Continuity Of Care Model Research Articles

Medical oncologist's commitment in end-of-life care of cancer patients

Cancer patients and family members can feel abandoned by their oncologist at the transition to end-of-life (eoL) care. In this study, we evaluated the level of satisfaction of family caregivers when the oncology team assisted the patient until death. Two oncology units were reorganized to ensure continuity of care; oncologists trained in palliative care medicine assisted patients until death. Relatives who assisted the patient at home or at an inpatient hospice underwent a semi-structured phone interview >1 month after the patient's death. Satisfaction was measured using a five-point Likert scale ranging from very dissatisfied (score 0) to very satisfied (score 100). Relatives of 65 patients were contacted, 55 accepted the interview. Patients were followed at home (41) or at an inpatient hospice (14), for 1-24 weeks (median 3 weeks). A specific question on the relevance of the oncologist having a role in EoL care produced a score of 82. The overall satisfaction score was higher than in our previous study in which a continuity of care model was not adopted, with a score improvement from 55/100 to 84/100 (p < 0.001). A care program where the oncologist is involved in EoL management improved the satisfaction of caregivers of cancer patients. When a longstanding and trusting relationship has been established, the connection between the patient and the oncologist should not be lost.

Medical oncologist’s commitment in the end of life (EoL) care of cancer patients: The caregiver's perspective.

9098 Background: Optimizing the impact of EoL care on cancer patients (pts) and their caregivers should be a primary goal of an oncology unit. In this study we evaluated satisfaction of family caregivers when the medical oncology team assisted pts until death. Methods: Two oncology units were reorganized to ensure continuity of care; oncologists trained in palliative care medicine assisted pts until EoL. The model assumes that the medical oncologist (MO) is the physician in charge throughout the entire disease trajectory. Relatives of pts assisted at home or at an inpatient hospice underwent a semistructured phone interview conducted by a psychologist or a social worker &gt; 1 month after pts' death. Satisfaction was evaluated for symptoms control, communication, psychological support, overall quality of care and continuity of therapeutic relationship with the MO. A final open-ended question was included for any additional comment. Satisfaction was measured using a five-point Likert scale ranging from very dissatisfied to very satisfied and converted to a 0-to-100 scale. Results: Relatives of 65 pts were contacted, 55 accepted the interview (27 spouses, 22 sons, 5 in-laws, 1 parent); 50/55 were the leader caregiver. Patients were followed at home (41) or at an inpatient hospice (14), for 1-24 wks. Satisfaction mean scores were: symptoms control 76/100, communication 85, psychological support 82 and overall quality of care 87; a specific question on the relevance of the MO in EoL care produced a score of 87, with no negative or neutral responses recorded for this item. Of note, a common perception among caregivers was the appreciation of the MO's commitment during EoL in addition to the technical quality of the intervention. The overall satisfaction score was higher than in our previous study in which a continuity of care model was not formally adopted, with a score improvement from 55 to 87/100. Conclusions: A care pathway where the MO is involved in EoL management of cancer pts improved satisfaction of caregivers.When a longstanding and trusting relationship has been established, the pts-MO connection should not be lost to prevent feelings of abandonment.

Bridging gaps in handoffs: A continuity of care based approach

Handoff among healthcare providers has been recognized as a major source of medical errors. Most prior research has often focused on the communication aspects of handoff, with limited emphasis on the overall handoff process, especially from a clinician workflow perspective. Such a workflow perspective that is based on the continuity of care model provides a framework required to identify and support an interconnected trajectory of care events affecting handoff communication. To this end, we propose a new methodology, referred to as the clinician-centered approach that allows us to investigate and represent the entire clinician workflow prior to, during and, after handoff communication. This representation of clinician activities supports a comprehensive analysis of the interdependencies in the handoff process across the care continuum, as opposed to a single discrete, information sharing activity. The clinician-centered approach is supported by multifaceted methods for data collection such as observations, shadowing of clinicians, audio recording of handoff communication, semi-structured interviews and artifact identification and collection. The analysis followed a two-stage mixed inductive–deductive method. The iterative development of clinician-centered approach was realized using a multi-faceted study conducted in the Medical Intensive Care Unit (MICU) of an academic hospital. Using the clinician-centered approach, we (a) identify the nature, inherent characteristics and the interdependencies between three phases of the handoff process and (b) develop a descriptive framework of handoff communication in critical care that captures the non-linear, recursive and interactive nature of collaboration and decision-making. The results reported in this paper serve as a “proof of concept” of our approach, emphasizing the importance of capturing a coordinated and uninterrupted succession of clinician information management and transfer activities in relation to patient care events.

Midwives' group supervision and the influence of their continuity of care model - a pilot study

Midwives' different leadership and supervisory styles influence women's experiences of childbirth in various ways. The aim of this study was to evaluate midwives' experiences of group supervision and the influence of the continuity of care model, with particular focus on childbearing women's need for emotional support. An additional aim was to evaluate the development of the midwives' professional competence. Qualitative thematic analysis was used to analyse the notes made during the supervision sessions and focus group discussion. The significance of the midwives' continuity of care model was: assessment of the women's individual needs, enabling strategies to create a deeper relationship and acknowledging the vulnerability in the relationship with the women. The outcome of the midwives' group supervision was increased professional competence. Three themes emerged: Integrating science into midwifery practice, Awareness of one's professional role and Sensitivity in one's professional role. These findings provide a clear indication that the women's need for emotional support can be fulfilled by the midwives' leadership. The development of the midwife's role as a leader in maternity care is closely related to the opportunities for the provision of supervision aimed at increasing her professional competence.

Psychiatric Hospitalists and Continuity of Care: A Comparison of Two Models

The Michael E. DeBakey Veterans Affairs (VA) Medical Center inpatient psychiatry program underwent a series of substantial changes that led to a shift from a continuity of care (COC) model to a hospitalist environment in 2007. Although similar changes in other fields of medicine (general medicine, pediatrics, surgery, cardiology, and neurology) have been associated with several care benefits, no studies to date have evaluated the potential effects of such a change in models in psychiatry. The shift at the Michael E. DeBakey VA Medical Center thus provided a unique opportunity to compare these two models of care and gather evidence about which model may be more beneficial to patients. Data were derived retrospectively from two separate periods of time, one representative of the COC model (July-December 2006) and one representative of the hospitalist model (July-December 2008). The total number of discharges increased significantly from the first to the second period. Although the average length of stay remained similar, the number of readmissions occurring within 30 days of discharge was much lower during the hospitalist period. In addition, patients discharged in the hospitalist period were more likely to attend their outpatient mental health appointments. Findings suggest a preference for the hospitalist model over a COC model.

THE CARING DILEMMA IN MIDWIFERY

The caring dilemma, first described by Reverby in 1987, denotes the tension caused by being obliged to provide care without the right to determine how that care is to be provided. Such a dilemma is salient in the practice of midwifery based on a continuity of care model that has recently emerged or been implemented in various jurisdictions. Briefly, this model involves the provision of care by a single midwife or pair of midwives to a woman throughout her pregnancy, birth and post-natal period. Continuity of care necessitates that midwives be on call for significant lengths of time to ensure attendance at the woman's birth. It is the on-call nature of this form of midwifery work that most significantly poses a caring dilemma for midwives. In this paper, we trace both the structural and experiential aspects of the caring dilemma through an examination of midwifery in the Canadian province of Ontario. Our analysis reveals that despite being a salient feature of midwifery practice, some work structures can be created to mediate the caring dilemma experienced by midwives. Le dilemme de la prise en charge, que Reverby a évoqué la première fois en 1987, dénote la tension que cause le fait d’être tenu d'offrir une prise en charge sans avoir le droit d’établir de quelle manière l'offrir. L'exemple des sages-femmes, dont la pratique repose sur un type de soin continu qui est récemment apparu ou qu'on vient de mettre sur pied dans diverses administrations, illustre très clairement ce dilemme. Pour résumer, ce modèle veut qu'une femme enceinte soit prise en charge pendant sa grossesse, à son accouchement et durant sa période postnatale par une ou deux sages-femmes. La continuité de la prise en charge oblige les sages-femmes à être sur appel durant des périodes prolongées pour que la femme qui accouche bénéficie de leur présence. Pour les sages-femmes, c'est la nature même de leur travail effectué sur appel qui engendre, de façon cruciale, le dilemme de la prise en charge. Dans cet article, nous abordons les aspects structurels et expérimentaux que représente le dilemme de la prise en charge par le biais d'une étude sur la pratique du métier de sage-femme dans la province canadienne de l'Ontario. Notre analyse révèle que, si le dilemme de la prise en charge est inhérent à la profession de sage-femme, il n'empêche que des structures professionnelles peuvent être mises en place pour en atténuer les aspects négatifs.

Continuity of Care

Recent changes in health care mandate innovative approaches to teaching. Rehabilitation as part of the continuum of disability motivated the "continuity of care model." This model permits the presentation of rehabilitation in its global sense: from onset of injury through re-integration into the community. This report describes a curriculum for physical medicine and rehabilitation residents that comprises a three-phase approach to rehabilitation: acute care, inpatient rehabilitation and community re-entry. The curriculum is adaptable for medical students. A secondary benefit of the project for the resident is a better understanding of relevant cost benefit/cost effective concepts in the delivery of quality services. The close interaction of residents with community agencies permits these agencies to gain a better understanding of the medical needs of disabled people.