Model Of Care For Patients Research Articles

Strategies for Effective Health Services Management in Hospitals: A Systematic Review of Key Models and Practices

Background: Effective health services management is critical in hospitals, where the demands for improved patient outcomes, operational efficiency, and cost containment are paramount. Over the years, several management models and practices have been implemented in hospital settings, with varying degrees of success. Objective: This systematic review aims to examine and synthesize key models and practices in health services management that have proven effective in enhancing hospital performance, focusing on their impact on patient care, staff efficiency, and operational outcomes. Methods: A systematic literature search was conducted across major databases, including PubMed, Scopus, and Google Scholar, using keywords such as "hospital management," "health services management," and "patient care models." Studies were included if they focused on hospitals, were published in the past ten years, and evaluated the effectiveness of management practices. Results: The review identified several effective management models, including Lean Management, Six Sigma, Patient-Centered Care, Workflow Optimization, and Total Quality Management (TQM). Key practices contributing to successful management included leadership engagement, technology integration, performance measurement, and patient safety protocols. These strategies collectively improved patient satisfaction, reduced wait times, and enhanced hospital efficiency. Conclusion: This review highlights evidence-based management strategies that have a significant impact on hospital operations and patient care. Implementing these practices can help hospital administrators optimize resources, improve staff productivity, and enhance patient experiences.

Prevalence of Dementia in the Geriatric Population Residing in a Long-term Care Facility: An Updated Systematic Review and Meta-Analysis

Background: The global rise in the geriatric population is increasing dementia cases, imposing significant burdens on families and society, making long-term care facilities (LTCFs) essential. Thus, updated dementia prevalence data are crucial for effective health-care planning and policy-making. Methodology: A systematic review and meta-analysis, updating Fagundes et al. (2021), included articles post-August 2, 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were selected based on predefined criteria, and data extraction was independently performed by two reviewers, focusing on dementia prevalence rates, assessment tools used, and regional variations. Meta-analytic techniques estimated pooled dementia prevalence rates and assessed study heterogeneity, focusing on assessment tools and regional variations. Results: The review included 38 studies, with 18 new ones since the previous review. The pooled dementia prevalence in LTCFs was 57.8% (confidence interval 51.63–63.98; P < 0.01), up from 53%. Europe had the highest rate, while other regions showed variability. High heterogeneity suggests diverse factors, such as diagnostic criteria and population characteristics, influence prevalence estimates. Discussion: The rising dementia prevalence in LTCFs highlights the need for specialized care, improved health policies, and resource allocation. Regional prevalence variations may be due to differences in diagnostic criteria, health-care infrastructure, and societal factors, with high heterogeneity reflecting diverse methodologies and populations. Increased public awareness and ongoing research are essential for developing innovative, tailored care models for dementia patients in LTCFs. Conclusion: This updated review shows a higher dementia prevalence in LTCFs, highlighting the need for targeted interventions and policy adjustments to improve care quality and outcomes. Further research is needed to explore regional prevalence factors and develop standardized care practices.

Assessment of the relevance of a prescribing competency framework in Kuwait – An e-Delphi study

Abstract Introduction Prescribing is the most common intervention used to manage patients. Globally, prescribing competency frameworks have been developed to standardize prescribing practice across all healthcare disciplines1. Research on prescribing practice in different chronic diseases in Kuwait has shown some inconsistencies in the quality of care delivered to patients. Aim This study assesses the relevance of the National Pharmaceutical Society (NPS) MedicineWise Prescribing Competency Framework statements amongst physicians, dentists, and pharmacists in Kuwait as a first step in developing a National Prescribing Competency Framework for Kuwait. Methods Ethical approval was granted by Kuwait’s Ministry of Health (MOH) for this project. A 4-phase adopt and adapt approach was planned to develop the Prescribing Competency Framework for Kuwait. This study covers phases 1 and 2 of this approach. Phase one involved translating the Framework into Arabic using parallel translation. Phase two utilised the e-Delphi method to reach consensus on the relevance of 48 statements (divided into 7 Competency Areas) for prescribing in Kuwait. For this phase, a survey, with a 4-point Likert scale, was developed using Google Forms and distributed to experts participating in the e-Delphi process. Purposive and snowballing method was used to recruit the experts, targeting all doctors, dentists, and pharmacists working in MOH. Participants were asked to rate their agreement with the relevance of the statements to Kuwait and allowed to leave comments. Statements achieving a consensus level ≥90%, with no answer as strongly disagree, were deemed relevant. Statements not reaching consensus will be reevaluated in Round 2 of the e-Delphi process (planned for July-September 2024). Results The translation phase yielded a bilingual framework that could be utilised by prescribers in Kuwait. Round 1 of the e-Delphi included 36 experts (22 doctors, 8 dentists, and 6 pharmacists). Out of the seven Competency Areas in the NPS framework, four Competency Areas reached 100% consensus (Areas 1, 4, 5, and 6). 90% of the statements in Competency Area 2 reached consensus, while only 40% of the statements in Competency Area 3, and 85.7% of the statements in Competency Area 7 reached consensus. Competency statements that did not reach consensus will be re-assessed in Round 2 of the e-Delphi process. Conclusion To our knowledge, this is the first study conducted to initiate the process of adopting and adapting a Prescribing Competency Framework in Kuwait. Competency statements involving patient engagement in their management plan seemed to gain the least consensus in Round 1 of our study, which will be explored further in Round 2 of our e-Delphi process. This is consistent with current published literature in the Middle Eastern and North African regions which shows that there is no clear understanding by healthcare professionals of how to apply patient-centred care2,3. Limited comments on disagreed statements in Round 1 require further clarification. There is a need to standardize the prescribing process due to the complexity of choosing the right medication, the imperative to optimize medication use, a change in the patient's care models, and the possibility of other healthcare professionals taking on prescribing roles.

Multidisciplinary models of primary health care for patients with chronic non-communicable diseases

Introduction. Chronic non-communicable diseases (CNCD) requires a variety of strategies from different perspectives and at different levels, including individual and country-specific. Comprehensive patient-oriented and proactive approaches play an important role in the provision of multidisciplinary teams of medical care to patients with established CNCD. The purpose of this study is to present the Moscow experience in managing multidisciplinary teams for the treatment of CND patients, using the example of arterial hypertension in the framework of a pilot project in the outpatient clinics of the Troitsk and Novomoskovsky administrative districts (TiNAO; were attached to the territory of Moscow in 2012). Materials and methods. The study was conducted in two stages: at the first, a literature review was carried out, at the second, the stages of launching a pilot project on the management of multidisciplinary teams for the treatment patients with CNCD, using the example of arterial hypertension in the outpatient clinic of TinAO, were developed and discussed. Results. The research analyzes approaches to the use of multidisciplinary teams in the world. Based on the analyzed current regulatory documents, adjustments were made to the foreign model for its possible adaptation to Moscow polyclinics, focusing on proactive dispensary dynamic monitoring. Research limitations. The results of the conducted research are based on operational data from Moscow and can be applied only to the formation of management decisions in Moscow. Conclusion. According to the results of the pilot project testing, an increase in the level of coverage of the attached population with medical care, accessibility of narrow specialists and provision of equal opportunities for obtaining medical care for Muscovites was noted.

Effectiveness and sustainability of a multidisciplinary care model for patients with hemodialysis access dysfunction.

A multidisciplinary care model involving the interventional radiologist, vascular surgeon, interventional nephrologist, renal advanced nurse practitioner, and renal coordinators was implemented to improve the care for the patient admitted with dysfunctional hemodialysis access. This study aims to evaluate the effectiveness and sustainability of this multidisciplinary care model. A dedicated interventional nephrology suite was established to perform endovascular procedures for patients admitted with hemodialysis access dysfunction via the emergency department of the hospital. We retrospectively collected data from electronic medical records 1-year before and after the implementation (April 2015). Outcome measures include waiting time for intervention, length of stays (LOS), number of dialysis catheter insertions before the intervention, number of inpatient dialysis required, and success rates of the interventions. The waiting time for intervention and LOS was tracked over the next 3 years to determine the sustainability of the care model. Eight hundred eighty-one endovascular interventions (314 angioplasties, 567 thrombolysis) were performed on 554 patients. Post-implementation, a greater proportion of intervention was performed within 24 h (238 (50.2%) vs 70 (17.2%), p < 0.001) with lesser proportion of patients requiring bridging hemodialysis via temporary catheter, 156 (32.9%) versus 215 (52.8%), p < 0.001. A shorter median LOS and days-to-intervention were reported, 3 (IQR 2-6) versus 5 days (IQR 3-8), p < 0.001 and 1 (IQR 1-2) versus 3 days (IQR 2-4), p < 0.001 respectively. Less hemodialysis session/patient required, 2 (IQR 1-3) versus 3 (IQR 2-4), p < 0.001. The procedural success rate was greater, 440 (92.8%) versus 355 (87.2%), p = 0.020. Three years following implementation, the proportion of patients who received intervention within 24 h and were discharged within 48 h was reported to be persistently greater, 43% versus 13%, p < 0.001, and 27% versus 6%, p < 0.001 respectively. This multi-disciplinary collaboration demonstrated a sustainable care model in improving the delivery of healthcare services for patients with dysfunctional hemodialysis access.

Development and piloting of nurse-led mHealth care for heart failure patients: A feasibility study

Development and piloting of nurse-led mHealth care for heart failure patients: A feasibility study Abstract: Background: Chronic heart failure (cHI) is the most common reason for hospitalization. Telemonitoring (TM) and Heart Failure Nurses (HFN) can detect decompensations and prevent hospitalizations. Aim: The aim was to develop and examine the feasibility of a digitally supported care-guided care model for cHI patients and to evaluate it in terms of adherence, technology usability, satisfaction, self-care and health literacy, disease knowledge, quality of life and health status. Methods: The study was conducted in a user-centered manner using mixed. The 6-month pilot was carried out in the patients' domestics using qualitative (e.g. focus groups) and quantitative methods (validated questionnaires). Results: A total of n = 30 cHI patients (age: M 66, SD 14 years; ♀ n = 10 [31%], ♂ n = 22 [69%]) completed the clinical testing. The intervention consisted of: Training, the TM application, nursing/medical advice and support and a digital library. Adherence to TM was over 80% (relative adherence: M 87, SD 16%; absolute adherence: M 82, SD 19%). Health literacy, disease knowledge and quality of life increased. The state of health improved and those affected felt more confident in dealing with the disease. No changes were recorded for self-care skills. Conclusions: Hybrid care is very well received and demonstrates the potential to promote self-care for those affected.

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

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

Integrated models for concurrent disorders from a Public Mental Health lens: a Systematic Review

Abstract Concurrent disorders (COD), historically defined by the World Health Organization as the simultaneous presence of a psychoactive substance use disorder and another psychiatric disorder within the same individual, pose a significant challenge to public mental health. In today’s global landscape of mental health services, the prevalence of COD is on the rise, underscoring the need for an integrated approach to management. This review aims to provide an overview of existing global models and the evaluation approaches. This systematic review examined research evidence in PubMed, Scopus and Web of Science up to 2023 regarding integrated management systems for COD. Following PRISMA guidelines, we included articles describing specific models and evaluating the effectiveness of integrated versus non-integrated approaches. Quality assessment was conducted using the appropriate scales. Out of 7700 screened articles, 18 were included, all of fair or good quality. A diverse array of patient care models, programs, and interventions addressing comorbidities between mental health and substance use disorders emerged. The majority of studies focused on clinical outcomes, particularly alcohol and drug dependence, with global mental health consequences also under examination. Psychodiagnostics and social outcomes were also considered in a significant portion of the research, shedding light on health services utilization patterns. The integrated model for concurrent disorders in psychiatry stands as an effective approach, yet its implementation encounters challenges. This study showcases successful integration examples, providing valuable insights for policymakers and healthcare professionals to enhance existing models or develop new ones, particularly within European healthcare reforms like Italy’s restructuring of primary care, where they could serve as a criterion for the setting and organization of community houses. Key messages • COD, involving both substance use and psychiatric disorders, present a significant challenge to public mental health. Rising prevalence underscores the need for integrated management approaches. • Insights from successful integration examples offer valuable guidance for healthcare professionals and policymakers, particularly within healthcare reforms like Italy’s restructuring of primary care.

Effectiveness of the re-engineered discharge (RED) care model in patients with rheumatoid arthritis.

This study aims to investigate whether the re-engineered discharge (RED) model can significantly improve the quality of life, enhance the health status, and reduce the levels of depression and anxiety in patients with rheumatoid arthritis during hospitalization. This study selected 108 rheumatoid arthritis patients treated at our facility between February 2023 and February 2024. Based on the different treatment methods, these patients were divided into a control group and an observation group, with 54 patients in each group. During hospitalization, both groups received standardized routine care provided by the hospital. After discharge, the control group continued with regular follow-up visits, while the observation group received a more comprehensive and multidimensional extended care based on the RED model. The intervention period for both groups was set to 3 months. The core observation indicators of this study focused on the emotional fluctuations, symptom improvement, and changes in self-care ability of the patients before and after the intervention. After the intervention, the scores of the Self-Rating Anxiety Scale and Self-Rating Depression Scale in both groups showed significant decreases, with the scores in the observation group being significantly lower than those in the control group, showing a highly significant statistical difference (P < .01). Additionally, the joint pain scores in both groups were alleviated, reflected by shorter morning stiffness times, reduced joint swelling, and increased grip strength. The observation group had lower joint pain scores, shorter morning stiffness times, fewer swollen joints, and stronger grip strength, all of which were statistically significant (P < .01). Furthermore, the distribution of self-care abilities in the observation group showed a significant difference compared to the control group (P < .05), with the observation group having a higher proportion of self-care abilities, which was also statistically significant (P < .05). For patients with rheumatoid arthritis, the implementation of the RED model nursing strategy can significantly alleviate negative emotions, reduce the distress caused by symptoms, and markedly improve their quality of life, providing a more comfortable and reassuring treatment experience.

A controlled study: Evaluating the clinical impact of a nurse-centred multidisciplinary hospice care model on anxiety, depression, and quality of life in patients with advanced malignant tumours.

To explore the clinical effect of a nurse-centred multidisciplinary collaborative hospice care model in patients with advanced malignant tumours. A total of 30 patients with advanced malignant tumours were hospitalised and randomly divided into a study group and a control group, each consisting of 15 cases. The study group received nurse-led multidisciplinary collaborative hospice care, whereas the control group underwent high-quality nursing intervention. Variables such as the self-rating anxiety scale (SAS) score, self-rating depression scale (SDS) score, quality of life scale (EORTC QLQ-C30) score, patient happiness, and nursing satisfaction were compared between the two groups. Post-intervention, the SAS and SDS scores in the study group were lower than those in the control group (p < 0.01). The overall quality of life score of the study group was higher than that of the control group (p < 0.01). The Memorial University of Newfoundland Scale of Happiness scores in the study group also surpassed those of the control group (p < 0.01). Additionally, nursing satisfaction in the study group exceeded that of the control group (p = 0.027). The nurse-led multidisciplinary collaborative hospice care model substantially alleviated negative emotions among patients, effectively improved their quality of life and happiness, and garnered positive evaluations of nursing satisfaction.

DEVELOPMENT OF ORAL HEALTH CARE FOR COMPLETE DENTURES TREATMENT

Based on data from the Basic Health Research 2018, indicate a correlation between age and tooth loss, yet denture utilization remains comparatively low. Dental therapists are primarily responsible for enhancing oral health by preventing, treating, and managing dental problems. While authorized to collaborate with dental specialists in providing medical dental procedures. However, in many clinical settings, dental therapists are often relegated to the role of dental assistants. This limitation can be attributed to the lack of integrated dental care models for complete denture cases within specialized prosthodontic services. This study aimed to evaluate the effect of developed dental and oral health care model on patients with complete denture care on changes in the behavior of dental therapists in implementing the model. This study employs a quasi-experimental research design with a pretest-posttest design (non-equivalent control group). The research was conducted the entire population of 12 dental therapists at the prosthodontic clinic of the dental and oral hospital were randomly assigned to two groups. The intervention group received socialization on an oral health care model. Knowledge, attitude, and skills were assessed through questionnaires and observational methods both before and after the intervention. Data were analyzed statistically using paired t-test, and independent t-test. Its model is effective in behavior changes: improving knowledge (p-value 0.025; ? 7.50), attitudes (p-value 0.012; ? 7.33), skills (p-value 0.002; ? 26.67). Development of a dental and oral health care model in patients with complete denture care is effective in changing the behavior of dental therapists.

Determining the Need for Palliative Care Patients with Multiple Sclerosis-A Cross-Sectional Study.

Multiple sclerosis is characterised by the manifestation of heterogeneous symptoms that affect daily functioning. Patients face physical impairment, psychological problems and socioeconomic changes. Depending on the form of the disease, they may have different needs, which are often unsatisfied and could be overcome by including palliative care in the treatment. Despite the above, not enough is known about this population's needs for palliative care. This cross-sectional study aimed to identify the need for palliative care and assess the functional dependence level in daily living activities in patients with multiple sclerosis. The sample consisted of 120 patients from the Neurology Clinic of the University Clinical Center of Vojvodina, Serbia. The following research instruments were used: a General questionnaire, Sheffield Profile for Assessment and Referral for Care, Multiple Sclerosis Impact Scale and Barthel Index. The need for palliative care was expressed by 36.7% of patients, who expressed the most concern for the physical symptoms, independence and activity domains. Also, it was determined that the disease prevents patients from doing demanding physical tasks and that they are worried about multiple sclerosis. Almost a quarter of patients have had complete/severe dependence on other persons in performing daily activities. The most frequently reported physical symptoms by patients with MS were weakness, bladder problems, fatigue and different levels of dependence, while concerns related to sexual health, low mood and anxiety emerged as key challenges in the psychological domain. These findings underscore the importance of conducting needs assessments to guide the development of an appropriate palliative care model for MS patients.

The effectiveness of enhanced reality simulation on postmastectomy patient care management provided by nursing students: a quasi-experimental study

AimThe aim of this study was to evaluate the effect of enhanced reality simulation on nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. BackgroundBreast cancer is a common disease with increasing incidence and mastectomy is the treatment of choice. Postmastectomy patient care is a multidimensional and complex process. For various reasons, nursing students today graduate with inadequate clinical skills and do not have experience with many cases. DesignThis quasi-experimental study was conducted using a pretest–posttest design with a nonequivalent control group. MethodsThis study was conducted with fourth-year nursing students (78 students). Students were allocated to each group through a simple random allocation using IBM SPSS Statistics version 24. Research data were collected at the Clinical Simulation Training Center of the university in 2020–2021 academic year. The study group (n=39) learned using a scenario-based learning approach with moulage in a real clinical setting using enhanced reality simulation, while the control group (n=39) learned using the same scenario-based approach with the routine practice adult standard patient care model. The data were collected through the “Student Sociodemographic and Descriptive Characteristics Data Collection Form”, the “Student Satisfaction and Self-Confidence in Learning Scale”, the “Postmastectomy Patient Care Skills Checklist” and the “Pre–Post Knowledge Test on Postmastectomy Patient Care Management”. ResultsAll 78 participants completed the training course. The training significantly increased the Student Satisfaction and Self-Confidence in Learning Scale subdimension scores of both groups (p<0.05). The Postmastectomy Patient Care Management scores of the study group students who received enhanced reality simulation training significantly increased (p<0.05), while there was no significant effect on the scores of the control group students (p>0.05). While most the students in the study group increased their rates of correct answers to Postmastectomy Patient Care Management questions significantly (p<0.05) after the enhanced reality simulation training, the students in the control group showed no significant improvement (p>0.05). The training significantly (p<0.001) increased the mean postmastectomy patient care skills control scores. This increase had a high effect size on the study group. ConclusionEnhanced reality simulation is a learning method that increases nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. Learning with enhanced reality simulation is an effective approach for nursing education that improves nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care.

OA07.05 Improving Supportive and Social Care in Lung Cancer with the 4R Oncology Model for Patient Care Planning and Delivery

OA07.05 Improving Supportive and Social Care in Lung Cancer with the 4R Oncology Model for Patient Care Planning and Delivery

The integral co-management role of the medical pediatric urologist: Improving the care of children with urological conditions

The complexities of modern medicine prompt a re-evaluation of traditional patient care models to enhance safety and quality. We implemented a one-year pilot Medical Pediatric Urology fellowship, jointly developed by Urology and Pediatric Hospital Medicine, where a pediatrician received postgraduate training in both specialties. This innovative program aimed to augment knowledge and expertise in non-surgical aspects of pediatric urology. Upon completion of the fellowship, the trained pediatrician assumed the role of medical pediatric urologist (MPU), integrating into both Pediatrics and Urology faculties. Unlike the traditional specialist consultation model, the MPU became integral member of the Urology Division, working full-time and sharing responsibilities for both inpatient and outpatient pediatric urology care at a tertiary pediatric hospital in Canada. This study aims to delineate the training curriculum, role, clinical outcomes, and educational impact of the MPU over eight years. We retrospectively analyzed clinical outcomes, including patient volumes seen annually by MPU, urologists, and nurse practitioners from 2021 to 2023. Clinic wait times and patient satisfaction were compared between MPU's community and tertiary hospital pediatric urology clinics. Educational impact was assessed through pediatric residents' ratings for the MPU as a clinical teacher during urology rotations using a Likert scale. Integration of MPU led to the establishment of specialized clinics, including those for neurogenic bladder and posterior urethral valves. MPU accounted for approximately 34.7% of all outpatient clinic visits. Subjective feedback highlighted enhanced quality of care with MPU co-management in the inpatient setting. Additionally, in a community-based medical urology clinic (CUC) staffed by the MPU and a pediatric urology nurse practitioner, patients experienced shorter wait times and higher satisfaction (53±36 days and 194±108 days) (p<0.01), with 97% vs. 91% of families reported feeling highly satisfied with care (p<0.01) compared with hospital clinics, respectively. The MPU received ratings of 4/5 or 5/5 as a clinical teacher from 81.82% of pediatric residents. Our novel co-management approach in pediatric urology integrates medical and surgical expertise. However, limitations include the retrospective design and single-center setting. Nonetheless, this framework presents a potential model for other surgical specialties, offering a unique practice niche for trainees interested in the medical management of surgical conditions. The medical pediatric urologist plays a pivotal role as an educator, hospitalist, and director of the outpatient clinic, effectively integrating medical and surgical expertise. The MPU model is promising for optimizing safety and quality of care in pediatric urology.

The Canadian Heart Failure (CAN-HF) Registry: A Canadian Multicentre, Retrospective Study of Outpatients with Heart Failure

BackgroundGuideline-directed medical therapy (GDMT) reduces events in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Despite this impact, underutilization of GDMT persists. This report sought to describe HF management in Canadian outpatients treated at specialized HF clinics (HFCs). MethodsThe Canadian Heart Failure (CAN-HF) study was retrospective and observational, and it included 1775 patients from 6 Canadian outpatient HFCs, from the period January 2017-April 2020. ResultsWe observed improvement in prescription rates in patients with HFrEF, between their first visit and their most-recent clinic visit, across all GDMT classes, in those who were followed at the HFC for ≥ 6 months. The largest prescription rate increases were observed for angiotensin receptor–neprilysin inhibitors and mineralocorticoid-receptor antagonists. However, more than half of the patients remained on angiotensin-converting enzyme inhibitors and/or angiotensin-receptor blockers, despite being symptomatic, according to their New York Heart Association class. Most patients (50%) were on triple therapy, as of their most-recent visit, with fewer (36%) on dual therapy, monotherapy (13%), or no GDMT (2%). Our data also suggest that patients who had been managed at the HFC for > 6 months had higher prescription rates of GDMT and were on higher doses of GDMT, compared to those who were new to the clinic. For patients with HF with preserved ejection fraction, few patients were on candesartan and less than half were on a mineralocorticoid-receptor antagonist. ConclusionsOur data from HFCs that in most cases were affiliated with academic centres compare favourably with data from other analyses of ambulatory patients with HFrEF, evidence that supports the use of a specialized patient-care model.

Managing Patients With COVID-19 in Armenia Using a Remote Monitoring System: Descriptive Study.

The COVID-19 pandemic has imposed immense stress on global health care systems, especially in low- and middle-income countries (LMICs). Armenia, a middle-income country in the Caucasus region, contended with the pandemic and a concurrent war, resulting in significant demand on its already strained health care infrastructure. The COVID@home program was a multi-institution, international collaboration to address critical hospital bed shortages by implementing a home-based oxygen therapy and remote monitoring program. The objective of this study was to describe the program protocol and clinical outcomes of implementing an early discharge program in Armenia through a collaboration of partner institutions, which can inform the future implementation of COVID-19 remote home monitoring programs, particularly in LMICs or low-resource settings. Seven hospitals in Yerevan participated in the COVID@home program. A web app based on OpenMRS was developed to facilitate data capture and care coordination. Patients meeting eligibility criteria were enrolled during hospitalization and monitored daily while on oxygen at home. Program evaluation relied on data extraction from (1) eligibility and enrollment forms, (2) daily monitoring forms, and (3) discharge forms. Over 11 months, 439 patients were screened, and 221 patients were managed and discharged. Around 94% (n=208) of participants safely discontinued oxygen therapy at home, with a median home monitoring duration of 26 (IQR 15-45 days; mean 32.33, SD 25.29) days. Women (median 28.5, mean 35.25 days) had similar length of stay to men (median 26, mean 32.21 days; P=.75). Despite challenges in data collection and entry, the program demonstrated feasibility and safety, with a mortality rate below 1% and low re-admission rate. Opportunities for operational and data quality improvements were identified. This study contributes practical evidence on the implementation and outcomes of a remote monitoring program in Armenia, offering insights into managing patients with COVID-19 in resource-constrained settings. The COVID@home program's success provides a model for remote patient care, potentially alleviating strain on health care resources in LMICs. Policymakers can draw from these findings to inform the development of adaptable health care solutions during public health crises, emphasizing the need for innovative approaches in resource-limited environments.

Effectiveness of integrated care models for stroke patients: A systematic review and meta-analysis.

Given that stroke is a leading cause of disability and mortality worldwide, there is an urgent need for a coordinated healthcare approach to mitigate its effects. The objectives of this study were to perform a systematic review and meta-analysis of stroke integrated care models and develop recommendations for a representative model. A systematic review and meta-analysis. The literature search identified randomized controlled trials comparing integrated care models with standard care for stroke patients. The included studies followed PICOs inclusion criteria. The qualitative analysis included creating a flowchart for the literature screening process, and tables detailing the basic characteristics of the included studies, the adherence to the ten principles and the results of the quality assessments. Subsequently, quantitative meta-analytical procedures were conducted to statistically pool the data and quantify the effects of the integrated care models on stroke patients' health-related quality of life, activities of daily living, and depression. The China National Knowledge Infrastructure (CNKI), Wanfang Data, Chongqing VIP Chinese Science and Technology Periodical Database (VIP), China Biology Medicine Disc (CBMDISC), Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science, Embase, Google Scholar, and Clinical Trials were searched from inception to March 13, 2024. Of the 2547 obtained articles, 19 were systematically reviewed and 15 were included in the meta-analysis. The integrated care models enhanced stroke patients' health-related quality of life, ability to perform activities of daily living, and reduced depression. Adherence to the 10 principles varied: comprehensive services, patient focus, and standardized care delivery had strong implementation, while gaps were noted in geographic coverage, information systems, governance structures, and financial management. Integrated care models improve outcomes for stroke patients and adherence to the 10 principles is vital for their implementation success. This study's findings call for a more standardized approach to implementing integrated care models, emphasizing the need for integrated services, patient-centred care, and interdisciplinary collaboration, while also addressing the identified gaps in terms of integration efforts. This study provides evidence-based recommendations on the most effective integrated care approaches for stroke patients, potentially leading to better patient outcomes, reduced healthcare costs, and improved quality of life.

Bridging the gap and developing a home-based palliative care model for cancer patients

ObjectiveEarly integration of palliative care into home health care services is essential for cancer patients to improve their Quality of Life and reduce their health care costs. Thus, this study aimed to develop a home-based palliative care model for adult cancer patients in Iran. MethodsThis is a health policy and systems research based on the World Health Organization guide. It consists of four phases; an integrative review, a qualitative study through individual semi-structured interviews (n ​= ​37), and one focus group interview (n ​= ​8), integrating these results in the third phase and generating model indicators. In the last phase, the evaluation of the importance of the indicators and the validation of the model were carried out during four classic Delphi rounds. ResultsBarriers to home-based palliative care were extracted from the first phase, and then 22 categories in eight pillars emerged from the qualitative phase. The indicators created for the model from two phases were integrated in the third phase (n ​= ​118). After the four-round of the Delphi, a conceptual model for home-based palliative care in cancer patients, including 92 indicators within eight pillars was created. ConclusionsAlthough this model was designed for our society, it can be utilized as a useful guide in other similar societies to design practical models and innovative programs to provide home-based palliative care in cancer patients. The application of the model in predicting different outcomes should be investigated in future trials.

GHESKIO's model of patient care during civil unrest in Haiti.

GHESKIO's model of patient care during civil unrest in Haiti.