Home Visits Research Articles

Enhancing Healthcare Management: Assessing User Acceptance and Usability of the 'SmartCG' Mobile Application.

In Thailand, increasing caregiving needs for senior citizens, particularly in low-income homes, may elevate the caregiver (CG) burden. This study assesses the user acceptance and usability of the 'SmartCG' mobile application in enhancing healthcare management. The app offers health evaluations, home visits, knowledge management, screening forms, and care plans. Using the Technology Acceptance Model, 402 caregivers from Mahasarakham province evaluated the app's usability on a 5-point Likert scale. Results showed a significant increase in acceptance scores after using SmartCG (11.49 ± 1.54 to 13.19 ± 2.74, p < 0.001). Users reported high satisfaction with its ease of use (mean = 4.10 ± 0.61) and found the knowledge-based menu (mean = 4.07 ± 0.63) and visiting/map menus (mean = 4.05 ± 0.63) user-friendly. This study provides empirical evidence that the SmartCG app effectively enhances healthcare management, emphasizing the importance of user-friendly interfaces in healthcare technology.

Pengisian Family Folder Untuk Optimalisasi Kegiatan Home Visit Pasien Diabetes Mellitus Tipe II

The existence of health services that are accessible, good quality, and answer the needs of community can improve public health. One of the programs provided by health center to resolve patient problems is the Home Visit. During the home visit, various accurate and up-to-date data will be obtained regarding the health condition of patients and family members, environmental conditions around the house, and relationships between family members. One of the supporting instruments that can be used for home visit as an effort to optimize health services is the availability of medical records in the form of a family folder. Community service activities carried out in the form of home visits to one patient with Type II Diabetes Mellitus in the working area of the Jeulingke Health Centre. Home visit activities to the preparation of reports are supervised by supervisors from the Family Medicine Department of the Faculty of Medicine, Syiah Kuala University, Banda Aceh. Home visits were carried out twice in one family. The aims are to evaluate treatment, obtain more information about the health condition of patient and family, patient-family relationship, living conditions to the environmental conditions around the patient and family members who live with the patient. Home visit activities are complemented by completing the family assessment tools which consists of a genogram, family life cycle, family map, family APGAR, family SCREEM and family life line.

"Why should care workers be any different from prison workers?" A qualitative study of second-hand smoke exposure during home-care visits and potential measures to eliminate exposure.

Despite world-leading measures in place to protect employees from second-hand smoke exposure in workplaces in the United Kingdom, workers who deliver health and social care in private homes remain unprotected legally in this setting from second-hand smoke exposure (SHS). Fourteen individuals took part in either an in-depth telephone interview (n = 11) or an online focus group discussion (n = 3), including home-care workers (n = 5) and managers (n = 5) based in Lanarkshire (Scotland) and local/national policy makers (n = 4). Participants were asked about the extent to which exposure to SHS is an issue during home visits and possible additional measures that could be put in place to eliminate exposure. Participants highlighted the difficulties in balancing the provision of care in a person's own home with the right of workers to be able to breathe clean air and be protected from SHS. Current strategies to reduce staff exposure to SHS during home visits were often reported as inadequate with SHS not a hazard considered by managers beyond protecting pregnant staff or those with pre-existing respiratory conditions such as asthma. Simple respiratory protective equipment (as used during the COVID-19 pandemic) was rightly identified as being ineffective. Methods such as nicotine replacement therapy and e-cigarettes were identified as potential ways to help people who smoke achieve temporary asbstinence prior to a home visit. Implementing appropriate and proportionate measures to protect home-care workers from the harms posed by SHS should be a priority to help protect the health of this often overlooked occupational group.

Reaction to at-home air purifiers installed to reduce traffic-related air pollution in near-highway residences

Background and aimTraffic-related ultrafine particle pollution near highways is associated with adverse health. Reducing exposure by use of portable air purifiers in homes is one approach to reducing this risk. However, the reaction of residents to having air purifiers in homes is not well studied.MethodsWithin the framework of our randomized crossover trial of air purifiers in homes near a major highway, we collected data about participants’ use and reactions to air purifiers using questionnaires at their 30-day and 90-day home visits, recorded electricity consumption using HOBO monitors, and conducted structured interviews with participants.ResultsNearly all 150 participants reported running the air purifiers virtually 24 h every day in both their living room and their bedroom in the prior month. The units’ HOBO electricity use, from a subset of 45 participants, supported the participants’ responses from the questionnaire. Approximately 80% of participants reported setting their air purifier on the medium setting. Tolerance to air purifier noise increased significantly between the 30-day and 90-day home visits, with approximately two thirds reporting not being bothered at all by the noise. The qualitative interviews in a subset of 26 participants yielded consistent responses to those from the questionnaires. Size of unit, airflow, and energy consumption were additional concerns that emerged during the interviews.ConclusionsResults from the questionnaires, HOBO data, and structured interviews all suggest participants had positive reactions towards the presence of in-home APs, and therefore may be receptive to using air purifiers in their homes on a regular basis.Trial registrationClinicalTrials.gov, NCT04279249. Registered 09 October 2019.

Protocol for an intervention for new parents experiencing moderate psychosocial adversity: pilot feasibility randomised trial

ABSTRACT Background Parents exposed to psychosocial adversities often experience challenges which, combined with the needs of a new-born infant, can be difficult to manage and increase the risk of poor outcomes for both parents and infants. Psychosocial adversity can disrupt the development of parental-foetal attachment to the baby during pregnancy, which can have a negative effect on parental care and quality of interaction during the postnatal period. This intervention is based on the proposition that enhanced parental capacity to mentalise and emotionally connect to unborn children during pregnancy, and better understanding about how to manage distressing infant behaviour (i.e., persistent crying and sleep problems) will: (i) promote the development of secure parent-infant attachment; (ii) improve antenatal bonding and postnatal parenting; and, (ii) reduce parental distress. Method This protocol is for a pilot randomised control trial evaluating a new intervention, which makes use of innovative technologies to support parents experiencing moderate psychosocial adversity (Australian New Zealand Clinical Trials Registry: ACTRN12622000287730). The New Technology for New Parents (NTNP) intervention provides support using antenatal ultrasound scans and ‘virtual home visits’ during the perinatal period. Quantitative outcomes include mentalising capacity, parental-foetal/infant attachment, and parental competence. Conclusion To the best of our knowledge, no study has evaluated the combined effectiveness of two novel technologies (3D/4D ultrasound scans and virtual home visits) to support parents across the antenatal and postnatal periods. This protocol, which includes the rationale for this innovative intervention, addresses a gap in services for parents experiencing moderate psychosocial adversity.

Parents in the Driver's Seat-Experiences of Parent-Delivered Baby-mCIMT Coached Remotely.

Background/Objectives: Recent guidelines on early intervention in children at high risk of cerebral palsy (CP) recommend parental involvement and family-centered home-based interventions with parents as primary trainers. Therapist coaching by home visitation is resource demanding, and telerehabilitation is a viable option for remote intervention and coaching. This study aims to describe parents' experiences of engaging in Baby-mCIMT coached remotely. Their infants are at high risk of unilateral cerebral palsy and the parents have been the primary trainers in regard to home-based intervention, optimizing the use of the affected hand. Methods: A qualitative approach involving semi-structured interviews with eight parents was employed. Data were analyzed using qualitative content analysis. Results: The overarching theme "Parents in the driver's seat-learning through remote coaching to create conditions to enhance the child's motor skills" describes parents' experiences as primary training providers. The following three underlying categories with subcategories were identified: (1) Baby-mCIMT coached remotely in an everyday context-practical and technical prerequisites; (2) the child's response and the therapists' coaching supports active parental learning; (3) capability and sense of control-strengthening and demanding aspects. Conclusions: Our findings revealed that Baby-mCIMT coached remotely empowered the parents as primary trainers, which provided them with opportunities for understanding and learning about their child and their development. The findings underscore the importance of responsive professional guidance and a strong therapist-parent relationship to succeed with the Baby-mCIMT program coached remotely and to manage the digital coaching format.

Barriers and facilitators of screening postpartum depression by primary maternal health workers: A mixed methods study based on the normalization process theory

BackgroundPostpartum depression (PPD) significantly impacts mothers and children's health. China aims to incorporate PPD screening in postpartum home visits, but research on implementation barriers and facilitators is scarce. We designed and implemented a new PPD screening program in Changsha, China, requiring maternal health workers to integrate PPD screening into their postpartum home visits. AimsTo identify real-world barriers and facilitators associated with integrating PPD screening into routine home visits from the perspective of maternal health workers. MethodsWe employed a mixed-methods approach. Maternal health workers involved in the newly introduced PPD screening program were included. Guided by Normalization Process Theory (NPT), quantitative data were collected using the NoMAD instrument, and qualitative data were obtained through semi-structured interviews. Data were analyzed using descriptive statistics for the survey and thematic analysis for the interviews. ResultsAll 42 maternal health workers involved in the new PPD program completed the quantitative survey, and nine participated in qualitative interviews. The NoMAD survey revealed high scores for Coherence and Cognitive Participation, but lower scores for Collective Action, particularly regarding insufficient skills and resource adequacy. Thematic analysis identified several barriers, including workload concerns, the need for enhanced psychological healthcare capacity, and lack of economic incentives. Facilitators included the integration of structured feedback and clear referral pathways. ConclusionAddressing identified barriers through targeted skill training, well-defined referral pathways, and formal recognition of the screening program in performance evaluations could help achieve successful normalization.

Randomized controlled trial of the parents as teacher home visiting program: Outcomes of the intervention on families at six month follow-up

Family support programs are considered central to improving the health and development of children, and home visitation remains one of the most frequently used early intervention strategies. This study utilized a randomized controlled trial (RCT) design to test the effectiveness of the Parents as Teachers (PAT) home visiting program intervention on child and caregiver outcomes, measured at six months post enrollment, with families randomized to study groups. Four PAT affiliates selected for the study are “blue ribbon” programs that meet certain quality standards. A total of 461 families (a 69 % retention rate) completed both baseline and 6-month data collection, including n = 295 for intervention and n = 166 for control. Differential attrition was 3.7 %. Baseline equivalency tests confirmed that the random assignment was effective and the groups were equivalent. Significant differences were observed between intervention and control groups, favoring the PAT intervention group, in 3 of the 4 domains assessed: child development, including Vineland-II Listening and Understanding and Talking and frequency of reading to the child; parenting practices, including improved sense of parenting efficacy and hopefulness; and family health and safety, including improved safety practices at home and reduced risk scores that capture depression and parenting stress. Estimated effect sizes for significant measures ranged from 0.12 to 0.28 and thus were in the range of what would be considered to have meaningful impact when compared with similar studies. Our findings contribute significantly to the understanding of home visitation program outcomes and adds to existing research by showing gains in child development that can be attributed to the PAT program. The RCT provides valuable evidence supporting the PAT program’s role in enhancing child development, improving parenting practices, and ensuring family health and safety. However, the lack of difference in service utilization between groups and the challenges faced during the study highlight the need for consideration of external factors, such as the impact of the COVID-19 pandemic on service availability and utilization. This study contributes to the broader understanding of early childhood interventions and their efficacy in real-world, community settings.

Navigating Real-World Randomized Clinical Trials: The 'Parents as Teachers' Experience.

The Parents as Teachers Randomized Controlled Trial (PAT RCT) Case Study investigates the multifaceted impact of implementing the PAT RCT in Arizona, U.S.A., shedding light on both the positive and negative effects. There has been a recent focus on improving the implementation of RCTs in community settings, as this issue has not been fully addressed. This research presents a case study examining the implementation of a community-based RCT in home visitation. This study also addresses the strategies that can be employed to mitigate some of the challenges in the implementation of an RCT, offering valuable insights for future RCTs in the domain of home visiting. The PAT program, aimed at providing parent education and family engagement for children from birth to kindergarten, encompasses a range of services, including personal visits, group connections, child screenings, and community resource linkages. The Parents as Teachers Randomized Controlled Trial (PAT RCT) directly promotes health by educating parents about health and wellness as well as providing early child screenings and heath referrals, all of which enhance health outcomes through timely interventions and improved parental practices. Lessons from the study also aim to improve the implementation of future health-related RCTs, ensuring effective delivery and impactful results.

Little Talks: Building Home Visiting’s Capacity to Promote Communication and Language Skills for Children under Three Years of Age

Poverty continues be most prevalent among young children under three years of age, when development, particularly in communication and language skills, is rapid and vulnerable to socioeconomic impacts. Home visiting was intentionally formulated to support parents in promoting children’s development and health, offsetting poverty’s threats. Little Talks, a parent-mediated intervention to promote children’s communication and language growth, was designed for implementation in home visiting programs. Developed through community-partnership research methods, Little Talks is a modular intervention that is tailored to parents’ styles and preferences for interacting with their children. A randomized control trial of Little Talks’ effectiveness in attaining outcomes aligned with the two-generational processes inherent in home visiting was undertaken. Situated in an Early Head Start program, home visitors and the families they served were randomly assigned to receive EHS with Little Talks and typical EHS services. Assessed across four time points during a 10-month period, Little Talks was demonstrated to significantly enhance the quality of home visits and parents’ involvement in their children’s early learning experiences. In addition, parents’ depressive symptoms did not increase as noted for the comparison condition. Communication and language growth improved for EHS Little Talks children, although statistical significance was not attained. Moreover, parenting outcomes were greatest for families who were less acculturated to US either by immigration status and/or language preferences. Implications advancing Little Talks as a feasible and effective addition to home visiting programs are offered.

Corporal Punishment of Young Children: Parents’ Perceptions and Family Practices

ABSTRACT Our study aim was to examine the perceptions and experiences of parents regarding corporal punishment of children during early childhood within the context of traditional families. Participants of this qualitative phenomenological study were parental pairings of 11 preschool-aged children living in Eyyübiye district of Şanlıurfa, Türkiye. Data were collected through participant interviews during home visits and content analysis was followed for data analysis. It was revealed through the findings that parents used various forms of corporal punishment as a means of protecting family dignity as well as disciplining their children. It was also pointed out those traditional and cultural elements including parental respect, patriarchal structure, parental responsibilities of children, religious beliefs, and intergenerational transmission, which shaped how parents utilized and perceived corporal punishment. Finally, our study results were discussed in light of the relevant literature.

Factors associated with non-response and nutrional status of non-responders at 6-month post-discharge: a cohort study nested in a MUAC-based nutrition programme for acutely malnourished children in Mirriah, Niger.

In the treatment of acute malnutrition (AM), non-response is considered a treatment failure for not meeting recovery criteria within a therapeutic window of 12-16 weeks, but this category of children is misunderstood. As current research emphasizes ways to simplify and optimize treatment protocols, non-response emerges as a new issue to enhance program efficiency. A prospective cohort study was conducted from 2019 to 2020 at two health centres in Mirriah, Niger among children aged 6-59 months with uncomplicated AM treated under the Optimising treatment for Acute MAlnutrition (OptiMA) protocol. Children who did not meet recovery criteria by 12 weeks (mid-upper arm circumference (MUAC) ≥125 mm without oedema for two consecutive weeks) were classified as non-responders. Non-responders received a home visit six-months post-discharge. Logistic regression was used to analyze factors associated with non-responders compared with children who recovered. Of the 1,112 children enrolled, 909 recovered and 139 were non-responders, of which 127 (80.6%) had significant MUAC gain (mean: +9.6 mm, sd = 5.1) at discharge. Girls (adjusted hazard ratio (aHR) = 2.07, 95% CI 1.33-3.25), children <12 months of age (aHr = 4.23, 95% CI 2.02-9.67), those with a MUAC <115 mm (aHR = 11.1, 95% CI 7.23-17.4) or severe stunting (aHR = 2.5, 1.38-4.83) at admission and a negative or flat MUAC trajectory between admission and week 4 (aHR = 4.66, 95% CI 2.54-9.13) were more likely to be non-responders. The nutritional status of non-responders had generally improved 6 months after discharge, but only 40% had achieved MUAC ≥125 mm. Non-responders are not a homogeneous group; while most children ultimately show significant nutritional improvement, rapid hospital referral is crucial for those not gaining MUAC early in treatment. As efforts to expand MUAC-based programming progress, adapting exit criterion and/or providing additional food supplementation with smaller daily ration for children with risk factors discussed here may help improve programme efficiency without adding to the cost of treatment.

Development, Acceptability, and Initial Implementation of an Interactive Text-Messaging Program for Fathers with Low Income.

This study describes the development, acceptability, and implementation of an interactive text messaging program to engage fathers enrolled in home visitation programs. We used an iterative development approach that integrated rapid testing of intervention content with acceptability feedback from program participants to examine the processes of implementation. In Study 1, we describe the rapid testing framework and present data from 171 men who provided feedback on Text4Dad content via three online surveys. In Study 2, a case study, we use administrative data from 108 fathers with whom we pilot-tested Text4Dad in three community-based home visiting programs, with the program implemented by fatherhood program community health workers (F-CHWs). Content analysis of exchanges between F-CHWs and fathers describes the specific use of Text4Dad. Across all three online surveys, fathers reported positive reviews of the Text4Dad content. The F-CHWs used Text4Dad mainly to push out information, especially that related to home visit scheduling and local events, instead of engaging in bidirectional interactions with fathers. We conclude with a set of recommendations for social service and maternal and child health providers regarding the feasibility of implementing text messaging to support home visiting in community-based settings.

Care models for older people based on a case study-Geriatrics as an active discipline

Geriatrics can enable and monitor aholistic care of older people through acomprehensive geriatric assessment in a structured way. Therefore, it must be integrated much more closely with preventive, rehabilitative and acute care units. Geriatrics are not seen in any aspects as areplacement for general practitioners or in-hospital structures but much more as asupplement to them. With its function-oriented concept, geriatrics can best coordinate the demographically necessary triage between prevention, acute treatment, rehabilitation and palliative care, thus avoiding undertreatment and overtreatment. This can only succeed in collaboration with general practitioners and specialist colleagues. The article categorizes geriatric care structures, such as preventive home visits, acute complex medical treatment, delirium prevention, outpatient and inpatient rehabilitation services based on acase example and makes proposals for structural changes that urgently need to be considered in the current healthcare reform, such as outpatient geriatric centers (AGZ).

"Sustaining NSW Families" as a hybrid face-to-face/virtual program: Experiences of clients and clinicians.

To explore clients' and clinicians' perspectives about the acceptability and perceived outcomes of the Sustaining New South Wales (NSW) Families (SNF) program shifted to a hybrid service delivery model during the COVID-19 pandemic. Mixed methods design comprising cross-sectional online surveys and a focus group. Eighty clients who accessed the SNF service and 12 SNF clinicians. Anonymous client survey comprising questions about perceived benefits and impacts of the hybrid SNF program model, and suggestions for change. Clinician focus group discussion about perceived benefits and challenges of the hybrid SNF model. The hybrid SNF program is a child and family health nursing home visitation program for families with moderate level psychosocial risks. It comprises a mix of face-to-face and virtual telehealth/telephone appointments, delivered during pregnancy and up to 2 years postpartum. Clients reported high levels of satisfaction with the program, and improvements in confidence and decision-making. Clinicians spoke of increased efficiency and flexibility, and capacity for ongoing service provision during the COVID-19 period. Technology access issues were identified as a barrier. Overall, however, both clients and clinicians expressed a preference for face-to-face SNF service provision. While further studies are required to test clinical outcomes, the hybrid SNF model is acceptable to clients and clinicians.

Impact of the Korea Early Childhood Home-visiting Intervention (KECHI) on child health and development and maternal health: a randomised controlled trial protocol

IntroductionRandomised controlled trials (RCTs) of early childhood home-visiting interventions led by nurses have been conducted mainly in Western countries, whereas such trials have been limited in non-Western cultures, including Asia....

The effect of nursing interventions applied at home to improve rational use of medicines and awareness of elderly individuals: A randomized controlled study.

The aim of this study was to evaluate the effect of nursing interventions applied to elderly individuals to improve rational use of medicines (RUM) and awareness through home visits. It was carried out in a prospective, randomized controlled experimental design with the pretest-post-test control group. The study was completed with 74 elderly individuals aged ≥65 years living in a rural area. The intervention group received education, counselling, brochures and pill boxes through home visits to increase RUM and awareness. The study data were collected between September and December 2022 using the face-to-face interview method, the elderly identification form, the Rational Use of Medicines Scale and the Rational Drug Use Awareness Scale. After nursing interventions were applied at home, it was determined that, the mean scores of RUM and Awareness of RUM of the intervention group increased compared to the control group and that, interventions to improve RUM and awareness were effective. In line with these results, training sessions on RUM should be organized periodically for elderly individuals and home visits should be planned by nurses at regular intervals to ensure the sustainability of RUM in the home environment.

Stress and child internalizing symptoms: Examining the moderating role of Latino fathers' warmth and support.

Latino immigrants within the United States experience various stressors, which have been linked to the development and exacerbation of internalizing symptoms among Latino youth. Therefore, it is crucial to explore factors that may buffer the impact of stress among immigrant families. Fathers may influence child outcomes through positive parenting behaviors, yet Latino fathers have been underrepresented in research. This study examined how paternal warmth and support may moderate the association between the accumulation of stress and child internalizing symptoms among low-income, Latino immigrant families. Participants included 62 children between the ages of 6 and 10, and their paternal caregivers (94% fathers; 90% born in Mexico). This study utilized a multi-method approach including parent-report, child-report and observational measures. Participants completed questionnaires and video-recorded family interaction tasks during home visits. Stress was positively associated with child-reported depression. Self-reported paternal warmth was associated with fewer parent-reported child internalizing symptoms and moderated the effects of stress on symptoms. Analyses showed a significant positive association between paternal stress and child internalizing symptoms for children with the lowest levels of parental warmth. However, when paternal warmth was high, accumulation of stress and child internalizing symptoms were not related. Thus, high levels of warmth buffered the impact of stress on internalizing symptoms. This study highlights the importance of Latino fathers' parenting behaviors on child internalizing symptoms.

Evaluation of Patients Receiving Home Care Services and Services Provided

Aim: It is important to know patient characteristics and medical needs in the planning and operation of home care services (HCS). In this study, the descriptive characteristics of patients who received HCS and the medical services provided were evaluated. Materials and Methods: Patients receiving HCS for at least one-year were included this cross-sectional study. Patient records were examined and in addition to descriptive features, the number of visits made by the HCS unit in the last year for each patient, the reasons for these visits and the procedures performed was recorded. Results: While 60.4% of the patients were female, 83.6% were ≥65 years. It was determined that 72.6% of the patients were bedridden, 30.5% used a urinary catheter and 32.9% had pressure ulcer. A total of 2774 (median=16) home visits were made, and the most common medical procedures were blood test and wound dressing. Functional bed use and pressure ulcer for wound dressing, rural location and diabetes for blood test and rural location, urinary catheter use and history of pulmonary embolism for urinalysis were determined as risk factors. Conclusion: The characteristics of the patients receiving HCS, and the services provided were determined and it was seen that they were related to each other.

Care models for individuals with chronic multimorbidity: lessons for low- and middle-income countries

BackgroundPatients with multiple long-term conditions requires understanding the existing care models to address their complex and multifaceted health needs. However, current literature lacks a comprehensive overview of the essential components, impacts, challenges, and facilitators of these care models, prompting this scoping review.MethodsA scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews guideline. Our search encompassed articles from PubMed, Web of Science, EMBASE, SCOPUS, and Google Scholar. The World Health Organization’s health system framework was utilized to synthesis the findings. This framework comprises six building blocks (service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance) and eight key characteristics of good service delivery models (access, coverage, quality, safety, improved health, responsiveness, social and financial risk protection, and improved efficiency). Findings were synthesized qualitatively to identify components, impacts, barriers, and facilitators of care models.ResultsA care model represents various collective interventions in the healthcare delivery aimed at achieving desired outcomes. The names of these care models are derived from core activities or major responsibilities, involved healthcare teams, diseases conditions, eligible clients, purposes, and care settings. Notable care models include the Integrated, Collaborative, Integrated-Collaborative, Guided, Nurse-led, Geriatric, and Chronic care models, as well as All-inclusive Care Model for the Elderly, IMPACT clinic, and Geriatric Patient-Aligned Care Teams (GeriPACT). Other care models (include Care Management Plus, Value Stream Mapping, Preventive Home Visits, Transition Care, Self-Management, and Care Coordination) have supplemented the main ones. Care models improved quality of care (such as access, patient-centeredness, timeliness, safety, efficiency), cost of care, and quality of life for patients that were facilitated by presence of shared mission, system and function integration, availability of resources, and supportive tools.ConclusionsCare models were implemented for the purpose of enhancing quality of care, health outcomes, cost efficiency, and patient satisfaction by considering careful recruitment of eligible clients, appropriate selection of service delivery settings, and robust organizational arrangements involving leadership roles, healthcare teams, financial support, and health information systems. The distinct team compositions and their roles in service provision processes differentiate care models.