Innovative Health Care Models Research Articles

Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services

BackgroundPeople who inject drugs (PWID) remain a high priority population under the federal Ending the HIV Epidemic initiative with 11% of new HIV infections attributable to injection drug use. There is a critical need for innovative, efficacious, scalable, and community-driven models of healthcare in non-stigmatizing settings for PWID. We seek to test a Comprehensive-TeleHarm Reduction (C-THR) intervention for HIV prevention services delivered via a syringe services program (SSP).MethodsThe CHARIOT trial is a hybrid type I effectiveness-implementation study using a parallel two-arm randomized controlled trial design. Participants (i.e., PWID; n = 350) will be recruited from a syringe services program (SSP) in Miami, Florida. Participants will be randomized to receive either C-THR or non-SSP clinic referral and patient navigation. The objectives are: (1) to determine if the C-THR intervention increases engagement in HIV prevention (i.e., HIV pre-exposure prophylaxis; PrEP or medications for opioid use disorder; MOUD) compared to non-SSP clinic referral and patient navigation, (2) to examine the long-term effectiveness and cost-effectiveness of the C-THR intervention, and (3) to assess the barriers and facilitators to implementation and sustainment of the C-THR intervention. The co-primary outcomes are PrEP or MOUD engagement across follow-up at 3, 6, 9 and 12 months. For PrEP, engagement is confirmed by tenofovir on dried blood spot or cabotegravir injection within the previous 8 weeks. For MOUD, engagement is defined as screening positive for norbuprenorphine or methadone on urine drug screen; or naltrexone or buprenorphine injection within the previous 4 weeks. Secondary outcomes include PrEP adherence, engagement in HCV treatment and sustained virologic response, and treatment of sexually transmitted infections. The short and long term cost-effectiveness analyses and mixed-methods implementation evaluation will provide compelling data on the sustainability and possible impact of C-THR on comprehensive HIV prevention delivered via SSPs.DiscussionThe CHARIOT trial will be the first to our knowledge to test the efficacy of an innovative, peer-led telehealth intervention with PWID at risk for HIV delivered via an SSP. This innovative healthcare model seeks to transform the way PWID access care by bypassing the traditional healthcare system, reducing multi-level barriers to care, and meeting PWID where they are.Trial Registration: ClinicalTrials.gov NCT05897099. Trial registry name: Comprehensive HIV and Harm Prevention Via Telehealth (CHARIOT). Registration date: 06/12/2023.

Innovative Healthcare Models for Nursing Excellence and Patient Safety

This article delves into the exploration of innovative healthcare management models designed to cultivate nursing excellence and elevate patient safety within healthcare settings. Employing a mixed-methods approach, the study systematically assesses the effectiveness of these models through comprehensive research endeavors. The findings uncovered through this research shed light on the tangible impact of innovative management strategies on both nursing practices and patient outcomes. The study, rooted in a commitment to evidence-based inquiry, navigates the complex intersection of healthcare management and frontline care delivery. By adopting a mixed-methods approach, it incorporates quantitative and qualitative analyses, offering a nuanced understanding of the multifaceted dynamics at play within these innovative models. The revealed insights serve as a beacon for healthcare administrators and policymakers, providing them with valuable considerations as they strive for excellence in care delivery. The implications extend beyond theoretical observations, offering practical guidance for the implementation and refinement of healthcare management strategies. The study's outcomes contribute to the ongoing discourse surrounding the continuous improvement of patient care, positioning innovative management models as instrumental components in shaping the landscape of modern healthcare.

Demographic shifts and healthcare: A review of aging populations and systemic challenges

This comprehensive review examines the intricate relationship between demographic shifts, specifically the aging of populations, and the systemic challenges faced by healthcare systems globally. As societies experience a significant increase in life expectancy and a decline in birth rates, the proportion of elderly individuals within the population is on the rise. This demographic transformation poses multifaceted challenges to healthcare systems, necessitating a thorough exploration of its implications. The review first delves into the demographic shifts, presenting a nuanced analysis of the factors contributing to the aging of populations. Exploring advancements in healthcare, lifestyle changes, and socio-economic factors, the paper establishes a foundation for understanding the intricate dynamics driving this global phenomenon. Subsequently, the focus shifts towards the healthcare sector, elucidating the manifold challenges arising from the aging demographic. With a surge in chronic diseases and age-related conditions, healthcare systems are confronted with increased demand for specialized and long-term care. This has far-reaching implications on resource allocation, workforce planning, and the overall sustainability of healthcare infrastructures. The review also highlights the importance of addressing the psychological and social dimensions of aging, emphasizing the need for holistic healthcare approaches that go beyond traditional medical paradigms. Societal attitudes, stigma, and the provision of adequate support systems become crucial considerations in achieving comprehensive and patient-centered care for the elderly. In conclusion, this review underscores the urgency for healthcare systems to adapt to demographic shifts, particularly the challenges posed by aging populations. It advocates for a proactive and holistic approach, calling for policy interventions, innovative healthcare models, and a re-evaluation of societal perspectives on aging. By navigating the complexities inherent in demographic transitions, healthcare systems can strive towards inclusivity, sustainability, and improved quality of life for the growing elderly population.

The Digital Hospital: A Scoping Review of How Technology Is Transforming Cardiopulmonary Care.

Innovative models of health care that involve advanced technology in the form of a digital hospital are emerging globally. Models include technology such as machine learning and smart wearables, that can be used to integrate patient data and improve continuity of care. This model may have benefits in situations where patient deterioration must be detected quickly so that a rapid response can occur such as cardiopulmonary settings. The purpose of this scoping review was to examine the evidence for a digital hospital model of care, in the context of cardiac and pulmonary settings. Scoping review. Databases searched were using PsycInfo, Ovid MEDLINE, and CINAHL. Studies written in English and containing key terms related to digital hospital and cardiopulmonary care were included. The Joanna Briggs Institute methodology for systematic reviews was used to assess the risk of bias. Thirteen (13) studies fulfilled the inclusion criteria. For cardiac conditions, a deep-learning-based rapid response system warning system for predicting patient deterioration leading to cardiac arrest had up to 257% higher sensitivity than conventional methods. There was also a reduction in the number of patients who needed to be examined by a physician. Using continuous telemonitoring with a wireless real-time electrocardiogram compared with non-monitoring, there was improved initial resuscitation and 24-hour post-event survival for high-risk patients. However, there were no benefits for survival to discharge. For pulmonary conditions, a natural language processing algorithm reduced the time to asthma diagnosis, demonstrating high predictive values. Virtual inhaler education was found to be as effective as in-person education, and prescription error was reduced following the implementation of computer-based physician order entry electronic medical records and a clinical decision support tool. While we currently have only a brief glimpse at the impact of technology care delivery for cardiac and respiratory conditions, technology presents an opportunity to improve quality and safety in care, but only with the support of adequate infrastructure and processes. Open Science Framework (OSF: DOI 10.17605/OSF.IO/PS6ZU).

Innovative models of healthcare delivery: an umbrella review of reviews

ObjectiveTo undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals.DesignUmbrella review.SettingInterventions delivered inside and outside of acute care settings.ParticipantsChildren and...

Primary Care Aspects in the German Coalition Agreement 2021

Despite statewide rising numbers of family physicians during the last legislative period, their overall health care providing capacity has declined, mainly due to their working part-time. In the legislative period starting in 2021, this trend appears likely to continue. The German Health System Advisory Council foresees the number of general practitioners (GPs) who will have to be replaced by the next federal election in 2025 as exceeding 26,000. This results in a need for political action to sustain the primary care workforce. We conducted a content analysis of the coalition agreement 2021 between SPD, Greens and FDP with regard to explicit and related topics of GP care. A mixed inductive-deductive classification of the included text passages was used to thematically structure the results. A total of 34 relevant text passages were identified between pages 8 to 139 of the coalition agreement. Family physician care was explicitly addressed only once, when the planned abolition of budgeting was discussed. Other proposals which affect family physicians work included reduction of bureaucracy, prevention, or easier access to medical care for disadvantaged groups. Other passages of the coalition agreement regarding security of medical supply, included demand planning, innovative healthcare models, and cross-sectoral care. One focus of the coalition agreement was on digitalization. It mentions e. g., a digitization strategy for the healthcare sector, telemedicine services, and the electronic medical record, including opt-out possibility. Other assessed passages included projects to facilitate research or climate change and health. Despite the lack of mention of family physicians in the coalition agreement, many projects relate to the work of family physicians. Some of the ideas mentioned have also already been written down by the German Society for General Practice and Family Medicine (DEGAM) in its positions on the future of general practice, digitization or climate change and health. The planned projects in the coalition agreement have the potential to strengthen health care by family doctors and also make it more attractive for young doctors. However, further measures may be necessary to maintain GP care in the short and long term.

The Correlation between the Implementation of Patient-Centered Care (PCC) and the Fulfillment of Patient Rights at Regional General Hospital of Bireuen Regency

Introduction: Patient-Centered Care is an innovative healthcare model in which planning, implementation, and evaluation combine healthcare providers, patients, and families to provide better services. This study aimed to examine the relationship between implementing Patient-Centered Care and fulfilling patient rights in hospitals.Methods: This study used a cross-sectional research design. Data analysis was performed using the Chi-square test and Logistic Regression. The number of samples was as many as 104 people selected by proportional sampling.Results: All dimensions of Patient-Centered Care correlated with the fulfillment of patient rights (p<0.05). In addition, the logistic regression test showed that emotional support was the dimension with the highest correlation value (p = 0.012) with an odds ratio of 7.947. This indicates that patients with the correct dimensions of emotional support are 7.947 times more likely to have their rights fulfilled than patients who do not receive emotional support.Conclusion: The results of this study conclude that to fulfill the rights of patients in hospitals, a targeted and structured implementation is needed in providing patient-centered services to improve the quality of health services. Health care workers are urged to encourage patients and their families to participate in the care process actively.

Employing Family Caregivers: An Innovative Health Care Model.

Employing Family Caregivers: An Innovative Health Care Model.

User-Centered Development of a Web Platform Supporting Community-Based Health Care Organizations for Older Persons in Need of Support: Qualitative Focus Group Study.

BackgroundThe ongoing changes in population demographics increase the relevance of dignified aging across Europe. Community-based health care (CBHC) organizations are necessary to provide sustainable strategies for organizing care for older persons in need of support. To support the digitalization of these organizations, new business models and suitable web platforms are necessary.ObjectiveThis study, which is part of the European Active and Assisted Living (AAL) project called “ICareCoops”, aimed to explore concepts, approaches, and workflows of CBHC organizations to achieve a comprehensive understanding of extant services offered and relevant requirements to support these services with information and computer technology (ICT) solutions.MethodsA qualitative study with six focus groups (FGs) with 40 participants was conducted in Switzerland and Slovenia to identify potential stakeholders’ needs and requirements for the user-centered development of a web platform. Data were collected from three different stakeholder groups: (1) older persons in need of support as care receivers, (2) significant others of older persons in need of support, and (3) managers or care providers of CBHC organizations. A semistructured interview guide with open questions was used for data collection. FG sessions were audio-recorded and transcribed verbatim. Thematic content analysis was used to analyze the content of the FG sessions. To assist with further web platform development, the responses of the FG participants were translated into user stories to describe technical requirements.ResultsBy analyzing the transcripts, five main categories were identified: (1) ICT usage behavior of users, (2) challenges of web platform usage, (3) content and technical requirements for the web platform, (4) form and services of CBHC organizations, and (5) rationales of CBHC organizations. The main issues identified were the need for seniors to have individual contact with the CBHC organization and the possibility to coordinate routine services via the web platform, such as ordering meals-on-wheels or booking a caregiver to accompany an older person to the doctor.ConclusionsThe majority of participants showed a lack of familiarity with the usage of ICT. Nevertheless, they were open-minded regarding web platform usage to facilitate workflows and to benefit CBHC organizations. Cooperatives as an organizational model demonstrate a high potential to address users’ needs. Therefore, the web platform offers an essential tool for innovative health care models in the future. Searching for care services, contacting care providers, and communicating with care providers was preferred via personal contact and seemed to be the key element for user acceptance and for the successful implementation of a web platform like “ICareCoops” to support CBHC organizations.

A Virtual Ward Model of Care for Patients With COVID-19: Retrospective Single-Center Clinical Study.

BackgroundCOVID-19 has necessitated the implementation of innovative health care models in preparation for an influx of patients. A virtual ward model delivers clinical care remotely to patients in isolation. We report on an Australian cohort of patients with COVID-19 treated in a virtual ward.ObjectiveThe aim of this study was to describe and evaluate the safety and efficacy of a virtual ward model of care for an Australian cohort of patients with COVID-19.MethodsRetrospective clinical assessment was performed for 223 patients with confirmed COVID-19 treated in a virtual ward in Brisbane, Australia, from March 25 to May 15, 2020. Statistical analysis was performed for variables associated with the length of stay and hospitalization.ResultsOf 223 patients, 205 (92%) recovered without the need for escalation to hospital care. The median length of stay in the virtual ward was 8 days (range 1-44 days). In total, 18 (8%) patients were referred to hospital, of which 6 (33.3%) were discharged after assessment at the emergency department. Furthermore, 12 (5.4%) patients were admitted to hospital, of which 4 (33.3%) required supplemental oxygen and 2 (16.7%) required mechanical ventilation. No deaths were recorded. Factors associated with escalation to hospital care were the following: hypertension (odds ratio [OR] 3.6, 95% CI 1.28-9.87; P=.01), sputum production (OR 5.2, 95% CI 1.74-15.49; P=.001), and arthralgia (OR 3.8, 95% CI 1.21-11.71; P=.02) at illness onset and a polymerase chain reaction cycle threshold of ≤20 on a diagnostic nasopharyngeal swab (OR 5.0, 95% CI 1.25-19.63; P=.02).ConclusionsOur results suggest that a virtual ward model of care to treat patients with COVID-19 is safe and efficacious, and only a small number of patients would potentially require escalation to hospital care. Further studies are required to validate this model of care.

Using Linked Health Service Data in The Evaluation of Innovative Models of Healthcare

IntroductionAgeing populations place considerable burden on healthcare systems. Innovative methods to implement and evaluate new care models to reduce unwarranted hospital presentations, are needed.
 Objectives and ApproachTo use linked Electronic Medical Record (EMR) data to evaluate a pilot community-based model of care to reduce hospital presentations in a cohort of patients at-risk of hospital representations following an acute admission. Patients admitted to a metropolitan hospital with a non-surgical condition andidentified as being at-risk of readmission using a state-wide risk algorithm, were eligible to receive a 30-day care navigation model of care. The intervention group were matched to similar eligible patients, who received usual care using propensity score matching. Linked data were obtained from the EMR based Data Warehouse to provide information on subsequent readmissions and community-based health service contacts. Readmission rates were compared at 30, 60, and 90-days post-discharge using Cox Proportional Hazards Regression, adjusted for confounders and weighted by the propensity score. Descriptive analyses were used to compare demographics and healthcare utilisations.
 ResultsData from 412,971 potentially eligible patients were extracted. Sixty-five received the intervention of which 63 were matched to 280 controls (aged 51-91 years, 54% female, 63% lived alone). At 30-days post-discharge (during intervention delivery) an 80% reduction in readmission rate in the intervention group was observed (Hazard Ratio [HR] 0.20; 95%Confidence Interval (CI) [0.01, 4.20]). At 60-days (HR 0.48; 95%CI [0.03, 8.05]) and 90-days (HR 0.83; 95%CI [0.06, 11.36]), readmission rate reductions decreased to 52% and 17% respectively. In the intervention group, 68.9% received an out-patient appointment compared to 40% of controls (P<0.001) and 7.7% received allied health compared to none of the controls (p=0.003) within 90-days post-discharge.
 Conclusion/ImplicationsResults have informed hospital-wide service implementation thereby demonstrating the value of linked EMR data and advanced statistical methods in the evaluation of real-world healthcare.

How medical-legal partnerships help address the social determinants of mental health

Conditions related to where you are born, live, learn, work, and age—the social determinants of health—account for more than half of overall health and well-being. Problems in these areas include food insecurity, unsafe and unaffordable housing, family violence and instability, employment discrimination, inadequate education, and lack of access to health insurance and care. Such problems negatively affect physical and mental health and contribute to the health disparities that disproportionately impact low-income and marginalized communities of color. Housing instability and homelessness, for example, can increase the risk of chronic illness, infectious disease, and death, and also have a profound impact on mental health, creating or exacerbating psychological distress, anxiety, and depression. Research indicates that even years after an eviction, mothers are more likely to be depressed and report feeling increased material hardship and parental stress. Many underlying social determinants of health implicate or raise legal issues that require advocacy to overcome. One patient might skip critical medical or psychiatric appointments because he is unaware of his legal rights in the workplace and is afraid of losing his job if he misses work. Another may suffer from severe depression even with significant counseling and medication management because of anxiety and stress associated with overwhelming debt or the threat of imminent family violence. Such “health-harming legal needs” create barriers to achieving good health and are major contributors to health disparities. Although nurses and other healthcare providers understand the significant impact social determinants have on health, they do not always draw connections between those determinants and the legal issues they raise. Nor do they generally think of law as a tool that can be prescribed to improve a patient's health and well-being. Medical Legal Partnership (MLP) is an innovative healthcare model that fills that gap by bringing doctors, nurses, and other health professionals together with lawyers to address unmet legal needs that negatively impact health and well-being.

Virtually possible: using telehealth to bring reproductive health care to women with opioid use disorder in rural Maine.

Maternal opioid use disorder (OUD) has increased more sharply in recent years among rural residents in the United States than among urban residents. In 2018, the prevalence of maternal OUD accounted for 3.5% of all hospital deliveries in Maine. Opioid use during pregnancy is associated with negative health effects for both the woman and infant. While many women with OUD use contraception, few report using a highly reliable method. A family planning clinic in Maine piloted a program to increase reproductive health access for women with OUD through the use of telehealth. In this model, a community outreach educator travelled to a community organization that serves this population to provide reproductive health information and an opportunity to connect with a nurse practitioner via telehealth to receive the following reproductive health services: HIV counseling and testing, contraception, or pregnancy testing and counseling. We assessed the feasibility of this program through the following outcome measures: number of women who engaged with the community outreach educator, number of women who used telehealth services, and number of women who received services at a referred clinic during the six-month pilot. During the pilot program, the community outreach educator held eighteen educational sessions and engaged fifty-one women; providing condoms and/or answers to various reproductive health questions. Fifteen women used telehealth services. The majority used the service to receive testing for sexually transmitted infections (STI) such as HIV. Four women used telehealth for contraceptive services and received either birth control or the Depo-Provera injectable on-site. A third of the women received more than one reproductive health service via telehealth. Of the women who were referred to a family planning clinic for additional services, only 2 attended their appointment. No challenges with hearing or seeing the practitioner through the video platform were recorded. Improving women's access to effective contraceptive methods and preventive reproductive health services is critical to ensuring women with OUD are able to seek effective treatment and to ensure the health of future pregnancies. Findings from this pilot program suggest that innovative health care models such as on-site provision of reproductive health care through telehealth have the potential to increase access to reproductive care for this hard-to-reach population.

Development of new health provision models by advanced practice midwives - The Master of Science in Midwifery at the Bern University of Applied Sciences (BFH): an educational concept for the future

Background: The increase in chronic diseases, dealing with a diverse clientele, the rapidly developing digitalization in healthcare as well as the demand for interprofessionalism poses complex demands on the midwifery as profession. Within this context institutions of higher education are expected to train midwives as trendsetters in the development of new, integrated healthcare models which can meet the health needs of mothers and their families. Goal: The goal of the master course in midwifery is to increase awareness of the relevance of current challenges in maternity care. Midwives are prepared to competently deal with current health issues, using innovative healthcare models, by taking on advanced and specialized roles. Methods: The course imparts knowledge and know-how for midwives who wish to prepare to take on duties in modern obstetric and maternity care. Midwifery master students complete interprofessional course modules, such as Ethics, Advanced Practice or Health Policy and Health Economics, conjointly with fellow students of nursing, physiotherapy as well as nutrition and dietetics degrees. Three profession-specific course modules focus on the challenges imposed by complex processes in perinatal care. Results: The case study of a 5th semester student shows how the course supports the development of the new role of an Advanced Practice Midwife (APM) in the field of perinatal mental health. As an assignment within the profession-specific course module Perinatal Mental Health the student developed a concept draft for an APM role. She presented the concept in her own field of work, where she was charged with further developing and advancing the project. Furthermore, the student focused her Transfer Course modules on the project and deepened her skills in mental health and research skills through work shadowing in a research department and mental health ward, also called ,,Crisis lntervention Centre", in a university psychiatric clinic. Based on the APN model she finally developed how to establish the APM role in her master thesis. To conduct the needs assessment for mentally ill pregnant women and mothers she is conducting a secondary data analysis of a research project of the Division of Midwifery of BFH. Relevance: The establishment of integrated and intersectoral healthcare models is currently being discussed in Switzerland. The models require specific skills in healthcare professionals. The interprofessionally oriented master studies at BFH teach midwives to meet the requirements of needs-based, family-centred perinatal healthcare and strengthen its quality. Recommendations/Conclusions: The interlocking of master studies and practice offers the unique opportunity to further develop innovative healthcare models which are aimed at addressing present and future challenges in healthcare delivery and which are based on research.

Workers' Healthcare Assistance Model (WHAM): Development, Validation, and Assessment of Sustainable Return on Investment (S-ROI).

The present study aimed to present and validate the Worker´s Healthcare Assistance Model (WHAM), which includes an interdisciplinary approach to health risk management in search of integral and integrated health, considering economic sustainability. Through the integration of distinct methodological strategies, WHAM was developed in the period from 2011 to 2018, in a workers’ occupational health centre in the oil industry in Bahia, Brazil. The study included a sample of 965 workers, 91.7% of which were men, with a mean age of 44.9 years (age ranged from 23 to 73 years). The Kendall rank correlation coefficient and hierarchical multiple regression analysis were used for the validation of WHAM. The assessment of sustainable return on investment (S-ROI) was made using the WELLCAST ROI™ decision support tool, covering workers with heart disease and diabetes. WHAM can be considered an innovative healthcare model, as there is no available comparative model. WHAM is considered robust, with 86% health risk explanatory capacity and with an 85.5% S-ROI. It can be concluded that WHAM is a model capable of enhancing the level of workers’ health in companies, reducing costs for employers and improving the quality of life within the organization.

A Reverse Colocated Integrated Care Model Intervention among Persons with Severe Persistent Mental Illness at the U.S.-Mexico Border: A Randomized Controlled Trial Protocol

Persons with severe persistent mental illness (SPMI)—which include individuals with schizophrenia, bipolar disorder, and mood disorders such as major depression—are at high risk for poor health outcomes and premature death. Persons with SPMI are largely absent from research evaluating innovative health care models due to recruitment and retention barriers. This paper presents the protocol for a randomized control trial testing a reverse colocated integrated care model in an SPMI population receiving care at a mental health clinic at the U.S.-Mexico border. The study employs a randomized control trial design to determine whether reverse colocated integrated care improves physical and mental health of persons with SPMI. Participants will be randomized to receive the integrated primary care intervention or usual care (behavioral health only). All study participants will complete baseline, 6-, and 12-month assessments. Study outcomes included blood pressure, HbA1c, cholesterol, body mass index, depression, and adult functioning. Despite challenges in recruiting and retaining SPMI patients, co-locating primary care services within a local mental health authority has the potential to improve health and reduce health disparities experienced by persons with SPMI. The study will determine the impacts of this colocated integrated care model among SPMI patients in a socio-economically disadvantaged region.Clinical Trials.gov Identifier: NCT03881657.

Innovative care models for people with schizophrenia

Schizophrenia is acomplex mental disorder. Hence, the mental health system faces enormous structural, therapeutic, and health-economic challenges. Innovative models of healthcare can facilitate making treatment more efficient and effective.This paper aims to give an overview of evidence-based and innovative models of care and treatment for schizophrenia and severe mental illnesses. For this purpose, we performed aliterature search covering the last 10years of publications regarding "care or treatment models" and "schizophrenia," "psychosis," or "severe mental illness."Many publications do not provide details about the tested care model. Innovative care models for schizophrenia comprise early psychosis services (EPSs) or models for severe mental illnesses (SMI) integrating, combining and/or developing the treatment models crisis resolution team (CRT), assertive community treatment (ACT), and/or (intensive) case management (ICM). For illustration, the innovative models Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia, the Flexible Assertive Community Treatment model in the Netherlands, and the Therapeutic Assertive Community Treatment model in Hamburg are explained. All three models regularly offer integrated, specialized, and assertive care.In Germany, innovative models of care have not been implemented sufficiently: neither EPS nor ACT are part of standard care; CRT can now be funded by health insurances via "ward-equivalent treatment" as defined by anew German law (§§39 und 115d SGBV). Regarding the implementation of CRT and ACT in Germany, aclinical study evaluating the RECOVER model is underway. This is astepped-care, trans-sectorally coordinated and evidence-based treatment model, the evaluation of which is supported by the innovation fund of the Joint Federal Committee (Gemeinsamen Bundesausschuss, G‑BA) from 2017 to 2020.

Implementierung von Modellen zur Sicherung der Gesundheitsversorgung in ländlichen Regionen: Entwicklung eines Beratungsangebots

IntroductionThe combination of an ageing population and unequal distribution of healthcare capacity between rural and urban regions requires the development of innovative healthcare models, especially in rural areas, thus increasing the need to involve community representatives. The aim of this study was to ascertain the need for support and advice among municipalities and family doctors planning and implementing regional projects to ensure the provision of healthcare, and to develop a support and consultancy service on that basis. MethodsUsing semi-structured telephone interviews, 16 local representatives of the target groups (representatives from rural districts, mayors of rural municipalities and communities, doctors in private practice) were asked to identify the kind of support and advice they needed. The interviews were evaluated using the framework approach, a form of qualitative content analysis, and the results used to develop modules of a support and consultancy service. We discussed and finalized the concept during several workshops involving different representatives of the target groups (another 36 general practitioners, 19 mayors and representatives from rural districts). ResultsAfter taking into account the expressed need for advice and support, the developed consultancy service included the following modules: local situation/needs analysis, financial support options (e. g., grant application), concept/project development (including presentation of best practice examples), networks, assessment and evaluation, junior staff recruitment and introduction to other experts (for legal or IT-related advice, mediation, etc.). DiscussionThe study showed that local representatives have a substantial need for advice and support for which no nationwide consultancy service is yet available. Future practice tests should establish the extent to which local participants and projects can benefit from the consultancy service we have developed.

Deliberate and emergent strategies for implementing person-centred care: a qualitative interview study with researchers, professionals and patients

BackgroundThe introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies.MethodsThis paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT).ResultsIn addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication.ConclusionNPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients’ perceptions to evaluate outcomes.

Enablers and inhibitors of the implementation of the Casalud Model, a Mexican innovative healthcare model for non-communicable disease prevention and control.

BackgroundThe Mexican healthcare system is under increasing strain due to the rising prevalence of non-communicable diseases (especially type 2 diabetes), mounting costs, and a reactive curative approach focused on treating existing diseases and their complications rather than preventing them. Casalud is a comprehensive primary healthcare model that enables proactive prevention and disease management throughout the continuum of care, using innovative technologies and a patient-centred approach.MethodsData were collected over a 2-year period in eight primary health clinics (PHCs) in two states in central Mexico to identify and assess enablers and inhibitors of the implementation process of Casalud. We used mixed quantitative and qualitative data collection tools: surveys, in-depth interviews, and participant and non-participant observations. Transcripts and field notes were analyzed and coded using Framework Analysis, focusing on defining and describing enablers and inhibitors of the implementation process.ResultsWe identified seven recurring topics in the analyzed textual data. Four topics were categorized as enablers: political support for the Casalud model, alignment with current healthcare trends, ongoing technical improvements (to ease adoption and support), and capacity building. Three topics were categorized as inhibitors: administrative practices, health clinic human resources, and the lack of a shared vision of the model.ConclusionsEnablers are located at PHCs and across all levels of government, and include political support for, and the technological validity of, the model. The main inhibitor is the persistence of obsolete administrative practices at both state and PHC levels, which puts the administrative feasibility of the model’s implementation in jeopardy. Constructing a shared vision around the model could facilitate the implementation of Casalud as well as circumvent administrative inhibitors. In order to overcome PHC-level barriers, it is crucial to have an efficient and straightforward adaptation and updating process for technological tools. One of the key lessons learned from the implementation of the Casalud model is that a degree of uncertainty must be tolerated when quickly scaling up a healthcare intervention. Similar patient-centred technology-based models must remain open to change and be able to quickly adapt to changing circumstances.Electronic supplementary materialThe online version of this article (doi:10.1186/s12961-016-0125-0) contains supplementary material, which is available to authorized users.