Health Care Coordination Research Articles

Determining the factors influencing the selection of post-acute care models by patients and their families: a qualitative content analysis

BackgroundThis study conducted in-depth interviews to explore the factors that influence the choice of a post-acute care (PAC) model (inpatient rehabilitation hospital, skilled nursing facility, home health, and outpatient rehabilitation) among stroke patients and their families.MethodsWe conducted semi-structured, in-depth interviews of 21 stroke patients and their families at four hospitals in Taiwan. Content analysis was used in this qualitative study.ResultsResults revealed five main factors that influence respondents’ choice of PAC: (1) medical professionals’ suggestions, (2) health care accessibility, (3) continuity and coordination of care, (4) willingness and prior experience of patients and their relatives and friends, and (5) economic factors.ConclusionsThis study identifies five main factors that affect the choice of PAC models among stroke patients and their families. We suggest that policymakers establish comprehensive health care resources based on the needs of patients and families. Health care providers shall provide professional recommendations and adequate information to support decision-making, which aligns with the preferences and values of patients and their families. From this research, we hope to improve the accessibility of PAC services in order to enhance the quality of care for stroke patients.

Addressing Health Care Transition Competencies in Nurse Practitioner Education

Coordinating health care transition across care settings is a national core competency for nurse practitioner education. Caring for children and youth with special health care needs requires a collaborative approach to transition from a child-centered to an adult-focused care model. Adding this content is challenging, given the gaps in the health care transition literature and inconsistent faculty expertise. This report describes one university’s innovative quality improvement project aimed at developing competency in health care transition for children and youth with special health care needs among nurse practitioner students. The design, implementation, and evaluation of teaching strategies that resulted in significant knowledge gain for students are reported.

Realigning theory with evidence to understand the role of care coordination in mental health services research.

Current theoretical models intended to guide health services research and evaluation lack care coordination-its features and impacts. These aspects are critical for understanding the role of care coordination in healthcare use, quality, and outcomes. In this Focus article, we briefly review the well-known Andersen individual behavioral model (IBM) of healthcare use and the Donabedian health system and quality model (HSQM) together with recent practice-based evidence. We propose a new integrated theoretical model of healthcare and care coordination. The model can serve as a guide for future research to better understand the variation in care coordination services and delivery and its added value to improving mental health in different real-world settings.

Nursing Care Coordination in Primary Healthcare for Patients with Complex Needs: A Comparative Case Study.

Despite nurses' substantial role in care coordination, few education programs exist to better support them in this role. Identification of a set of core care coordination activities across heterogeneous care coordination programs would facilitate the development of a standard of practice. We sought to examine care coordination activities across two care coordination programs in Family Medicine Groups in Quebec, and their relationship to the program design. We performed a comparative case study of two care coordination programs in primary care targeting frequent users of healthcare services and people with Alzheimer's disease and related disorders. Data collection included documents and semi-structured interviews with key informants. Several activities were common to both programs, such as patient identification; assessment, development of an individualized service plan; and linking patients and caregivers with professionals and services. However, their components were different due to the impact of the integrated care program design, policy environment, and the target patient populations' complex needs. The homogeneity or heterogeneity of patients' complex needs shapes their care trajectory and the intensity of their care coordination needs. As the complexity of these needs grows, so does the necessity to build the care coordinators' capacity for integrated care.

Voice-Based Screening for SARS-CoV-2 Exposure in Cardiovascular Clinics (VOICE-COVID-19-II): Protocol for a Randomized Controlled Trial.

The COVID-19 pandemic has disrupted the health care system, limiting health care resources such as the availability of health care professionals, patient monitoring, contact tracing, and continuous surveillance. As a result of this significant burden, digital tools have become an important asset in increasing the efficiency of patient care delivery. Digital tools can help support health care institutions by tracking transmission of the virus, aiding in the screening process, and providing telemedicine support. However, digital health tools face challenges associated with barriers to accessibility, efficiency, and privacy-related ethical issues. This paper describes the study design of an open-label, noninterventional, crossover, randomized controlled trial aimed at assessing whether interactive voice response systems can screen for SARS-CoV-2 in patients as accurately as standard screening done by people. The study aims to assess the concordance and interrater reliability of symptom screening done by Amazon Alexa compared to manual screening done by research coordinators. The perceived level of comfort of patients when interacting with voice response systems and their personal experience will also be evaluated. A total of 52 patients visiting the heart failure clinic at the Royal Victoria Hospital of the McGill University Health Center, in Montreal, Quebec, will be recruited. Patients will be randomly assigned to first be screened for symptoms of SARS-CoV-2 either digitally, by Amazon Alexa, or manually, by the research coordinator. Participants will subsequently be crossed over and screened either digitally or manually. The clinical setup includes an Amazon Echo Show, a tablet, and an uninterrupted power supply mounted on a mobile cart. The primary end point will be the interrater reliability on the accuracy of randomized screening data performed by Amazon Alexa versus research coordinators. The secondary end point will be the perceived level of comfort and app engagement of patients as assessed using 5-point Likert scales and binary mode responses. Data collection started in May 2021 and is expected to be completed in fall 2022. Data analysis is expected to be completed in early 2023. The use of voice-based assistants could improve the provision of health services and reduce the burden on health care personnel. Demonstrating a high interrater reliability between Amazon Alexa and health care coordinators may serve future digital tools to streamline the screening and delivery of care in the context of other conditions and clinical settings. The COVID-19 pandemic occurs during the first digital era using digital tools such as Amazon Alexa for disease screening, and it represents an opportunity to implement such technology in health care institutions in the long term. ClinicalTrials.gov NCT04508972; https://clinicaltrials.gov/ct2/show/NCT04508972. DERR1-10.2196/41209.

How Effective are Current Joint Working Practices between Children and Family Social Workers and Mental Health Care Coordinators, in Supporting Families in which there is a Primary Care-giver, with a Diagnosis of Emotionally Unstable Personality Disorder?

Abstract Emotionally Unstable Personality Disorder (EUPD) is a complex and often stigmatising diagnosis. Although falling under the remit of mental health services, it is not always seen as a mental health need, and research suggests that if parents or carers are not provided with more holistic support, parental mental health will deteriorate with children likely to have poorer outcomes, placing them at an increased risk of harm. This likelihood of harm increases with compounding factors such as substance misuse and domestic abuse. One organisation alone cannot effectively address the complex difficulties that people with this diagnosis may experience, thus inter-agency working is necessary. This article explores the barriers and facilitators to inter-agency working to support parental care-givers with a diagnosis of EUPD between Children’s Social Care and a Community Mental Health Team within the same English area. Five mental health care coordinators and two children and families’ social workers who had experience working with this client group were interviewed. Participants identified the challenges and benefits of working with their partner agency around communication, knowledge, stigmatisation and resources. The research provides suggestions to develop current inter-agency working relationships and to enhance care and support available to people experiencing the diagnosis.

How does people-centered integrated care in medical alliance in China promote the continuity of healthcare for internal migrants: The moderating role of respect.

Continuity is crucial to the health care of the internal migrant population and urgently needs improvements in China. Chinese government is committed to promoting healthcare continuity by improving the people-centered integrated care (PCIC) model in medical alliances. However, little is known about the driving mechanisms for continuity. We created the questionnaire for this study by processes of a literature research, telephone interviews, two rounds of Delphi consultation. Based on the combination of quota sampling and judgment sampling, we collected 765 valid questionnaires from developed region and developing region in Zhejiang Province. Structural equation models were used to examined whether the attributes of PCIC (namely coordination, comprehensiveness, and accessibility of health care) associated with continuity, and explored the moderated mediating role of respect. The result of SEM indicated that coordination had direct effect on continuity, and also had mediating effect on continuity via comprehensiveness and accessibility. The hierarchical linear regression analysis showed that the interactive items of coordination and respect had a positive effect on the comprehensiveness (β = 0.132), indicating that respect has positive moderating effect on the relationship between coordination and comprehensiveness. The simple slope test indicated that in the developed region, coordination had a significant effect on comprehensiveness for both high respect group(β = 0.678) and low respect group (β = 0.508). The moderated mediation index was statistically significant in developed areas(β = 0.091), indicating that respect had moderated mediating effect on the relationship between coordination and continuity via comprehensiveness of healthcare in the developed region; however, the moderated mediation effect was not significant in the developing region. Such regional differences of the continuity promoting mechanism deserve the attention of policy-makers. Governments and health authorities should encourage continuity of healthcare for migrants through improving the elements of PCIC-coordination, comprehensiveness and accessibility of healthcare, shaping medical professionalism of indiscriminate respect, and empowering migrants to have more autonomy over selection of services and decisions about their health.

Neurological disorders in pregnant women in low- and middle-income countries-Management gaps, impacts, and future prospects: A review perspective.

Neurological disorders during pregnancy are a substantial threat to women's health, particularly in low- and middle-income countries. Furthermore, a critical shortage of mental health workers and neurologists exacerbates the already pressing issue, where a lack of coordination of respective healthcare among multidisciplinary teams involved in managing these conditions perpetuates the current state of affairs. Financial restrictions and societal stigmas associated with neurological disorders in pregnancy amplify the situation. Addressing these difficulties would necessitate a multifaceted approach comprising investments in healthcare infrastructure, healthcare professional education and training, increased government support for research, and the implementation of innovative care models. Improving access to specialized treatment and coordinated management of antenatal neurological diseases will precipitate improved health outcomes for women and their families in low- and middle-income countries.

A scoping review of veteran suicide prevention programs in Native American communities and in the general population.

Suicide is a major public health problem that disproportionately impacts veterans in the general U.S. population. Recent analyses indicate that American Indian and Alaska Native (AI/AN) veterans may be two to three times as likely as non-Hispanic White veterans to experience suicidal ideation. Although suicide prevention programs have been successfully implemented for many at-risk populations, to our knowledge, none have been designed or implemented for AI/AN veterans. To address this gap, we conducted a scoping review of suicide prevention programs with the objective of identifying promising strategies and lessons learned to identify promising practices for preventing suicide among AI/AN veterans. We conducted two parallel literature searches-a review of suicide prevention programs for the general U.S. adult population and AI/AN communities. We rated programs on 16 criteria, covering five domains-best practices in suicide prevention, U.S. Department of Veterans Affairs (VA) Office of Rural Health Promising Practice criteria, cultural fit, care coordination, and outcomes. Our findings indicate that many of the VA evidence-based or best practice programs are available system-wide, but none have been tailored for AI/AN veterans or the communities in which they live. Conversely, we found that many culturally specific programs implemented in AI/AN communities were rarely disseminated beyond tribal land and none were specifically developed for veterans. Based upon these findings, and to advance suicide prevention programs for AI/AN veterans, we propose a suicide prevention model that builds upon existing VA infrastructure to disseminate best practices to AI/AN communities and integrate tribal-specific cultural approaches to suicide prevention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

End of life at home: all you need to know

Many patients in Switzerland wish to die at home. Nevertheless, end-of-life home care requests specific considerations such as basic palliative care knowledge among health care professionals and a well-organized and coordinated health care network which needs to be put in place as early as possible. Beforehand, an open discussion with the patient and the caregiver about their expectations and wishes is mandatory. Furthermore, anticipation about the evolution of the disease, potential symptoms, material requests, psychological and social barriers is the key element to provide home palliative care until the end of life. Most "cantons from the Romandie" have a large offer in health care services allowing for home end-of-life care.

Peer support and whole health coaching to address the healthcare needs of homeless veterans: a pilot study

BackgroundHomelessness is a robust social determinant of acute care service utilization among veterans. Although intensive outpatient programs have been developed for homeless veterans who are high utilizers of acute care (“super utilizers”), few scalable programs have been implemented to address their needs.ObjectiveDescribe the development and pilot testing of a novel intervention that integrates the roles of a peer and whole health coach (“Peer-WHC”) in coordination with primary care teams to reduce homeless veterans’ frequent use of acute care.DesignSingle-arm trial in three outpatient primary care clinics at a Veterans Health Administration (VHA) medical center; pre/post design using mixed-methods.ParticipantsTwenty veterans from VHA’s homeless registry who were super-utilizers of acute care and enrolled in primary care.InterventionWeekly health coaching sessions with a peer over 12 weeks, including discussions of patients’ health care utilization patterns and coordination with primary care.Main measuresRates of session attendance and intervention fidelity, patient-reported satisfaction and changes in patient engagement and perceptions of health, pre/post utilization of acute and supportive care services, and qualitative interviews with multiple stakeholders to identify barriers and facilitators to implementation.Key resultsOn average, patients attended 6.35 sessions (SD = 3.5, Median = 7). Satisfaction scores (M = 28.75 out of 32; SD = 2.79) exceeded a priori benchmarks. Patients’ perceptions of health improved from pre to post [t(df)=-2.26(14), p = 0.04]. In the 3-months pre/post, 45% (n = 9) and 15% (n = 3) of patients, respectively, were hospitalized. Qualitative feedback from patients, providers, and peers and fidelity metrics suggested value in increasing the length of the intervention to facilitate goal-setting with patients and coordination with primary care.ConclusionFindings support the feasibility, acceptability, and utility of Peer-WHC to address the healthcare needs of homeless veterans. A future trial is warranted to test the impact of Peer-WHC on reducing these patients’ frequent use of acute care.

Health Insurance Coverage for Farmworkers in California After the Introduction of the Affordable Care Act: A Mixed-methods Study.

Previous studies have found that health insurance coverage expanded for farmworkers from 2011-2012 to 2015-2016 due in part to the introduction of the Patient Protection and Affordable Care Act (ACA). This study examines the continued impact of the ACA on insurance coverage for farmworkers to 2018 and identifies barriers to further expansion. A mixed-methods approach was utilized. Weighted statistical analyses were conducted on the National Agriculture Worker Survey (NAWS) data for 2011-2012, 2015-2016, and 2017-2018. Qualitative interviews conducted with agricultural employers, health care providers, and community-based organizations examined the impact of the ACA on health insurance coverage for farmworkers. Though health insurance coverage for farmworkers in California increased after the introduction of the ACA (from 37.3% in 2011-2012 to 56.5%% in 2015-2016), coverage rates grew only modestly between 2015-2016 and 2017-2018 (64.8%). Coverage rates were higher for documented (43.0% in 2011-2012 and 77.7% in 2017-2018) than for undocumented workers (26% in 2011-2012 and 46.8% in 2017-2018). The results from the qualitative interviews suggested that barriers to increased coverage include the high cost of insurance for growers, high deductibles and copays for farmworkers, and distrust of government agencies. While the period after the ACA was associated with notable improvements in health insurance coverage for farmworkers in California, important barriers remain for farmworkers seeking to obtain insurance and for growers seeking to provide coverage. States should consider funding a farmworker-specific Medicaid program to provide health insurance coverage and care coordination across counties and states.

Perceptions towards integrated care through the narrative of practicing social workers and psychologists in PHC: a cross-case analysis

PurposeIn a collective effort to build a patient-centered and coordinated health care system, social workers and psychologists are being progressively introduced to primary health care (PHC) settings worldwide. The present study aims to explore the current status of integration through the narrative of social workers and psychologists in PHC settings in Kazakhstan.Design/methodology/approachIn this paper purposive snowball sampling was utilized to recruit social workers and psychologists who work, or used to work, in PHC settings since the onset of integration in Nur-Sultan for participation in an in-depth interview. A semistructured interview guide was based on normalization process theory (NPT). Interviews were conducted via video conference, in Russian language, lasted no more than 50 min, and transcribed verbatim. Cross-case analysis of eight cases was performed using NPT constructs.FindingsCross-case analysis included findings from the interviews from five social workers and three psychologists. Four major constructs of implementation process from NPT were reflected in the findings: coherence (believes integration improves patient care, functions within integrated care), cognitive participation (individual changes to role performance, mechanisms of work), collective action (status of support from stakeholders, cooperation within a multidisciplinary team) and reflective monitoring (existing mechanisms for monitoring the integration).Research limitations/implicationsDespite organizational integration, there is a lack of successful clinical integration of social workers and psychologists in PHC settings of Kazakhstan, which is manifested by a lack of understanding of responsibilities and functions of these mental health care specialists. Consensus was reached by all participants that both social workers and psychologists are valuable assets in a multidisciplinary team.Originality/valueThe present study contributes to the current knowledge of integrated PHC service delivery by addressing the status of integrated care in Kazakhstan from interviews with key stakeholders in social work and mental health. Moving forward, improvements are needed to (1) establish the monitoring mechanism to evaluate the status of integration, (2) enhance effective collaboration within multidisciplinary teams in PHC settings and (3) increase awareness among medical workers and community members on mental health issues and the available support offered by social workers and psychologists to promote quality of life in a holistic, integrated manner.

The Burden of Next-of-Kin Carers of Dementia Sufferers in the Home Environment.

The role and responsibilities of next-of-kin carers are significant, filling several years of their lives and causing them to experience a burden of care. This study was conducted to investigate the burden of next-of-kin carers for dementia sufferers in Slovakia. Data were compiled via the Relatives' Stress Scale (RSS) screening instrument through a survey of 112 primary next-of-kin carers and analysed using the statistical tests of descriptive statistics, means, scores and significance differences (Wilcoxon test). This is one of the few scales which provides: (a) specific measures of caregiver stress, and (b) is standardised for a population of informal carers in the home environment. The profiles of Slovak next-of-kin carers were identified with statistically significant characteristics (gender, age of carers). The study identified a high level of caregiving stress (82.15%), and selected factors were found to be significant in all burden dimensions: emotional stress (p = 0.001), social stress (p = 0.003), and negative feelings (p = 0.002). The results emphasise the need for coordination of healthcare and social services, possibly by expanding the network of social support groups, operating a counselling hotline/chat, and introducing national educational programmes for the next-of-kin carers of dementia sufferers. The results are also a source of reference for the umbrella organisation 'the Slovak Alzheimer's Society' to access when implementing changes at a national level.

Age Friendly Care: What do Community Aging Services Professionals Need to Know?

ABSTRACT There is an increasing need for community-based health education to help older adults understand and manage their complex medical needs. Community Aging Services Professionals (CASPs) are non-medical service providers who facilitate aging in place by providing health education, socialization, and care coordination for older adults in community settings. Through in-depth interviews with 13 CASPs, this study assessed CASPs’ knowledge of older adults’ medical issues and health education needs. Our goal was to assess CASPs’ knowledge of older adults’ medical issues and health education needs and determine overlap with the Age Friendly Health System 4 Ms framework. CASPs described promoting older adults’ health by providing medical referrals, education, and advice. The interviews revealed that CASPs feel underprepared to provide requested medical support for older adults, and that both CASPs and older adults desire more clinical education to help identify and manage older adults’ medical conditions. This study established CASPs as ideal providers to receive and disseminate clinical health education for older adults aging in the community. The results also showed the 4 Ms model of age friendly care is well-received as a framework for health education in community settings.

Unmet Medical Needs and Food Insecurity in Children with Neurodevelopmental Disorders: Findings from the 2019 National Health Interview Survey (NHIS).

In the United States, 17% of children ages 3-17 have a developmental disorder. The complexity of care for such children require families to provide a significant amount of health care at home, representing a substantial economic cost. Our study identifies sociodemographic characteristics of children with neurodevelopmental disorders (NDD) that are predictive of unmet medical needs and food insecurity. We modeled the outcomes using a multivariable generalized linear model and a robust Cox proportional hazard model. Among children with NDD, 7.4% reported a delay in obtaining care, 3.6% avoided getting care and 17.3% live in a household that experienced food insecurity. Lack of health insurance and lack of usual source of care increased the risk for cost-related delay in medical care and cost-related avoidance of medical care. Children with NDD whose parents have less than a college degree and those from households with income <$75,000 had increased risk for food insecurity in the past 30 days. Our results underscore the need to implement additional screening to identify children with NDD who are at greater risk for unmet medical and social needs by health care providers and care coordination organizations.

Development of technologies to support the diagnosis of infectious diseases and cancer to support the primary health care

PurposePrimary Health Care (PHC) is the coordinator of health care in Brazil and needs to be strengthened in the diagnostic field to increase health care quality. Aiming to improve the diagnostic tools currently available in PHC, this work describes the process of development and validation of two point-of-care biomedical devices for screening patients with syphilis or different kinds of cancer.MethodsThe development of these devices followed nine stages of action based on the requirements established by the Ministry of Health. During development, both systems followed the stages of circuit planning, software simulation to verify the components used, cost assessment for the acquisition of features, simulation in contact matrix, development of the embedded system, and planning of the printed circuit board and storage box.ResultsBoth devices underwent preliminary functionality tests to assess their quality. The performance tests applied on the device to diagnose syphilis performed 8,733,194 requests, with a flow of 2426 requests/second, reaching the desired parameters of robustness, integrity, durability, and stability. In addition, functioning tests on the cancer-screening device indicated the ability to detect standard fluorescence in a minimal (150 uL) sample volume.ConclusionsTogether, the methodology used for developing the devices resulted in promising equipment to improve the diagnosis and meet the requirements for executing technologies for testing and triaging patients in PHC.

Health and Social Care coordination in Andalusia within the European project VIGOUR

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Evaluating Social Determinants of Health in a Mobile Integrated Healthcare-Community Paramedicine Program.

In 2018, the University of Maryland Medical Center and the Baltimore City Fire Department implemented a community paramedicine program to help medically or socially complex patients transition from hospital to home and avoid hospital utilization. This study describes how patients' social determinants of health (SDoH) needs were identified, and measures the association between needs and hospital utilization.SDoH needs were categorized into ten domains. Multinomial logistic regression was used to measure association between identified SDoH domains and predicted risk of readmission. Poisson regression was used to measure association between SDoH domains and actual 30-day hospital utilization.The most frequently identified SDoH needs were in the Coordination of Healthcare (37.7%), Durable Medical Equipment (18.8%), and Medication (16.3%) domains. Compared with low-risk patients, patients with an intermediate risk of readmission were more likely to have needs within the Coordination of Healthcare (RRR [95% CI] 1.12 [1.01, 1.24], p = 0.032) and Durable Medical Equipment (RRR = 1.13 [1.00, 1.27], p = 0.046) domains. Patients with the highest risk for readmission were more likely to have needs in the Utilities domain (RRR = 1.76 [0.97, 3.19], p = 0.063). Miscellaneous domain needs, such as requiring a social security card, were associated with increased 30-day hospital utilization (IRR = 1.23 [0.96, 1.57], p = 0.095).SDoH needs within the Coordination of Healthcare, Durable Medical Equipment, and Utilities domains were associated with higher predicted 30-day readmission, while identification documentation and social services needs were associated with actual readmission. These results suggest where to allocate resources to effectively diminish hospital utilization.

Trends in health reforms in the Health System and Policies Monitor network: increasing interaction of primary health care and care coordination

Abstract Since 2018, the Health System and Policy Monitor (HSPM) network of the European Observatory on Health Systems and Policies has tracked health reform activity in its countries. Top three reforms are identified by national experts yearly and classified across 11 policy clusters. Efforts inform a standardized overview of healthcare development. 337 reforms have been assessed for 31 (mainly EU) countries over 4 years, with clear trends like the converging of PHC and care coordination. Main reform areas were primary/ambulatory care, governance, and hospital care (2018-2019); coordination, governance, and digital health (2020); and care coordination, governance, and insurance coverage/resource generation (2021). For PHC, this suggests a shift from leveraging innovations to support existing delivery mechanisms to transforming PHC. Some PHC reforms in 2018-2019 introduced elements of integrated care, but more focused narrowly on specific levers, e.g., gatekeeping. Early care coordination reforms focused on certain patient groups or care delivery across the system. Separately, PHC and care coordination have long been reform priorities. Since 2020, they are increasingly linked to one another, and to multidisciplinary care. This suggests a recognition that multidisciplinary processes/staffing are key to realizing the promises of PHC-to coordinate the care of patients and ensure comprehensive and continuous care over time for most health needs. This vision is underpinned by the UN SDGs and COVID-19, which highlighted the need for health systems to be set up for and with the resources to respond to crises while maintaining core functions. The overview of HSPM health reforms identifies reform trends and opportunities for cross-country learning. More research is needed for policymakers to benefit fully from reform experiences abroad. Case studies with in-depth analysis of reform design and implementation processes can help inspire or support future health reforms elsewhere.