Cross-sectoral Communication Research Articles

Collaboration to Reduce Sudden Unexpected Infant Death With Child Fatality Review and Outreach.

Sudden unexpected infant death (SUID) is the leading cause of postneonatal infant mortality in the United States, with disproportionately high rates in Baltimore City and Baltimore County in Maryland. This Advocacy Case Study describes the collaboration between the City and County Child Fatality Review teams to decrease infant mortality. B'more for Healthy Babies, formed in 2009 by the Bureau of Maternal Child Health in Baltimore City with the goal of reducing infant mortality through policy change, service improvements, community mobilization, and behavior change has had a sustained effort to respond to SUID. Recognizing that infants born in Baltimore City often reside in Baltimore County (and vice versa), collaboration with Baltimore County has been essential to increasing B'more for Healthy Babies' scope, reach, and effectiveness. Public health messaging campaigns, creation, and dissemination of a "SLEEP SAFE" testimonial video, and Safe Sleep Summits have involved caregivers, healthcare providers, and community partners. Outcomes of this ongoing collaboration demonstrate a decrease in sleep-related infant mortality rates. Our findings also highlight the need for continued, real time monitoring of sleep-related infant mortality trends with a coordinated, multidisciplinary, and crossjurisdictional response. This initiative can serve as a model of cross-sector communication that can be replicated in other similar geographic locations to further reduce SUID.

KardioNet Digital - a structured care model involving digital tools for intersectoral communication and a patient-focused strategy for treatment of heart failure

Abstract Introduction Inefficiencies and discontinuities in care at the interfaces within Germany's healthcare system, especially between acute and outpatient care, present significant challenges in managing patients with heart failure (HF). The management complexity of HF has increased with the advent of new digital tools, though patient acceptance of these tools remains contentious. The prevention of loss of diagnostic and therapeutic information for this complex disease is crucial for cross-sectoral communication (hospital - office-based cardiologist - general practitioner) and quality of care. Purpose Our goal was to examine the impact of digital app-supported coordination of HF management across different healthcare providers from hospital discharge to the ambulatory sector and to assess patients' acceptance of a structured care program. A patient-focused digital strategy, supported by a Heart Failure Nurse (HFN), aimed to facilitate structured follow-up and patient empowerment, focusing on patient-reported outcomes and experiences (refer to Table 1). Results Out of 401 patients screened during their hospital stay for HF, only 57 (14.9% male, 12.6% female) participated in the KardioNet Digital (KND) program. NYHA classifications were I (3.5%), II (49.1%), III (40.4%), and IV (7.1%); Diagnoses included CMP (26, 45.6%), CAD (19, 33.3%), valvular HF (8, 14.0%), and others (4, 7.0%). The mean age was 55.03 years, with a notable difference in participation based on age (≥70 years: 9.5% male, 33.3% female; <70 years: 90.5% male, 66.7% female). Age was a significant determinant of program participation. Patients who regularly used the app benefited from several features: A total of 35 alerts (17 patients) were triggered for reasons such as bodyweight increase (2kg or more) and device-induced alerts (i.e. false shock delivery, 3x slow-VT, Syncope), leading the HFN to contact the patients. This early intervention prevented rehospitalization due to decompensation of heart failure in 11 patients (64.7%) and addressed device-related alarms for organizing an emergency hospital visit by HFN. Despite substantial incentives, such as support from an HFN and expedited appointments with specialists for follow-up therapy, refusal rates were high (refer to Table 2). Conclusion A structured, digitally supported cross-sectoral care model for heart failure patients can potentially improve care coordination and outcomes. However, the success of such programs critically depends on patient willingness and the seamless integration into existing healthcare structures. Despite valuable incentives, we observed low acceptance of the program. Even among motivated participants (14.1%), there is a significant need for substantial support and education on digital literacy for the widespread implementation of digital tools in real-world settings for the treatment of heart failure.Workflow of structured digital supportReasons for Declining Participation

Potential sports industry Segorogunung village: a strategy for the paragliding sport tourism development model

The objectives of this study are as follows: (1) Determine the opportunities, threats, vulnerabilities, and strengths of the paragliding hill as a tourist attraction in Segorogunung village; and (2) Establish a model strategy for the development of paragliding sport tourism in Segorogunung village. This research employs a qualitative descriptive case study methodology incorporating an embedded research approach. Utilizing a strategic management concept-based approach, qualitative descriptive and SWOT analyses are utilized in research data analysis. The research findings indicate the following: (1) The accumulated value of the strength factor is 1.758; the accumulated value of the vulnerability factor is -1.255; the accumulated value of the opportunity factor is 1.855; and the accumulated value of the threat factor is -1.445. (2) The cumulative IFAS score for the (3) The progressive strategy model for the development of sports tourism in Segorogunung village requires the following concrete steps: a). Implementation of the pentahelix framework to facilitate the growth and progress of paragliding sports tourism. B). Cultivating a shared sense of mutual respect, trust, accountability, and benefit; establishing cross-sector communication forums; developing master plans for development; and fostering management collaboration in order to implement a management system based on good governance. According to the findings of this study, paragliding as a sports tourism incentive in Segorogunung village achieves Quadrant I (progressive strategy model) classification. This circumstance is extremely advantageous for paragliding tourism administrators, the village administration, and the regional administration of the Karanganyar Regency. Keywords: Sports industry, Paragliding, Segorogunung Village, Sports tourism.

Speaking the Same Language - The Development of a Glossary of Terms for Social Prescribing in Wales.

Social prescribing can facilitate the integration of health, social care and community support but has a diverse and confusing terminology that impairs cross-sectoral communication and creates barriers to engagement. To address this issue a mixed-methods approach that incorporated a scoping review, a group concept mapping study and consultation was employed to identify and classify the terminology associated with social prescribing. The findings were then used to inform the development of a glossary of terms for social prescribing. Many terms are used interchangeably to describe the same specific aspects of social prescribing. Much of the terminology originates from the health and social care literature of England. The terminology used in the academic literature may not accurately reflect the terminology used by the social prescribing workforce. The innovative and interactive glossary of terms identifies the terminology associated with social prescribing and provides additional contextual information. The process of developing the dual language glossary presented several considerations and challenges. The glossary of terms will facilitate cross-sector communication and reduce barriers to engagement with social prescribing. It takes an important first step to help clarify and standardise the language associated with social prescribing, for professionals and members of the public alike.

The effect of multisector integration communication on empowerment in rural areas

Background: Empowering impoverished communities has been a long-standing endeavor. However, the persistent prevalence of poverty still affects approximately 25 million individuals (BPS, 2023). Nevertheless, the government continues its relentless efforts to minimize the presence of impoverished families. One of the strategies employed is the implementation of the Family Hope Program (PKH). PKH stands as a program that has effectively fulfilled its mission. Various research studies have been conducted to comprehend the processes, mechanisms, impacts, and societal implications. However, research exploring the cross-sectoral communication aspects, elaborating on the involvement of stakeholders and PKH implementers spanning multiple institutions, remains lacking. Purpose: This research aims to measure the level of influence of multi-sectoral integration communication on the performance of individual PKH implementers. Methods: The employed methodology is an explanatory survey. The surveyed population comprises civil servants engaged in PKH. The population size consists of 80 individuals. Probability sampling is utilized as the sampling technique, with a sample size of 44 respondents, determined using the Slovin method. Hypothesis testing employs Path Analysis. Results: The research findings indicate a significant influence of cross-sectoral communication factors, encompassing organizational member perceptions, organizational strategies, communication climate, media quality, information accessibility, information dissemination, information accuracy, and organizational culture, on the performance of individual PKH implementers. Conclusion: Organizational member performance emerges as a critical aspect for the success of PKH implementation. The research results demonstrate that this performance is influenced by several factors, including information accessibility, media quality, information accuracy, organizational communication climate, organizational culture, information dissemination, and organizational strategies in the execution of the PKH program. Implications: The success of PKH is contingent upon the performance of individual members from collaborating institutions. Enhancing the effectiveness and efficiency of individual performance factors can be achieved by synergizing with cross-sectoral communication components.

Collaborative Governance in the Development of Likupang Super Priority Tourism Destination in North Sulawesi Province

This qualitative descriptive study investigates collaborative governance in the development of the Super Priority Tourism Destination (DPSP) Likupang, Indonesia, identifying factors that either support or hinder its effectiveness and efficiency. Indonesia's tourism sector, enriched by its diverse natural and cultural assets, contributes significantly to the economy through revenue, employment, and cultural promotion. However, the governance of DPSP Likupang's development has been inadequate, leading to underperformance in realizing the area's full potential. The research highlights that while the advancement of communication technologies and the collaborative culture of North Minahasa are supportive, significant barriers such as limited resources, insufficient cross-sectoral communication, and low political commitment obstruct progress. To address these challenges, the study proposes the Collaborative Governance Regime Integrated Driver Model, an adaptation of the CGR model by Emerson, Nabatchi, and Balogh (2012). This new model integrates local cultural values and political dynamics into the governance process, enhancing collaborative efforts and potentially leading to more effective development outcomes. This model is specifically tailored to overcome the unique challenges faced by DPSP Likupang, suggesting that integrating cultural insights and strengthening political will are crucial for improving governance and achieving sustainable development in tourism-heavy regions like North Minahasa. The findings and recommendations of this study are intended to guide policymakers and stakeholders in optimizing governance frameworks to better support the strategic growth of tourism destinations.

Global environmental change policy priorities from the Americas and opportunities to bridge the science-policy gap

ABSTRACT Governments and intergovernmental organizations support scientific research to produce the knowledge and tools needed to monitor and mitigate global environmental changes (GEC). However, GEC-related policy decisions are often not based on scientific evidence, and GEC research is often not based on policy-relevant questions, resulting in a science-policy gap. Assessing the GEC policy priorities of researchers and policymakers is an essential step towards closing this gap. This task was undertaken by the Inter-American Institute for Global Change Research (IAI), an intergovernmental organization pursuing science and capacity building to reach the vision of a sustainable Americas. The assessment included survey consultations, listening sessions, and an analysis of policy documents for 17 countries of the Americas. Three key findings emerged from this assessment. First, the top current priority for policymakers was Climate action, and Biodiversity and ecosystem services for researchers, with a poor alignment between the priorities of these social actors at the country level. Second, clusters of non-neighboring countries had a profile of GEC priorities more similar than clusters of neighboring countries, although there were some sub-regional clusters around particular GEC goals. Third, researchers and policymakers agreed that the lack of cross-sectoral collaboration and communication between technical and non-technical actors are important barriers. A key opportunity for policymakers was the growing funding and international cooperation for GEC, while for researchers, the growing body of evidence to inform GEC decision-making. These findings have implications for the design of research and capacity-building actions targeted to the priorities and needs of the region.

Collecting pieces for the 'puzzle': Nurses' intraprofessional collaboration in the hospital-to-home transition of older patients.

Communication is a key factor in intraprofessional collaboration between hospital nurses and homecare nurses in hospital-to-home transitions of older patients with complex care needs. Gaining knowledge of the nature of cross-sectoral communication is crucial for understanding how nurses collaborate to ensure a seamless patient trajectory. This study explores how cross-sectoral electronic health records communication influences collaboration between hospital nurses and homecare nurses when discharging older patients with complex care needs. The study is based on qualitative group interviews with six hospital nurses and 14 homecare nurses working at different hospitals and municipalities across Denmark. Data were analysed using reflexive thematic analysis, as described by Braun and Clark. The themes Collecting pieces for the 'puzzle': Losing the holistic picture of the patient; Working blindfolded: limited provision of and access to critical information; and Bypassing the 'invisible wall': dialogue supports cohesion illustrate the impact of organisational structures within electronic health records have on hospital nurses' and homecare nurses' intraprofessional collaboration across sectors. Challenges with predefined and word-limited elements in digital communication, and inadequate and limited access to significant medical information were identified. To compensate for the inadequacy of the electronic health records, direct contact and dialogue were emphasised as ways of fostering successful collaboration and overcoming the barriers created by electronic health records. Despite hospital nurses' and homecare nurses' desire to conduct holistic patient assessments, their ability to collaborate was hindered by failures in electronic health record communication resulting from restrictive organisational structures across sectors. Thus, it became necessary for hospital nurses and homecare nurses to bypass the electronic health record system and engage in dialogue to provide holistic care when discharging older patients with complex care needs. However, by hospital nurses and homecare nurses compensating for counter-productive organisational structures, problems brought about by the electronic health record system paradoxically remain invisible.

From theory to practice: Analyzing factors that foster the successful implementation of the one health approach for enhancing health security in Cameroon

BackgroundMultisectoral collaboration is crucial in effectively managing public health emergencies. The One Health approach, which emphasizes the interconnectedness of human, animal, and environmental health, has gained recognition as an effective strategy. This study analysis the factors influencing the implementation of the One Health approach in Cameroon and examines its effects on public health emergency management. MethodA survey was conducted among 44 stakeholders from key sectors involved in implementing the “One Health approach” in Cameroon. Data were collected with a structured questionnaire using a self-administered approach. Statistical analysis using the Ki Square test was conducted to identify associations between variables. ResultsThe findings revealed that stakeholders in Cameroon lacked prior training on the One Health approach, primarily due to its absence in their academic programs. However, ad hoc trainings during public health emergencies were effective in involving various sectors. Limited communication and collaboration between different sectors, often operating in silos, posed significant challenges. Stakeholders with previous collaborative experiences and existing relationships demonstrated a greater propensity for multisectoral collaboration. The involvement of environmental health professionals in collaboration activities was limited, highlighting the need for improved engagement. Strong leadership, supported by coordination structures and platforms, played a critical role in facilitating collaboration during public health emergencies. Communication channels, such as regular multisectoral meetings, were essential in fostering relationships and trust among stakeholders. However, financial constraints hindered cross-sector cooperation. ConclusionTo enhance multisectoral collaboration in public health emergency management, there is a need to prioritize training on the One Health approach and promote cross-sector communication and collaboration. Strengthening coordination structures and platforms, improving resource allocation, and fostering a culture of accountability and trust are crucial for effective implementation. This study provides insights into the challenges and opportunities in implementing the One Health approach in Cameroon and offers valuable lessons for other countries seeking to enhance their multisectoral response to public health emergencies.

Intersectoral cooperation between university hospitals and physicians in private practice in Germany– where the potential for optimization lies

BackgroundIntersectoral cooperation between physicians in private practice and hospitals is highly relevant for ensuring the quality of medical care. However, the experiences and potential for optimization at this interface from the perspective of physicians in private practice have not yet been systematically investigated. The aim of this questionnaire survey was to record participants’ experiences with regard to cooperation with university hospitals and to identify the potential for optimizing intersectoral cooperation.MethodsWe performed a prospective cross-sectional study using an online survey among practising physicians of all disciplines offering ambulatory care in Germany. The link to a 41-item questionnaire was sent via mail using a commercial mail distributor in which 1095 practising physicians participated. Baseline statistics were performed with SurveyMonkey and Excel.ResultsA total of 70.6%/722 of the responding physicians in private practice rated cooperation with university hospitals as satisfactory. Satisfaction with the quality of treatment was confirmed by 87.2%/956 of the physicians. The subjectively perceived complication rate in patient care was assessed as rare (80.9%/886). However, the median waiting time for patients in the inpatient discharge letter was 4 weeks. The accessibility of medical contact persons was rated as rather difficult by 52.6%/577 of the physicians. A total of 48.6%/629 of the participants considered better communication as an equal partner to be an important potential for optimization. Likewise, 65.2%/714 participants wished for closer cooperation in pre- and/or post inpatient care.ConclusionThe following optimization potentials were identified: timely discharge letters, clear online presentations of clinical contacts, improved accessibility by telephone, introduction or further development of a referral portal, regular intersectoral training and/or “get-togethers”, regular surveys of general practitioners and implementation of resulting measures, further development of cross-sectoral communication channels and strengthening of hospital IT.

A Digital Platform (Telepalliation) for Patients in Palliative Care and Their Relatives: Protocol for a Multimethod Randomized Controlled Trial.

The World Health Organization defines end-of-life palliative care as "prevention and relief of suffering, by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." Over 20 million people worldwide are in need of palliative care. In Denmark, palliative care is given at a general and a specialist level. The general level comprises health care professionals (HCPs) who do not perform palliative care full-time. The specialist level comprises specialized palliative care (SPC), where HCPs perform palliative care full-time. In total, 20%-30% of patients who need palliative care are referred to SPC. Challenges with SPC include a short time span from referral to end of life, patients who are very ill and may therefore find it hard to travel to an outpatient clinic, and the SPC unit having a relatively small staff. The need for SPC is expected to rise, as the number of patients dying from terminal diseases is increasing. Telehealth has been successfully implemented in different home care settings, including palliative care. The aim of the study is to present the research design of the clinical testing of a telepalliation program by the use of a digital platform for patients in palliative care and their relatives. The telepalliation program will be conducted as a multimethod randomized controlled trial. The intervention group will follow the telepalliation program, while the control group will follow the traditional standard of care program for palliative care. The primary outcome of the study is increased quality of life. Secondary outcomes include enhanced sense of security; reduced experience of pain; satisfactory experiences of patients and relatives with the TelePal platform and degree of satisfaction in being a part of the program; experiences with the use of the TelePal platform on the part of HCPs and the professionals' experiences of being a part of the program; the use of a cross-sector communication platform and the telepalliation program by patients, relatives, and HCPs; and the projected lower cost of health care services. These outcomes will be assessed using questionnaires, data generated by digital technologies, and semistructured interviews. The collection of data began in May 2021 and will be completed in August 2024. The results of the study will be published in peer-reviewed journals and presented at international conferences. Results from the telepalliation program are expected to be published by fall 2024. The expected outcomes of the study are increased quality of life and increased sense of security. We also expect that the study will have a clinical impact on future telepalliation for those patients who are referred to a palliative team. ClinicalTrials.gov NCT04995848; https://clinicaltrials.gov/study/NCT04995848. DERR1-10.2196/49946.

Bridging the gap between healthcare sectors: Facilitating the transition from NICU to the municipality and home for families with premature infants.

The transition from hospital to home can be challenging for parents of prematurely born infants. The aim of this ethnographic study was to describe a multidisciplinary and cross-sectoral discharge conference for families with premature infants transitioning from a neonatal intensive care unit to municipal healthcare services. An ethnographically/anthropologically inspired qualitative design was adopted. We conducted four participant observations of multidisciplinary and cross-sectoral discharge conferences and 12 semistructured interviews with four neonatologists, four nurses, and four health visitors who had attended one of the conferences. Salient themes were generated by two-part analysis consisting of a thematic analysis followed by Turner's ritual analysis. This study illustrated how multidisciplinary and cross-sectoral discharge conferences improved the quality of care for premature infants and their families in their transition process which was perceived as complex. These conferences contributed to promoting a sense of coherence and continuity of care. The healthcare professionals experienced that this event may be characterized as a ritual, which created structures that promoted cross-sectoral cooperation and communication while increasing interdisciplinary knowledge sharing. Thus, the conferences triggered a sense that the participants were building bridges to unite healthcare sectors, ensuring a holistic and coordinated approach to meet the unique needs of the infants and their families. This study presented a unique holistic and family-centered approach to constructing multidisciplinary and cross-sectoral discharge conferences that seemed to underpin the quality of interdisciplinary and health-related knowledge sharing and establish a crucial starting point for early interventions, preventive measures, and health-promoting efforts. Hopefully, our findings will encourage others to rethink the discharge conference as a transitional ritual that may potentially bridge the gap between healthcare sectors. Specifically, our findings contribute to the mounting body of knowledge of family-centered careby showing how healthcare professionals may-in a meaningful and tangible manner-operate, develop, and implement this somewhat elusive theoretical foundation in their clinical practice.

Effect of an entry-to-care intervention on diabetes distress in individuals with newly diagnosed type 2 diabetes: a study protocol for a cluster-randomized trial

BackgroundDiabetes distress (DD) affects at least 36% of T2DM patients and is often associated with insufficient support and care. This study examines an intervention that targets DD through enhanced cross-sectoral collaboration and treatment during the first 3 months following diagnosis. The intervention aims to improve care and self-management and to reduce DD.Methods and interventionThe study is designed as a cluster-randomized trial with the intervention focusing on four key elements of diabetes care: effective cross-sectoral communication and information sharing, systematic care, a “one-stop-shop” health screening and start-up conversation at the municipality, and improving patient insights into own care.This study requires 32 clusters (16/arm) to achieve 80% power and a 5% significance cut-off, with 270 patients required. GP recruitment occurred from May to Dec 2022. Patient recruitment is ongoing from May 2022 to Aug 2023. GPs were randomized 1:1 using computer-generated blocks of six.Participating GPs are located in Southern Denmark and are not participating in other trials. Patients must be 18 + years of age, have a T2DM diagnosis, and be fluent in spoken and written Danish. DD is the primary outcome and will be measured at baseline, at four months, and again at a 12-month follow-up. Secondary outcomes include quality of care, self-management, quality of life, and clinical factors. Tertiary outcomes comprise depression, stress, resilience, sleep quality, and social network quality.ConclusionThis study is among the first clinical trials exploring the development of DD from diagnosis to 12 months post-diagnosis. Many previous interventions did not directly target DD as the primary outcome. This research provides new insights into DD progression in patients newly diagnosed with T2DM and examines an intervention designed to lower DD in early diabetes stages, contributing to a better understanding of the development of DD and how this intervention affects patient well-being.Trial registrationClinicalTrial.gov NCT05571306. Registered on 07 October 2022.

Health Care Professionals' Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study.

Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs' needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. This study aimed to (1) investigate HCPs' perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources.

Cross-sectoral exchange of nurses: An intervention study.

In health policy, much attention has been paid to collaboration between the primary and secondary health care sectors, especially in relation to hospitalisation and discharge. Despite ideal plans for collaboration, the research literature shows that inadequate communication is a well-known problem that can be a barrier to a safe trajectory for the citizen. Based on the assumption that better knowledge of each other's work will lead to better collaboration, a cross-sectoral exchange program with nurses was initiated. The aim was to investigate which barriers to good patient trajectories the involved nurses attributed to cross-sectoral collaboration and what impact the exchange to the opposite sector had for them. Twenty-eight nurses were exchanged: 14 from a cardiology department and 14 from municipal home care. The nurses shadowed a colleague from the opposite sector in their daily work. Subsequently, six focus group interviews were conducted. The transcribed material was analysed based on Ricoeur's interpretation theory. Two main themes, including sub-themes emerged: (1) Challenging communicative conditions: (a) Inadequate digital communication, (b) Inadequate care plans and discharge reports, (c) Conversation promotes understanding, and (d) Challenging collaboration and communication with the discharge coordinators. (2) Perceived importance of the exchange: (a) Cross-sectoral relationship, prejudice and gaining respect for each other and (b) Working in two different worlds. Electronic communication is inadequate, and the IT systems do not support sufficient cross-sectoral communication. The organisational model in the municipal care sector is inflexible in terms of allocations for the current needs of citizens, and professionals feel that their professional judgements are not recognised. The nurses gained insight into each other's work and working conditions and respect for each other's professionalism. The exchange has the potential to both improve the relationship and communication between the sectors for the benefit of a better and more coherent patient course.

Interdisciplinary network care collaboration in Parkinson’s disease: a baseline evaluation in Germany

BackgroundThe strengthening of interdisciplinary care collaboration in Parkinson's disease is taking on increasing importance in daily medical routine. Therefore, care providers worldwide are organizing themselves in disease-specific regional network structures. However, the existing networks are heterogeneous, and the driving key players are yet unidentified.ObjectivesTo systematically identify key factors of the composition of health care professionals, who are initially interested in the development of a Parkinson network for interdisciplinary care collaboration, their motivation, and expectations, we conducted a basic evaluation in three different German regions covering a total number of 23,405 people with Parkinson’s.MethodsA specially developed semi-open questionnaire focusing on socio-demographic information, ways of contact, interdisciplinary collaboration, and connectedness was used. Statistical analyses were performed based on a predesigned codebook.ResultsThe most crucial professions were outpatient therapists (physio-, occupational-, speech therapists) (36.7%), average case load of 10.1 patients/3 months and inpatient movement disorder specialists (21.1%), average case load of 197.4 patients/3 months. Before implementation of PD networks, 48.9% of outpatient therapists did not have any contact with neurologists. 58.9% of caregivers considered the current frequency of collaboration to be insufficient. The lack of political support as well as a lack of time were identified as main hurdles to increased collaboration.ConclusionThe identified driving forces in strengthened care collaboration are assigned to different healthcare sectors. This makes networks which provide tools for specialized education and interdisciplinary, cross-sectoral communication indispensable. For an areawide rollout, a rethinking of political frameworks towards network care is strongly necessary.

Self-assessment tool for cross-sectoral health promotion

Finding sustainable solutions to complex health and well-being problems requires cross-sectoral cooperation. The Healthy Boost project, funded by the EU Baltic Sea Programme (2019-2021), together with 14 partners from seven countries, created a model and tools for enhancing cross-sectoral cooperation. The Self-Assessment Tool (SA) presented in this article was co-created and validated to enable different city sectors to identify their current state of cross-sectoral co-operation to promote urban health and well-being. Based on pilot self-assessment data, significant differences within and between cities exist, as regards their engagement in cross-sectoral cooperation. The most noticeable challenges were the ability to coordinate cross-sectoral cooperation, the lack of common cross-sectoral tools, communication, and resources. Based on the pilot feedback, the revised digital and matrix-based SA tool was developed. The revised SA tool provides both numerical and descriptive, verbal feedback on the state of cooperation between the city sectors. The revised SA tool has been made available to users in several languages and is intended for all professionals in different sectors of cities.

From Hospital to Home, following a Lower Limb Amputation: A Focus Group Study of Healthcare Professionals views an experience.

Introduction: Major limb amputations is often associated with loss- a loss of a limb but also independence. Patients undergoing lower limb amputations are often patients with multiple comorbidities, requiring care from numerous healthcare professionals (HCP). It is a patient population with complex needs and limited surplus that might benefit from an integrated care model. 
 Aim: This study aims to explore Health Care Professionals views and experiences during the transition process from Hospital to Home after a lower limb amputation, using the Safe Journey integrated care program.
 Patient population: Patients admitted to hospital for a lower limb amputation, and discharged using the Safe Journey integrated care program.
 Method: Two focus group interviews were conducted with 13 HCP’s from a Danish Hospital and three surrounding Municipalities. Included in both groups were nurses, occupational therapists and one physiotherapists. The interview was based on the following 5 questions, and the data was analyzed based on Braun and Clarke´s reflexive thematic analysis.
 -Which advantages of the systematic cross-sectoral collaboration did you find?
 -Which disadvantages of the systematic cross-sectoral collaboration did you find?
 -What do you consider to be most important issues regarding patients transfer?
 -What do you consider to be most important issues regarding collaboration?
 -How can we ensure safety and continuity when working with patient transfer?
 Results: Three themes were identified when analyzing the group interviews.
 -Becoming a team across sectors
 -Continuity of care as a driver of patients safety
 -Challenges in achieving safe transitions
 The Safe Journey integrated care program facilitated the construction of an interdisciplinary team and cross-sectoral communication and professional relations, increasing care continuity and patient’s safety. However, HCP’s experienced an increased workload, and The Safe Journey integrated care program was time consuming and required coordination and at-home patient’s visits.
 Conclusion: HCP’s found the The Safe Journey integrated care model to be valuable for patients undergoing major lower limb amputation and promotive of cross-sectoral professional relations, communication, continuity and patient safety. However, the model was time- and resource consuming compared to conventional models.
 Next step: Our next step will be to create a virtual model of the The Safe Journey integrated care program, to explore is the high quality can be maintained in a less time consuming model.

Implementation of tourism levy policy at Minanga beach in North Gorontalo district

The research objectives are: · To know and describe the implementation of retribution policy of Minanga beach tourism in North Gorontalo Regency, · To find out and describe the determinants of the success of the implementation of Minanga beach retribution policy in North Gorontalo Regency. Data collection techniques were observation, interview, and documentation which were then analyzed using qualitative analysis based on the concept of Miles and Huberman. The result of the research shows that: · Implementation of retribution policy for Minanga beach tourism in North Gorontalo Regency has been carried out starting from the stages of planning, implementation, and monitoring and evaluation, but still experiencing obstacles such as cooperation agreements that are considered to provide less value/benefit of economic improvement for the community, often asymmetric information between the management of retribution policy at the village level and at the regional level, lack of government attention in improving the availability of infrastructure, and still lack of supervision conducted by the Regional Government. · Factors determining the success of the implementation of the Minanga beach retribution policy in North Gorontalo Regency are appropriate and implemented starting from policy standards and objectives, factors of policy standards and objectives, resources, inter-organizational communication and strengthening activities, organizational characteristics of implementing agents, and factors of socio-economic and political conditions. However, there are still some obstacles in the retribution policy targets that are not yet visible, resource factors including facilities and infrastructure, as well as low budget capabilities and poor levels of cross-sector communication.

84 What works and why for interprofessional collaboration in older people’s care integration: realist evidence synthesis

Abstract Background Interdisciplinary Community Specialist Teams for older people (CSTs) are a novel innovation in Irish health service delivery and require, over time, a shift in cultures of care to allow for the development of interprofessional collaboration. However, there is limited international guidance on how to foster, enhance and sustain meaningful interprofessional collaboration in the context of interdisciplinary team-based care integration for older people. This realist review presents initial programme theories of what works and why in fostering competencies for interprofessional collaboration in CSTs for older persons. Methods Realist reviews are an interpretive theory-driven approach to evidence synthesis which uses multiple sources of evidence including published peer-reviewed studies, policy documents and grey literature. This evidence is combined with stakeholder theories and explanations of how interventions might work. Four stakeholder cohorts were identified: public and patient representatives of older people and family carers, healthcare professionals who are members of CSTs; team leads responsible for the operational management of CSTs, and healthcare managers responsible for national clinical programme design. Results This synthesis resulted in a series of evidence-based Initial Programme Theories (IPT) in the form of statements that explain the Mechanisms (M) and Resources (R), generated within particular Contexts (C) in response to interprofessional collaboration, that are thought to lead enhanced care Outcomes (O). For example: Where CST members have professional experience in different areas of service delivery (C), they bring to the team pre-existing relationships with other HCPs (R), enabling good cross-sectoral communication and trust (M) leading to enhanced continuity of care (O). Conclusion The IPTs generated from this realist synthesis of international literature support workforce education, development and planning. They also provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and realise the goals of care integration for older people.