Implementation Of Care Program Research Articles

Real-world implementation of serious illness care program (SICP) in cancer care.

e24112 Background: The Serious Illness Care Program (SICP) is a system-based intervention, including a conversation guide, which facilitates improved advance care planning (ACP) conversations between clinicians and seriously ill patients. A recent randomized control trial found the program reduced symptoms of depression and anxiety amongst oncology out-patients and improved process outcomes. We implemented the SICP in our center to determine if the effects of this program could be translated into the real world. Methods: Two outpatient oncology clinics implemented the SICP, each over a 16-week period. Patients were identified based on an answer of “no” to the question “would I be surprised if this patient died within the next year?”, or any patient with a diagnosis of metastatic pancreatic cancer, or symptom scores of > 7 on more than three categories of the patient reported outcome dashboard. Physicians were trained on how to conduct the SICP conversation. One patient per week was identified and prepared to have the SICP conversation with the goal of at least 12 conversations in each 16-week period. Rates of SICP conversation documentation on our system’s “ACP and goals of care designation (GCD) Tracking Record” and GCD orders were recorded. Patient satisfaction after each conversation and physician comfort level over time were assessed. Results: 16 patients were identified (8 patients in each 16-week period). One patient was lost to follow-up. Of the remaining 15 patients who had the SICP conversation, 14 (93%) had documentation on the Tracking Record and 8 (53%) had a GCD order. This was a major improvement over baseline rates of documentation (e.g. < 1 % Tracking Record use and 16% GCD for patients with GI cancers). 14 patients completed satisfaction surveys, of which 12 (86%) felt “completely” or “quite a bit” more heard or understood. Physician comfort level increased from 3.6 to 4.8 and from 4.8 to 5 out of 5, respectively over each 16-week period. Conclusions: SICP implementation resulted in high rates of documentation of goals and preferences. Patients felt heard and understood by their healthcare team, and comfort in these conversations improved over time for physicians. The goal number of conversations was not met, but otherwise the SICP was feasible to implement in the real world. Further study is required to identify the appropriate triggers and barriers to routine SICP conversations.

The Manage Care Model - Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes.

Background:Most current care models are disease- or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus.Method:An iterative approach was used combining systematic literature search with qualitative methods, including a standardised survey of experts in chronic care (n = 92), an expert workshop of professionals (n = 22) and a multilingual online survey (n = 659). Using three consensus meetings involving researchers, policy makers and experts in chronic care, a limited number of core components and care recommendations was set up to develop a new chronic care model.Results:The developed ‘MANAGE CARE MODEL’ includes aspects of the health and social care system, resources derived from the living environment, aspects of health promotion and prevention, as well as an expanded understanding of improved outcomes as an integral part of chronic care.Conclusion:The MANAGE CARE MODEL provides guidance for the development and implementation of chronic care programs, regional networks and national strategies. Future research is needed to validate the model as an instrument of regional chronic care management.

Factor Affecting the Success of Aged-Friendly Primary Health Care Program for Elderly in Surabaya City

Introduction: The elderly are human who experience various decreases in anatomical, physiological, socialand economic aspects, this can cause some elderly aren’t able to be independent in fulfilling their dailyneeds. One of efforts to improve the quality of life for the elderly, through the government issued a policyon the implementation of Aged-Friendly Primary Health Care Program for the elderly. Purpose: This studyaimed to explore the factors that affect the success of Aged-Friendly Primary Health Care Program for theelderly.Method: This study used qualitative study with a phenomenological approach. The saturation of datawas obtained by 15 participants which were conducted the data collection by using indept interview. Dataanalysis used Collaizi analysis method.Results: The identification found four main themes and eight sub themes: (1) characteristics of elderly(physiological and psychological factors), (2) Health workers (knowledge, services quality provided); (3)Health facilities (the availability of tools and technology, the distance of health care); (4) Family support(material supports, psychological supports).Conclusion: Aged-Friendly Primary Health Care Program for the elderly was affected by several factors, allof the factors were interrelated so that it is needed a good coordination among the elderly, family and healthworkers to provide a quality of aged-friendly services for the elderly.

Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems.

Introduction eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics. Materials and Methods In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country). Results 85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development. Conclusions Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.

Quality of clinicians' conversations with patients and families before and after implementation of the Serious Illness Care Program in a hospital setting: a retrospective chart review study.

Seriously ill patients in hospital have indicated that better communication with practitioners is vital for improving care. The aim of this study was to assess whether the quality of conversations about serious illness improved after implementation of the Serious Illness Care Program (SICP). In this retrospective chart review study, we evaluated patients who were admitted to a medical ward at Hamilton General Hospital, had a stay of at least 48 hours, and were at risk for a lengthy stay or increased need for community-based services (inter-RAI Emergency Department Screener score of 5 or 6). The SICP study period was from Mar. 1, 2017, to Jan. 19, 2018. We used a validated codebook to assess the quality of documented conversations regarding serious illness for eligible patients before (usual care [control group]) and after SICP implementation (intervention group), specifically examining the following domains: patients' values and goals, understanding of prognosis and illness, end-of-life care planning, and code status or desire for other life-sustaining treatments. The study sample included 56 patients in the control group and 56 patients in the intervention group. The overall quality of documented conversations about serious illness was significantly higher in the intervention group than in the control group (p < 0.001) and was significantly higher in the subdomains of values and goals (p < 0.001), understanding of prognosis and illness (p < 0.001) and life-sustaining treatments (p = 0.03) but not end-of-life care planning (p = 0.48). Implementation of the SICP in a hospital setting was associated with higher quality of documented conversations regarding serious illness with patients at high risk for clinical or functional deterioration. The SICP is transferable and adaptable to a hospital setting, and was associated with an increase in adherence to best practices compared to usual care.

Barriers and enablers to the implementation of the Australian Osteoarthritis Chronic Care Program (OACCP)

Purpose: The Osteoarthritis Chronic Care Program (OACCP) is an osteoarthritis (OA) management program delivered through public hospitals in New South Wales (NSW), Australia. Implemented by the NSW Agency for Clinical Innovation the OACCP aims to reduce pain, improve function and quality of life of people with hip and knee OA through the provision of best evidence OA care delivered by a multidisciplinary team of healthcare professionals. The NSW Department of Health is scaling out OACCP to all public hospitals across the state.

Scaling Implementation of the Serious Illness Care Program Through Coaching

BackgroundWe designed group coaching calls to reinforce communication skill acquisition and Serious Illness Care Program uptake in adult primary care. MeasuresPercentage of primary care physicians (PCPs) who have documented a serious illness conversation in the electronic health record (EHR) approximately three and six months after the coaching intervention. Participant feedback surveys to better understand provider attitudes toward the coaching intervention. InterventionWe offered 60-minute group coaching calls to internal medicine PCPs, previously trained in serious illness conversation skills, as part of an institutional quality incentive program. The calls addressed communication challenges common to serious illness care and instructed participants about how to document and bill for conversations. OutcomesWe completed 31 coaching calls during three months, in which 170 of 228 PCPs attended in groups of two to nine participants per call (74.6% penetration rate). The percentage of PCPs who documented at least one serious illness conversation in the EHR increased from 18.4% to 41.2% six months after the intervention. Primary care internal medicine physicians found the one-hour coaching calls to be highly valuable, with 86.9% of respondents attesting they would recommend the calls to their colleagues. Content analysis of participant feedback identified the most useful coaching content elements to be self-reflection around the impact of prior conversation skills training, instruction around using the EHR to find and document advance care planning discussions, the opportunity to share individual challenges and successes with peers, and feedback/advice from communication experts in palliative care. Conclusions/Lessons LearnedGroup coaching of PCPs resulted in more than a twofold increase in documented serious illness conversations.

Implementation Lessons from a Multifaceted National Newborn Program in Solomon Islands: A Mixed-Methods Study.

Multifaceted interventions are important in improving neonatal quality of care and health outcomes. This study describes the implementation of an intervention to improve the quality of newborn care in Solomon Islands, a small island developing state and lower middle-income country in the Western Pacific. Inputs included training, equipment provision, and healthcare system organizational changes. For evaluation, we used a mixed-methods design, using quantitative (audits of health facility equipment, structure, and organization) and qualitative (semi-structured interviews and focused group discussions with healthcare workers) methods. Participants highlighted the practical, interactive, coaching style of training and its short duration as positive features in establishing skills. Training had indirect impacts through improving culture of the workplace, and the evaluation provided a valuable opportunity for reflection of the implementation process for healthcare workers. Facility limitations from equipment deficits and poor condition of clinical areas had implications by limiting the provision of quality care, as well as contributing to healthcare workers feeling undervalued. Resuscitation of a nonbreathing baby was a stressful experience for many health workers, compounded by geographic isolation and feeling unsupported. Our findings highlight the importance of training methodology, impact from structural limitations, and experience of resuscitation for the healthcare worker. Attention to these factors may help the design and implementation of newborn care programs in similar contexts.

The HIV epidemic in Latin America: a time to reflect on the history of success and the challenges ahead.

The HIV epidemic in Latin America: a time to reflect on the history of success and the challenges ahead.

A Model to Improve the Workflow for Radiation Treatments in the Era of Bundled Payments: A Quality Improvement Project Report

The Centers for Medicare and Medicaid Services has proposed alternate payment models to improve the efficiency and decrease the redundancy of health care. Bundled payments or episode-based care is one example. Herein, we report on the successful implementation of a quality improvement project in which changing the clinical workflow for postoperative radiation treatment to the hip to prevent heterotopic ossification improved the efficiency of patient care and decreased cost by eliminating redundant imaging through multidisciplinary participation. This project is a model for interdisciplinary collaboration to improve patient care and reduce unnecessary health care spending in the era of bundled payment/episodes of care program implementation.

The implementation of community-based diabetes and hypertension management care program in Indonesia.

Since 2010, Indonesian government has initiated a chronic disease management program, Prolanis (Program Pengendalian Penyakit Kronis) targeted for diabetes and hypertension. The program is continued at the commencement of universal health coverage (UHC) in 2014. “This study aimed to report the utilization and cost of the implementation of Prolanis in Indonesia from 2014 to 2016, or two years since the commencement of Indonesian universal health coverage.” Secondary data analysis was performed using publicly available data and data obtained from the national health insurance agency (BPJS); while data on disease prevalence were collected from basic national health survey. There was an increase trend of Prolanis participants, from around 11,000 participants in 2014 to more than 250,000 in 2016. More than 70% of participants were adults living in Java, however, the acceptance rate was very low in other area. Across different activities in Prolanis, physical activity was the most participated ones. In comparison to other regions, regions in Java were the most active area. The total expenditure for Prolanis program in 2016 increased almost triple from the annual cost in 2014. However, the cost per person was actually decreased more than 50%. Within two years of UHC implementation, there were increase covered participants and total costs, but cost per individual was decreased and there was significant difference in of cost between Java and outside Java. Further study and routine monitoring-evaluation process by health authority is needed to assess whether the cost difference would affect the service quality.

Global systematic review and ecological analysis of HIV in people who inject drugs: National population sizes and factors associated with HIV prevalence

BackgroundPeople who inject drugs (PWID) are at elevated risk of HIV infection. Data on population sizes of PWID living with HIV are needed to inform the implementation of prevention, treatment and care programs. We estimated national population sizes of people who recently (past 12 months) injected drugs living with HIV and evaluated ecological associations with HIV prevalence in PWID. MethodsWe used national data on the prevalence of injecting drug use and of HIV among PWID, derived from systematic reviews, to estimate national population sizes of PWID living with HIV. Uncertainty was estimated using Monte Carlo simulation with 100,000 draws. We extracted data on sample characteristics from studies of HIV prevalence among PWID, and identified national indicators that have been observed or hypothesised to be associated with HIV prevalence in PWID. We used linear regression to evaluate associations between these variables and HIV prevalence in PWID. ResultsFour countries comprised 55% of the estimated global population of PWID living with HIV: Russia (572,500; 95% uncertainty interval (UI) 235,500–1,036,500); Brazil (462,000; 95% UI 283,500–674,500); China (316,500; 95% UI 171,500–493,500), and the United States (195,500; 95% UI 80,000–343,000). Greater anti-HCV prevalence and national income inequality were associated with greater HIV prevalence in PWID. ConclusionThe countries with the largest populations of PWID living with HIV will need to dramatically scale up prevention, treatment and care interventions to prevent further increases in population size. The association between anti-HCV prevalence and HIV prevalence among PWID corroborates findings that settings with increasing HCV should implement effective interventions to prevent HIV outbreaks. The association between income inequality and HIV among PWID reinforces the need to implement structural interventions alongside targeted individual-level strategies.

Effect of community mental health care programs in Australia: a systematic review.

Although numerous studies have examined the effects of community-based mental health care programs in Australia, no synthesis of this literature exists. This systematic review of peer-reviewed and grey literature described the types of community-based mental health care programs delivered and evaluated in Australia in the past 20 years, and evaluated their impact in improving outcomes for those with a serious mental illness (SMI). Articles were included if they evaluated the extent to which the programs delivered in Australia improved individual outcomes, including hospitalisations, psychiatric symptoms, substance misuse or psychosocial outcomes, for individuals with an SMI. Forty studies were included. Community-based mental health care programs were categorised into three types: case management (n=23), therapeutic (n=11) and lifestyle (n=6). Therapeutic programs were most effective in reducing psychiatric symptoms. Case management approaches yielded significant improvements in psychosocial outcomes. Lifestyle programs were inconclusive in improving individual outcomes. This review provides support for the implementation of community-based mental health care programs that are informed by both therapeutic and case management principles. A multidisciplinary team that can facilitate the provision of therapeutic and psychosocial support may be most beneficial for those with an SMI within the Australian community.

EVALUATION OF HOME CARE PROGRAM IMPLEMENTATION IN THE BARA-BARAYA PUSKESMAS MAKASSAR CITY

Home care services at midnight many residents complained and there is no distribution of home care officers at the Bara-Baraya Public Health Center in Makassar. The focus of research in this study is the evaluation of the implementation of home care programs at the Bara-Baraya Public Health Center in Makassar City. This study aims to evaluate the implementation of home care programs at the Makassar City of Bara Baraya Health Center. The approach used in this study is a qualitative approach that describes and observes deeply the evaluation of the implementation of home care programs at the Makassar City of Bara Baraya Health Center. This research also uses applied research design. The data source in this study was taken from four home care officers at the Bara-Baraya Public Health Center in Makassar City and four people who use home care services. The results showed that the input sub-variables can be quite good. Medical devices such as thermometers, tensimeters, and stethoscopes function properly and are suitable for use in home care health services. Then operational funds such as staff salaries are paid according to the number of visits to the community. The doctor for Rp. 100,000 / visit and nurses 75,000 / visit. But in the aspect of home care officers is still inadequate. Home care workers have a dual role between serving the community at the puskesmas, as well as serving the community at the residence. In the process sub-variables, it can be quite good. In the call center aspect, people can easily call the call center because this service is toll free. Home visits and observations have been carried out carefully. But the division of duties of home care officers is not optimal. In the output sub-variable, it can be said to be good because the public can directly benefit from home care services.

Seroprevalence Investigation of Newcastle Disease in Rural Poultries of the Northern Provinces (Golestan, Gilan, and Mazandaran) of Iran.

Rural poultry farming is common in the Northern provinces. Similar to commercial poultry, rural poultry is susceptible to most infectious diseases. In addition, by increasing the density of poultry farming, the probability of disease incidences has been increased. Newcastle disease is the most highly infectious disease which is endemic in Iran and causes outbreaks among commercial and rural poultry every year. The present study aimed to investigate the prevalence and virus circulation of Newcastle disease among rural poultry in Northern provinces of Iran. In the current study, 70 villages in 3 provinces (20, 30, and 20 villages in Mazandaran, Golestan, and Gilan, respectively) and a total of 1,374 birds (600, 400, and 374 birds in Mazandaran, Golestan, and Gilan, respectively) were sampled. Each village was regarded as an epidemiological unit. In the present study, birds of 67 (96%) villages were positive (presence of antibodies against Newcastle disease virus), including 28 (93.3%), 19 (95%), and 20 (100%) villages in Golestan, Mazandaran, and Gilan, respectively. Moreover, out of 1,374 birds, 616 (45%) of them were seropositive against Newcastle disease virus with 242 (41%), 159 (39.8%), and 211 (56%) samples in Mazandaran, Golestan, and Gilan, respectively. According to the results of the current study, the seroprevalence rate was reported to be high in both villages and birds. Such a high seroprevalence rate was indicative of the continuous exposure of the rural poultry to Newcastle virus and high virus circulation rate in the mentioned provinces which could result in the dissemination of the disease to commercial farms. Consequently, the implementation of proper control and care programs (e.g., vaccination of native poultry) can facilitate the reduction of Newcastle disease prevalence.

Process evaluation of the community-based newborn care program implementation in Geze Gofa district, south Ethiopia: a case study evaluation design

BackgroundThe Community-Based Newborn Care (CBNC) program is a comprehensive strategy designed to improve the health of newborns during pregnancy, childbirth, and the postnatal period through health extension workers at community levels, although the implementation has not been evaluated yet. Therefore, this study aimed to evaluate the process of the CBNC program implementation in Geze Gofa district, south Ethiopia.MethodsA case study evaluation design with a mixed method was employed from May 1 to 31, 2017. A total of 321 mothers who gave birth from September 01, 2016 to February 29, 2017, were interviewed. Similarly, 27 direct observations, six-month document reviews, and 14 key informant interviews were conducted. The quantitative data were entered into Epi-Data version 3.1 and exported to SPSS version 20 for analysis. In the multivariable logistic regression analysis, variables with < 0.05 p-values and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to declare factors associated with maternal satisfaction. The qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. The overall process of program implementation was measured based on pre-determined judgmental criteria.ResultsThe overall level of the implementation process of the CBNC program was 72.7%, to which maternal satisfaction, availability of resources, and healthcare providers’ compliance with the national guideline contributed 75.0, 81.0, and 68.0%, respectively. Essential drugs and medical equipment, like vitamin K, chlorohexidine ointment, neonatal resuscitation bags, and masks used in the program were out of stock. Very severe diseases were not treated according to the national guidelines, and the identification of neonatal sepsis cases was poor. Trading occupation (AOR: 0.16, 95% CI: 0.03–0.97) and low wealth status (AOR: 3.11, 95% CI: 1.16–8.36) were factors associated with maternal satisfaction.ConclusionThe process of CBNC program implementation was relatively good, although the compliance of healthcare providers with the national guideline and maternal satisfaction with the services was low. Some essential drugs and medical equipment were out of stock. Merchant and low wealth status affected maternal satisfaction. Therefore, healthcare offices should provide crucial medicines and equipment for better program implementation and improve the wealth status of mothers to enhance maternal satisfaction.

Developing Children's Oral Health Assessment Toolkits Using Machine Learning Algorithm.

Evaluating children's oral health status and treatment needs is challenging. We aim to build oral health assessment toolkits to predict Children's Oral Health Status Index (COHSI) score and referral for treatment needs (RFTN) of oral health. Parent and Child toolkits consist of short-form survey items (12 for children and 8 for parents) with and without children's demographic information (7 questions) to predict the child's oral health status and need for treatment. Data were collected from 12 dental practices in Los Angeles County from 2015 to 2016. We predicted COHSI score and RFTN using random Bootstrap samples with manually introduced Gaussian noise together with machine learning algorithms, such as Extreme Gradient Boosting and Naive Bayesian algorithms (using R). The toolkits predicted the probability of treatment needs and the COHSI score with percentile (ranking). The performance of the toolkits was evaluated internally and externally by residual mean square error (RMSE), correlation, sensitivity and specificity. The toolkits were developed based on survey responses from 545 families with children aged 2 to 17 y. The sensitivity and specificity for predicting RFTN were 93% and 49% respectively with the external data. The correlation(s) between predicted and clinically determined COHSI was 0.88 (and 0.91 for its percentile). The RMSEs of the COHSI toolkit were 4.2 for COHSI (and 1.3 for its percentile). Survey responses from children and their parents/guardians are predictive for clinical outcomes. The toolkits can be used by oral health programs at baseline among school populations. The toolkits can also be used to quantify differences between pre- and post-dental care program implementation. The toolkits' predicted oral health scores can be used to stratify samples in oral health research. This study creates the oral health toolkits that combine self- and proxy- reported short forms with children's demographic characteristics to predict children's oral health and treatment needs using Machine Learning algorithms. The toolkits can be used by oral health programs at baseline among school populations to quantify differences between pre and post dental care program implementation. The toolkits can also be used to stratify samples according to the treatment needs and oral health status.

Accountable Care Program Implementation and Effects on Participating Health Care Systems in Washington State: A Conceptual Model.

This study is based on key informant interviews with health care executives representing 5 large health systems that had entered into contracts with the Washington State Health Care Authority to provide accountable care network services under the State Innovation Model initiative. The purpose of this study was to explain effects of accountable care program (ACP) implementation on participating health care systems. Between January 2017 and May 2018, we conducted 2 rounds of semistructured interviews (n = 20). Results indicate the need to present a modified conceptual model aligned with ACP implementation in the current context.

Precision Medicine: Lessons Learned From Implementation of a Pharmacogenetics-Based Patient Care Program in a Real-World Setting.

Precision Medicine: Lessons Learned From Implementation of a Pharmacogenetics-Based Patient Care Program in a Real-World Setting.

Discretion and Dilemma of Street-Level Bureaucrats in Public Services: Home Cara Dottorotta

This article aims to describe the discretion and dilemma faced by street-level bureaucrats (SLBs) in the implementation of dottorotta home care programs in Makassar City, Indonesia. This study used a qualitative descriptive approach with data collection techniques in-depth interviews, observation, and analysis of documents relevant to the research. The results showed that in implementing the dottorotta home care program, SLBs were often faced with scarcity of resources, both human and financial, and limited service time. To deal with the scarcity of these resources, SLBs use their discretionary authority, but in reality they are often faced with ethical dilemmas and psychological dilemmas. In this situation, SLBs use their experience and expertise so that the decisions taken do not harm the organization and the community it serves.