN (N = 31,808) were used. For families that incurred out-of-pocket medical costs for their CSHCN, these costs represented 2.2% to 3.9% of income. Both insurance type and the medical home had significant effects on out-of-pocket costs. Lower out-of-pocket medical costs per $1000 of income were incurred by children with public insurance and those receiving care coordination services. Families with CSHCN incur lower out-of-pocket medical costs when their children receive health care in a setting in which the care-coordination component of the medical home is in place.

Community Dementia Care Management

Community Dementia Care Management

Decategorizing health services: interim findings from the Robert Wood Johnson Foundation's Child Health Initiative.

Although results from the evaluation are preliminary thus far, certain tentative conclusions can be reached. First, both care coordination on a small scale and the production of community health report cards are achievable within the relatively short life of a foundation grant. Moreover, both efforts can result in tangible improvements for children and their families. Report cards associated with the initiative have made children's issues more prominent and appear to have led many community leaders to focus greater attention on children's needs. Likewise, many of the care coordination systems developed under the initiative have produced real change for children and their families by guiding them to needed health care and other services. It is important, however, to keep these accomplishments in perspective. While of significant benefit to demonstration communities, the monitoring and care coordination components of this initiative are not unique. A large number of communities have adopted monitoring and reporting programs in recent years. Similarly, care coordination efforts are well established in many communities. What is unique about the RWJF initiative is its attempt at decategorization, and much less progress has been demonstrated for this component. The less-than-hoped-for progress in implementing decategorization at the original sites appears to be the product of a number of interrelated factors. These include an absence of existing models and appropriate technical assistance; political difficulties in gaining cooperation from multiple local agencies involved in service provision; limited progress in establishing needed connections with the state and federal agencies that have authority over categorical programs; and difficulties in implementing major programatic changes when the health care system itself is undergoing rapid change. In combination, these barriers have proven to be largely insurmountable for the originally funded sites, although it is too early in the project to determine which of these factors is predominantly responsible for the lack of success. Whether the newer sites can learn from the experience of the first group and adapt strategies to overcome the multiple hurdles involved remains to be seen. Decategorization is a tool that has the potential to rationalize a fragmented service system by facilitating the coordination of services, especially for children and families with multiple needs. The need for decategorization of funds will not disappear, even if the federal government chooses to combine more of its grant programs to the states into block grants.(ABSTRACT TRUNCATED AT 400 WORDS)