Health Care Service Delivery Models Research Articles

Bringing the Doctor to the Patients: Cardiology Outreach to Rural Areas

Clinical outreach is a crucial but understudied health care service delivery model. Physicians staffing rural outreach clinics must allocate a limited resource (i.e., their time) between caring for patients at their main sites and outreach locations. Using a unique 30-year data set of decisions made by cardiologists, the authors estimate a constrained utility maximization model of time allocations across home and outreach locations. The results show that travel distance, potential competition, and patient demand for cardiology services significantly influence allocation decisions. This structural model is used to simulate the impact of a predicted reduction in cardiologist supply. The expected impacts are unevenly distributed, with some rural locations experiencing large decreases in access. The authors evaluate two policies to restore rural access: targeted immigration and a subsidy program. A subsidy program with an estimated annual cost of $406,000 can restore outreach after a 10% reduction in cardiologist supply. This option should be preferred to recruiting and supporting five additional cardiologists under a targeted immigration strategy. This research demonstrates the value of marketing modeling in addressing limited access to health care services and evaluating alternative policies for maintaining access in the face of coming physician shortages.

Healthcare for Older Adults with Multimorbidity: A Scoping Review of Reviews.

To summarize adverse healthcare outcomes experienced by older adults with multimorbidity and barriers perceived by stakeholders regarding the healthcare systems primarily designed to address individual health conditions. Healthcare elements that aim to provide coordinated, continuous, and comprehensive services for this population were also identified. We applied the methodology framework developed by Arksey and O'Malley to guide the review. The three-step search strategy was used to identify relevant English reviews that focused on adverse healthcare outcomes and barriers encountered by older adults with multimorbidity and other stakeholders regarding the single-disease-focused healthcare systems, as well as those concentrated on healthcare elements that aim to provide coordinated, continuous, and comprehensive services for older adults with multimorbidity. Five electronic databases, including PubMed/Medline, CINAHL, Web of Science Core Collection, Cochrane Library, and Embase, were systematically searched from database inception to February 2022. A standardized table was used to extract data. Thematic analysis was then conducted under the guidance of the Rainbow Model of Integrated Care and the Chronic Care Model. Twenty reviews were included in this study. Therapeutic competitions, high healthcare service utilization, and high healthcare costs were three adverse healthcare outcomes experienced by patients. Both patients and healthcare professionals faced various barriers. Other stakeholders, including informal caregivers, healthcare managers, and policymakers, also perceived several barriers. Numerous healthcare elements were identified that may contribute to optimized services. The elements most frequently mentioned included the implementation of shared decision-making, comprehensive geriatric assessments, and individual care plans. This study conducted a comprehensive overview of the current knowledge related to healthcare for older adults with multimorbidity. In the future, it is necessary to develop more coordinated, continuous, and comprehensive healthcare service delivery models based on the healthcare needs of older adults with multimorbidity and the specific characteristics of different countries.

Barriers to Healthcare Across Rural Communities-Testing Telehealth as an Alternative Model of Healthcare Service Delivery

Healthcare consumers from rural areas in the United States have inadequate access to healthcare due to a lack of providers, ineffective healthcare networks, and impaired healthcare delivery models. Further, low income, insurance coverage, and transportation are significant challenges limiting rural healthcare consumers’ access to healthcare. Therefore, preventable hospitalizations are more common in rural areas. As a result, healthcare access in rural areas has become a pressing issue for healthcare leaders and the government. Therefore, the author would like to conduct a literature review to assess the barriers in rural areas and establish the framework for a pilot study to propose telehealth as an alternative healthcare service delivery model to improve healthcare accessibility and health promotion.

Rural mistrust of public health interventions in the United States: A call for taking the long view to improve adoption.

Rural mistrust of public health interventions in the United States: A call for taking the long view to improve adoption.

Healthcare Service Delivery Models for Emerging Economies: Insights from India

With the population growing at such a fast pace, expected to reach 1.4 billion by 2022, and more than 70% reside in rural areas, effective healthcare service delivery serves as a primary challenge in India. Ayushman Bharat scheme was launched in 2018 by the Government of India to serve the requirement for comprehensive primary healthcare. This case provides an overview of Ayushman Bharat regarding its impact compared to cross-subsidized models like Aravind Eye Care System (AECS) and Narayana Hrudayalaya (NH) and completely free healthcare delivery by Sri Sathya Sai Sanjeevani Hospitals (SSSSH). The case outlines the background and the operational model and also emphasizes on core principles of its founders, which have translated into a massive success. The case aims to ignite a discussion on their dynamic execution approach and how these models will evolve if replicated in high-volume government schemes. The emerging discussion points are expected to challenge the conventional beliefs in the health delivery system and expose the major lacunae in implementation, which shrinks the impact of nationwide schemes. The purpose is to ignite a discussion on the differences in strategies and execution of government schemes like the National Health Mission compared to the highly impactful one-person visionaries like AECS, NH and SSSSH. The case is a classic example of the operations strategy coupled with ethics and social responsibility towards improving the health and wellness quotient in the state.

The relationship between healthcare service provision models and patient experience.

User experience is key for measuring and improving the quality of services, especially in high personal and relation-intensive sectors, such as healthcare. However, evidence on whether and how the organizational model of healthcare service delivery can affect the patient experience is at an early stage. This study investigates the relationship between healthcare service provision models and patient experience by focusing on the nursing care delivery. 65 nurses' coordinators were involved to map the nursing models adopted in the healthcare organizations of in an Italian region, Tuscany. This dataset was merged with patient experience measures reported by 9,393 individuals discharged by the same organizations and collected through a Patient-Reported Experience Measures Observatory. The authors run a series of logistic regression models to test the relationships among variables. Patients appreciate those characteristics of care delivery related to a specific professional nurse. Having someone who is in charge of the patient, both the reference nurse and the supervisor, makes a real difference. Purely organizational features, for instance those referring to the team working, do not significantly predict an excellent experience with healthcare services. Different features referring to different nursing models make the difference in producing an excellent user experience with the service. These findings can support managers and practitioners in taking decisions on the service delivery models to adopt. Instead of applying monolithic pure models, mixing features of different models into a hybrid one seems more effective in meeting users' expectations. This is one of the first studies on the relationship between provision models of high-contact and relational-intensive services (the healthcare services) and users' experience. This research contributes to the literature on healthcare service management suggesting to acknowledge the importance of hybridization of features from different, purely theoretical service delivery models, in order to fit with providers' practice and users' expectations. This is one of the first studies on the relationship between provision models of nursing care and patient experience.Healthcare services' users appreciate service delivery characteristics identified with "be cared by," or in other words with having a reference nurse.Nursing models' features that relate to the organizations and that providers tend to judge as professionalizing and evolutive, such as team working, appear not key in relation to patient experience.Pure models of service delivery are theoretically useful, but hybrid models can better meet users' expectations.

Conventional and complementary health care use and out-of-pocket expenses among Australians with a self-reported mental health diagnosis: a cross-sectional survey

BackgroundMental health disorders are a global health concern. In Australia, numerous national reports have found that the current mental healthcare system does not adequately meet the needs of Australians with mental illness. Consequently, a greater understanding of how people with a mental health disorder are using the broader healthcare system is needed. The aim of this paper is to explore conventional and complementary health care use and expenditure among Australian adults reporting a mental health disorder diagnosis.MethodsA cross-sectional online survey of 2,019 Australian adults examined socio-demographic characteristics, complementary and conventional health care use and the health status of participants.Results32 % (n = 641) of the total sample (N = 2019) reported a mental health disorder in the previous 3 years. Of these, 96 % reported consulting a general practitioner, 90.6 % reported using prescription medicines, 42.4 % consulted a complementary medicine practitioner, 56.9 % used a complementary medicine product and 23 % used a complementary medicine practice. The estimated 12-month out-of-pocket health care expenditure among Australians with a mental health disorder was AUD$ 4,568,267,421 (US$ 3,398,293,672) for conventional health care practitioners and medicines, and AUD$ 1,183,752,486 (US$ 880,729,891) for complementary medicine practitioners, products and practices. Older people (50–59 and 60 and over) were less likely to consult a CM practitioner (OR = 0.538, 95% CI [0.373, 0.775]; OR = 0.398, 95% CI [0.273, 0.581] respectively) or a psychologist/counsellor (OR = 0.394, 95% CI [0.243, 0.639]; OR = 0.267, 95% CI [0.160, 0.447] respectively). People either looking for work or not in the workforce were less likely to visit a CM practitioner (OR = 0.298, 95% CI [0.194, 0.458]; OR = 0.476, 95% CI [0.353, 0.642], respectively).ConclusionsA substantial proportion of Australian adults living with a mental health disorder pay for both complementary and conventional health care directly out-of-pocket. This finding suggests improved coordination of healthcare services is needed for individuals living with a mental health disorder. Research examining the redesign of primary health care provision should also consider whether complementary medicine practitioners and/or integrative health care service delivery models could play a role in addressing risks associated with complementary medicine use and the unmet needs of people living with a mental health disorder.

Features of health care interventions associated with reduced services and spending.

This study examines 14 independent and diverse health care interventions funded under the second round of Health Care Innovation Awards by CMS to determine if any organizational, model, or implementation features were strongly associated with the programs' estimated impacts on total expenditures, hospitalizations, or emergency department visits. We estimated program impacts using awardee-specific difference-in-differences models based on Medicare and Medicaid enrollment and claims data for treatment and matched comparison groups from 2012 to 2018. We used 2 analytic approaches to identify program features associated with favorable impacts. The first method identified program characteristics that were common among programs that had estimated reductions in costs and service use and uncommon among those that did not. The second approach compared median impacts among awardees with a given distinguishing feature with median impacts among awardees that lacked the characteristic. Of the 23 program features examined, 7 were associated with favorable estimated impacts: 3 intervention components (behavioral health, telehealth, and health information technology) and 4 program design and organizational characteristics (having prior experience implementing similar programs, targeting patients with substantial nonmedical needs in addition to medical problems, being focused on individual patient care rather than transforming provider practice, and using nonclinical staff as frontline providers of the intervention). Innovative health care service delivery models with 2 or more of these 7 identified features were more likely than programs without them to reduce Medicare and Medicaid beneficiaries' needs for costly health care services.

Care transition for complex patients: a framework to analyse and develop the Operating Centres for Transition

PurposeTransitional care (TC) models emerged to ensure healthcare coordination and continuity, as at-risk patients transfer between different settings or different levels of care within the same setting. TC models have been developed in many countries as well as within different healthcare service delivery models and organizations. This paper aims to focus on a TC model developed in Italy called Operating Centre for Transition (OCT), in order to (1) explore its distinctive features by establishing a framework of analysis, (2) apply the framework to study two OCTs and (3) provide recommendations on how to use the framework to evaluate and develop new OCTs in the future.Design/methodology/approachThe authors adopted a grounded theory method to develop and validate the framework of analysis. The authors employed several qualitative methods following four iterative and recursive steps: (1) desk analysis of relevant documents, (2) in-depth interviews to key informants, (3) three meetings of an expert working group and (4) application of the framework to two case studies.FindingsThe framework of analysis identifies three core dimensions that are always present in any OCT: the service model, the functions and the organizational features. Moreover, for every dimension several variables that capture and understand OCTs’ nature, role and development level are identified.Originality/valueThe results of the study highlight the key elements of the OCT model in Italy and show that the proposed framework can be useful both to analyse existing OCTs and to support health managers and policy makers to create new OCTs or develop those already active.

Dealing with COVID-19 Epidemic in Italy: Responses from Regional Organizational Models during the First Phase of the Epidemic.

As the COVID-19 outbreak traveled through various Italian regions, all national and local administrations issued measures to counter the spread of the contagion and organize healthcare. The Italian healthcare system is, indeed, a decentralized system with 21 regional health systems (RHSs), with different models of healthcare service delivery and organization. This study investigates whether a different organization of RHSs would have led to different management of the COVID-19 epidemic, and evaluates the effect of different approaches in epidemic management on the COVID-19 epidemiological trend. A set of indicators is identified by conducting an online synchronous Focus Group, involving an experts panel. A Pearson’s correlation test was performed on the values assumed by the historical series of indicators investigate correlations among the trends represented by the indicators or between them and external factors. The comparison between the experiences of the different Italian regions, regarding the management of the epidemic, has helped to confirm and emphasize the importance of a community-based approach in health care—integrated with the hospital’s functions for the care of complex conditions and the need for specialized assistance.

Prioritising models of healthcare service delivery for a more sustainable health system: a Delphi study of Australian health policy, clinical practice and management, academic and consumer stakeholders.

Objectives Healthcare expenditure is growing at an unsustainable rate in developed countries. A recent scoping review identified several alternative healthcare delivery models with the potential to improve health system sustainability. Our objective was to obtain input and consensus from an expert Delphi panel about which alternative models they considered most promising for increasing value in healthcare delivery in Australia and to contribute to shaping a research agenda in the field. Methods The panel first reviewed a list of 84 models obtained through the preceding scoping review and contributed additional ideas in an open round. In a subsequent scoring round, the panel rated the priority of each model in terms of its potential to improve health care sustainability in Australia. Consensus was assumed when ≥50% of the panel rated a model as (very) high priority (consensus on high priority) or as not a priority or low priority (consensus on low priority). Results Eighty-two of 149 invited participants (55%) representing all Australian states/territories and wide expertise completed round one; 71 completed round two. Consensus on high priority was achieved for 59 alternative models; 14 were rated as (very) high priority by ≥70% of the panel. Top priorities included improving medical service provision in aged care facilities, providing single-point-access multidisciplinary care for people with chronic conditions and providing tailored early discharge and hospital at home instead of in-patient care. No consensus was reached on 47 models, but no model was deemed low priority. Conclusions Input from an expert stakeholder panel identified healthcare delivery models not previously synthesised in systematic reviews that are a priority to investigate. Strong consensus exists among stakeholders regarding which models require the most urgent attention in terms of (cost-)effectiveness research. These findings contribute to shaping a research agenda on healthcare delivery models and where stakeholder engagement in Australia is likely to be high. What is known about the topic? Healthcare expenditure is growing at an unsustainable rate in high-income countries worldwide. A recent scoping review of systematic reviews identified a substantial body of evidence about the effects of a wide range of models of healthcare service delivery that can inform health system improvements. Given the large number of systematic reviews available on numerous models of care, a method for gaining consensus on the models of highest priority for implementation (where evidence demonstrates this will lead to beneficial effects and resource savings) or for further research (where evidence about effects is uncertain) in the Australian context is warranted. What does this paper add? This paper describes a method for reaching consensus on high-priority alternative models of service delivery in Australia. Stakeholders with leadership roles in health policy and government organisations, hospital and primary care networks, academic institutions and consumer advocacy organisations were asked to identify and rate alternative models based on their knowledge of the healthcare system. We reached consensus among ≥70% of stakeholders that improving medical care in residential aged care facilities, providing single-point-access multidisciplinary care for patients with a range of chronic conditions and providing early discharge and hospital at home instead of in-patient stay for people with a range of conditions are of highest priority for further investigation. What are the implications for practitioners? Decision makers seeking to optimise the efficiency and sustainability of healthcare service delivery in Australia could consider the alternative models rated as high priority by the expert stakeholder panel in this Delphi study. These models reflect the most promising alternatives for increasing value in the delivery of health care in Australia based on stakeholders' knowledge of the health system. Although they indicate areas where stakeholder engagement is likely to be high, further research is needed to demonstrate the effectiveness and cost-effectiveness of some of these models.

Examining the health and well-being profile of people experiencing primary homelessness: the social work perspective at a major metropolitan teaching hospital.

Objective The literature has established a significant increase in morbidity and mortality among people experiencing primary homelessness, along with a pattern of using acute hospitals in place of primary healthcare services. This study examined how health services can engage and support people experiencing homelessness. Methods Participants were prospectively identified by acute hospital social workers in the course of providing usual care. All participants identified as experiencing primarily homelessness immediately before acute inpatient hospital admission. This study used the Vulnerability Index - Service Priority Decision Assistance Tool (VI-SPDAT) and Personal Wellbeing Index - Adult (PWI-A) to evaluate vulnerability and well-being respectively. VI-SPDAT data was analysed using frequencies and proportions for categorical variables and mean ± s.d. for continuous variables. PWI-A data was analysed using one sample t-tests were used to compare the study sample against representative data from the general population. Study data identified factors present in the sample population which are likely to impact their engagement with health services. Results On the PWI-A, study participants (n = 14) scored significantly lower on all measures of well-being than a representative sample from the general population (P ≤ 0.05). The VI-SPDAT indicated that 79% of participants experienced trimorbid physical, mental and substance misuse issues, and had high rates of indicators of past or current trauma, such as abuse or assault leading to or occurring while homeless (71%) and being raised in foster care (50%). Conclusions In conclusion, a model of health care provision to a homeless population should incorporate a trauma-informed, multidisciplinary approach across the inpatient-community continuum. This is consistent with findings and recommendations of other studies and will lead to better health and well-being outcomes. The anticipated benefits of such an approach include a decrease in preventable health conditions and opportunities to address issues that are not the primary reason for seeking health care, including access to housing and treatment for substance misuse. What is known about the topic? It has been established in the literature that people who are experiencing primary homelessness are likely to experience morbidity and mortality at a far higher rate than domiciled people. It has also been established that an underutilisation of primary and preventative healthcare services by this group results in a higher rate of preventable health conditions than for domiciled people. What does this paper add? This paper adds information regarding personal well-being and indicators of vulnerability in a population of patients who were identified as experiencing primary homelessness during an acute hospital inpatient admission. Analysis of these results provides a picture of the types of health conditions experienced by the participants, as well as indicators of trauma and adverse life events. We propose a model of healthcare service delivery that this study indicates would decrease the rate of preventable health conditions in the homeless population. This model would also provide a way to engage people experiencing homelessness. This then provides an avenue by which issues other than the primary reason for seeking health care can be addressed with this group, such as housing and treatment for substance misuse. What are the implications for practitioners? This paper provides a proposed model of health care delivery based on evidence from the present study and other literature. The evidence suggests that the model proposed would more effectively engage people experiencing homelessness in addressing their healthcare needs and reducing unnecessary utilisation of acute hospital inpatient beds.

Exploring an Innovative Care Model and Telemonitoring for the Management of Patients With Complex Chronic Needs: Qualitative Description Study.

BackgroundThe growing number of patients with complex chronic conditions presents an urgent challenge across the Canadian health care system. Current care delivery models are overburdened, struggling to monitor and stabilize the complex needs of this growing patient population.ObjectiveThis qualitative study aimed to explore the needs and perspectives of patients and members of the care team to inform the development of an innovative integrated model of care and the needs of telemonitoring (TM) for patients with complex chronic conditions. Furthermore, we explored how these needs could be successfully embedded to support this novel model of complex chronic care.MethodsA qualitative description design was utilized to conduct and analyze 29 semistructured interviews with patients (n=16) and care team members (CTM) (n=13) involved in developing the model of care in an ambulatory care facility in Southern Ontario. Participants were identified through purposive sampling. Two researchers performed an iterative thematic analysis using NVivo 12 (QSR International; Melbourne, Australia) to gain insights from examining multiple perspectives of different participants on complex chronic care needs.ResultsThe analysis revealed 3 themes and 13 subthemes, including the following: (1) adequate health care delivery remains challenging for patients with complex care needs, (2) insights into how to structure an integrated care model, and (3) opportunities for TM in an integrated model of care. Participants not only identified continued challenges in accessing and navigating care in a fragmented and disconnected delivery system but also identified the need for more self-management support. Patients and CTM described the structure of an integrated model of care, including the need for a clear referral and triage processes and composing a tight-knit circle of collaborating interdisciplinary providers led by a nurse practitioner (NP). Finally, opportunities for TM in an integrated model of care were identified, including increasing access and communication, the ability to monitor specific signs and symptoms, and building a clinical workflow around TM-enabled care.ConclusionsDespite entrenched health care service delivery models, a new model of care is acutely needed to care for patients with complex chronic needs (CCN). NPs are in a unique position to lead TM-enabled integrated models of care. TM can facilitate frequent and necessary monitoring of patients with CCN with more than one condition in integrated models of care.

Identifying alternative models of healthcare service delivery to inform health system improvement: scoping review of systematic reviews

ObjectiveTo describe available evidence from systematic reviews of alternative healthcare delivery arrangements relevant to high-income countries to inform decisions about healthcare system improvement.DesignScoping review of systematic reviews.Data sourcesSystematic reviews of...

Telehealth: Disrupting Time for Health Care Quantity and Quality.

Telehealth, defined simply as the delivery of health care services over a distance by using telecommunication technology, has become one of the most disruptive innovations in modern health care. This article explores the history and impact telehealth has had on provider and consumer supply and demand for time, becoming a widely adopted technological health care service delivery model that has demonstrated significant benevolent contributions to the health care industry and the patients it serves.

Transitional care: the evolution of an ever-green service to make integrated care happen

The coordination of care across the health care continuum represents the most critical organisational knot to meet the actual implementation, management, and outcome evaluation of a patient’s care plan. In fact, poor coordination of services, fragmentation of treatments, lack of discharge planning and ineffective handoff of information between care providers can lead to poor transitions and, in turn, can cause overlaps with treatment plans, duplicative testing, discrepancies in medications, missed physician follow-up, patient dissatisfaction and, consequently, burgeoning of health care costs. Transitional Care TC models are gaining increasing value and a wide spread out, at the international level, to improve the quality and efficiency of health services’ delivery and have been piloted and tested in different Countries as well as within different healthcare service delivery models and organisations. TC models have a long-lasting presence in the literature if we consider discharge management and planning services, however, analysis of the emergence of new TC models, especially exploiting the health service management perspective and the interest to generalise models of care to support health managers and policy makers are very limited. In this line, there is a widespread recognition across experts that more research is needed on services organisations. In this broad scenario, we aim to provide a comparative analysis of TC patterns across Europe by cross-tabulating independent and dependent variables featuring the institutional and organisational context of development. We therefore aim to explore what are the main characteristics of the health service delivery model; what are the opportunities, threats and levers of improvement across different organisational configurations; and to what extent organizational arrangements of TC models may impact their capacity to influence the health service delivery model, the strategic planning and indeed the capacity to meet patients’ needs. We employed mixed methods in order to exploit a multiple case-study analysis. These included a literature review of theoretical frameworks and TC experiences developed at an international level and an in-depth analysis of several TC experiences analysing local documents and interviewing key managers of the services. Whereas the new models of TC retain the original objectives of discharge management and planning services, their role and organisation is changing dramatically within the renewed model of delivery designed by managed care models and the search for integration across the overall care system from community to acute to end of life care. Of interest, in most cases, either due to the complexity of the new TC models, which require not only discharge management but the overall management of patient and of transitions across care settings, or due to the fragmentation of services, TC services have been externalised to new agencies or services outside the delivery system i.e. the service centre. The latter organisational choice allows TC models to serve the organisations as well as the patients and families. On the contrary, where TC models have been established within healthcare organisation, they are located as a strategy service unit belonging to the strategic board of managers, but these patterns serve only the organisation and not the patients.

Integration of mental health services into an innovative health care delivery model for children with chronic conditions

Coordinated Healthcare for Complex Kids (CHECK) is an innovative health care delivery demonstration project for children with chronic conditions and is supported by the Centers for Medicare and Medicaid Services Health Care Innovation Award Round Two. CHECK integrated behavioral health care into the model of comprehensive healthcare delivery. CHECK has provided a total of 31,470 services to 5923 children and their families. CHECK has provided 12,243 mental health screenings, 18,411 preventive interventions, 7511 consultative services, 2443 direct interventions, and 3105 referral services. A significant relationship was found between type of mental health service and disease and age. Children received different types of mental health services based on their type of chronic medical condition and age. CHECK is a promising model that has the potential to inform the development of future integrated health and behavioral health care service delivery models for children and youth with chronic medical conditions.

Health consumer and health provider preferences for an integrative healthcare service delivery model: A national cross-sectional study.

Although global interest in integrative healthcare (IHC) has escalated over the past few decades, stakeholder perspectives and preferences in relation to IHC remain poorly understood. Our study aimed to address this knowledge gap by exploring Australian health consumer (HC) and healthcare provider (HCP) understanding, attitudes and preferences for an IHC service delivery model, and to translate these views into an operational framework for IHC. The research used a cross-sectional study design. Eligible persons were informed of the study using a multi-modal recruitment approach. Adult HCs and HCPs from any medical, nursing, allied and traditional and complementary medicine discipline, who had internet access and resided in Australia, were eligible to complete the 55-item online questionnaire. Four hundred and nine participants completed the survey. HCs and HCPs shared a common understanding of, and positive attitude towards, IHC. When asked about the IHC service delivery model, participants advocated the provision of diverse healthcare and support services across multiple centres, to individuals mainly presenting with chronic/terminal conditions. The preference was for these services to be charged as fee-for-service, paid using a split payment system, and managed by a customised team of clinicians following triage by a non-medical staff member. These findings were subsequently translated into an operational framework for IHC. This is first known study to translate HC and HCP attitudes and preferences into an operational framework for IHC. A logical next step of this work will be to ascertain the feasibility of this model in primary care.

Decision-Making in Audiology: Balancing Evidence-Based Practice and Patient-Centered Care.

Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices.

The experiences of administrators, educators and clinicians during the development and implementation of interprofessional clinical learning units

Introduction: Interprofessional and collaborative practice is essential for effective patient care in new and evolving healthcare service delivery models. Traditionally, interprofessional clinical learning has focused on students and clinicians, however healthcare administrators and managers may play a key role in the success of interprofessional clinical learning. In this paper, the triumphs and trials of those engaged in the interprofessional clinical learning unit (IPCLU) conceptualisation, development and implementation are presented. Methods: Over 60 executives, directors, frontline managers, educators, researchers and staff participated in the development and initiation of an IPLCU in three distinct clinical settings in Alberta: tertiary rehabilitation, acute care and continuing care. Focus groups were used to explore participants’ experiences of developing, initiating and implementing an IPLCU. Results: A qualitative analysis revealed the following predominant themes that describe significant outcomes or considerations: pre-IPCLU challenges, team dynamics, student experiences, cultural changes, sustainability and leadership. Conclusions: Successful implementation of IPCLUs can be achieved with participation and leadership from clinicians and educators and the support of administration at both the academic institution and the healthcare agency.