Patient-centered Care Coordination Research Articles

Readiness for Hospital Discharge and Its Influencing Factors: A Review

Readiness for hospital discharge is a multidimensional concept involving needs assessment, collaborative patient-centered care, resource management, and care coordination. It begins with admission assessment and treatment planning and then predicts patient readmission and continuity of care. Different studies have revealed moderate readiness for hospital discharge in various patient groups, with a focus on somatic diseases and less on mental disorders. Low readiness for hospital discharge leads to hospital readmissions, as well as financial and psychosocial burdens on patients and their families. As a result, patients, families, healthcare professionals, and community workers must work together to ensure readiness for hospital discharge. Despite the fact that these procedures are currently performed by nurses, nurses’ heavy workloads may have an impact on patients' preparation for hospital discharge. Additionally, various social demographic factors, illness-related variables, and psychological support have an impact on readiness for hospital discharge. Younger age, urban residence, higher level of education, and better financial status are positively correlated with increased readiness for hospital discharge, but disease severity, long duration of hospital stay, and limited continuity of care are negatively correlated with readiness for hospital discharge. In conclusion, readiness for hospital discharge is crucial for safe transitions; thus, addressing its influencing factors through teamwork and patient-centered methods may enhance understanding and meeting the unique needs of patients, particularly those with chronic and mental illnesses, allowing a successful transition from the hospital to the community.

Medical Home Implementation and Follow-Up of Cancer-Related Abnormal Test Results in the Veterans Health Administration

Lack of timely follow-up of cancer-related abnormal test results can lead to delayed or missed diagnoses, adverse cancer outcomes, and substantial cost burden for patients. Care delivery models, such as the Veterans Affairs' (VA) Patient-Aligned Care Team (PACT), which aim to improve patient-centered care coordination, could potentially also improve timely follow-up of abnormal test results. PACT was implemented nationally in the VA between 2010 and 2012. To evaluate the long-term association between PACT implementation and timely follow-up of abnormal test results related to the diagnosis of 5 different cancers. This multiyear retrospective cohort study used 14 years of VA data (2006-2019), which were analyzed using panel data-based random-effects linear regressions. The setting included all VA clinics and facilities. The participants were adult patients who underwent diagnostic testing related to 5 different cancers and had abnormal test results. Data extraction and statistical analyses were performed from September 2021 to December 2023. Calendar years denoting preperiods and postperiods of PACT implementation, and the PACT Implementation Progress Index Score denoting the extent of implementation in each VA clinic and facility. Percentage of potentially missed timely follow-ups of abnormal test results. This study analyzed 6 data sets representing 5 different types of cancers. During the initial years of PACT implementation (2010 to 2013), percentage of potentially missed timely follow-ups decreased between 3 to 7 percentage points for urinalysis suggestive of bladder cancer, 12 to 14 percentage points for mammograms suggestive of breast cancer, 19 to 22 percentage points for fecal tests suggestive of colorectal cancer, and 6 to 13 percentage points for iron deficiency anemia laboratory tests suggestive of colorectal cancer, with no statistically significant changes for α-fetoprotien tests and lung cancer imaging. However, these beneficial reductions were not sustained over time. Better PACT implementation scores were associated with a decrease in potentially missed timely follow-up percentages for urinalysis (0.3-percentage point reduction [95% CI, -0.6 to -0.1] with 1-point increase in the score), and laboratory tests suggestive of iron deficiency anemia (0.5-percentage point reduction [95% CI,-0.8 to -0.2] with 1-point increase in the score). This cohort study found that implementation of PACT in the VA was associated with a potential short-term improvement in the quality of follow-up for certain test results. Additional multifaceted sustained interventions to reduce missed test results are required to prevent care delays.

Systems-Based Practice 20 Years On: Navigating the System for Better Care.

Systems-based practice (SBP) was introduced as 1 of 6 core competencies in 1999 because of its recognized importance in the quality and safety of health care provided to patients. Nearly 25 years later, faculty and learners continue to struggle with understanding and implementing this essential competency, thus hindering the medical education community's ability to most effectively teach and learn this important competency.Milestones were first introduced in 2013 as one effort to support implementation of the general competencies. However, each specialty developed its milestones independently, leading to substantial heterogeneity in the narrative descriptions of competencies including SBP. The process to create Milestones 2.0, and more specifically, the Harmonized Milestones, took this experience into account and endeavored to create a shared language for SBP across all specialties and subspecialties. The 3 subcompetencies in SBP are now patient safety and quality improvement, systems-navigation for patient-centered care (coordination of care, transitions of care, local population health), and physician's role in health care systems (components of the system, costs and resources, transitions to practice). Milestones 2.0 are also now supported by new supplemental guides that provide specific real-world examples to help learners and faculty put SBP into the context of the complex health care environment.While substantially more resources and tools are now available to aid faculty and to serve as a guide for residents and fellows, much work to effectively implement SBP remains. This commentary will explore the evolutionary history of SBP, the challenges facing implementation, and suggestions for how programs can use the new milestone resources for SBP. The academic medicine community must work together to advance this competency as an essential part of professional development.

Patients' Experience of Specialty Care Coordination: Survey Development and Validation.

Specialty care coordination relies on information flowing bidirectionally between all three participants in the "specialty care triad" - patients, primary care providers (PCPs), and specialists. Measures of coordination should strive to account for the perspectives of each. As we previously developed two surveys to measure coordination of specialty care as experienced by PCPs and specialists, this study aimed to develop and evaluate the psychometric properties of a related survey of specialty care coordination as experienced by the patient, thereby completing the suite of surveys among the triad. We developed a draft survey based on literature review, patient interviews, adaptation of existing measures, and development of new items. Survey responses were collected via mail and online in two waves, August 2019-November 2019 and September 2020-May 2021, among patients (N=939) receiving medical specialty care and primary care in the Veterans Affairs health system. Exploratory and confirmatory factor analysis were used to assess scale structure. Multiple linear regression was used to examine the relationship of the final coordination scales to patients' overall experience of specialty care coordination. A 38-item measure representing 10 factors that assess the patient's experience of coordination in specialty care among the patient, PCP, and specialist was finalized. Scales demonstrated good internal consistency reliability and, together, explained 59% of the variance in overall coordination. Analyses revealed an unexpected construct describing organization of care between patient and specialist that accounted for patient goals and preferences; this 10-item scale was named Patient-Centered Care Coordination. The final survey, Coordination of Specialty Care - Patient, or CSC-Patient for short, is a reliable instrument that can be used alone or with its companions (CSC-PCP, CSC-Specialist) to provide a detailed assessment of specialty care coordination and identify targets for coordination improvement.

How health systems facilitate patient-centered care and care coordination: a case series analysis to identify best practices

Large- and small-scale transformation of healthcare delivery toward improved patient experience through promotion of patient-centered and coordinated care continues to be at the forefront of health system efforts in the United States. As part of a Quality Improvement (QI) project at a large, midwestern health system, a case series of high-performing organizations was explored with the goal of identifying best practices in patient-centered care and/or care coordination (PCC/CC). Identification of best practices was done through rapid realist review of peer-reviewed literature supporting three PCC/CC interventions per case. Mechanisms responsible for successful intervention outcomes and associated institutional-level facilitators were evaluated, and cross-case analysis produced high-level focus items for health system leadership, including (1) institutional values surrounding PCC/CC, (2) optimization of IT infrastructure to enhance performance and communication, (3) pay structures and employment models that enhance accountability, and (4) organizing bodies to support implementation efforts. Health systems may use this review to gain insight into how institutional-level factors may facilitate small-scale PCC/CC behaviors, or to conduct similar assessments in their own QI projects. Based on our analysis, we recommend health systems seeking to improve PCC/CC at any level or scale to evaluate how IT infrastructure affects provider-provider and provider-patient communication, and the extent to which institutional prioritization of PCC/CC is manifest and held accountable in performance feedback, incentivization, and values shared among departments and settings. Ideally, this evaluation work should be performed and/or supported by cross-department organizing bodies specifically devoted to PCC/CC implementation work.

Impact of integrated care coordination on pediatric asthma hospital presentations.

IntroductionFrequent asthma attacks in children result in unscheduled hospital presentations. Patient centered care coordination can reduce asthma hospital presentations. In 2016, The Sydney Children's Hospitals Network launched the Asthma Follow up Integrated Care Initiative with the aim to reduce pediatric asthma emergency department (ED) presentations by 50% through developing and testing an integrated model of care led by care coordinators (CCs).MethodsThe integrated model of care was developed by a multidisciplinary team at Sydney Children's Hospital Randwick (SCH,R) and implemented in two phases: Phase I and Phase II. Children aged 2–16 years who presented ≥4 times to the ED of the SCH,R in the preceding 12 months were enrolled in Phase I and those who had ≥4 ED presentations and ≥1 hospital admissions with asthma attack were enrolled in Phase II. Phase I included a suite of interventions delivered by CCs including encouraging parents/carers to schedule follow-up visits with GP post-discharge, ensuring parents/carers are provided with standard asthma resource pack, offering referrals to asthma education sessions, sending a letter to the child's GP advising of the child's recent hospital presentation and coordinating asthma education webinar for GPs. In addition, in Phase II CCs sent text messages to parents/carers reminding them to follow-up with the child's GP. We compared the change in ED visits and hospital admissions at baseline (6 months pre-enrolment) and at 6-and 12-months post-enrolment in the program.ResultsDuring December 2016-January 2021, 160 children (99 in Phase I and 61 in Phase II) were enrolled. Compared to baseline at 6- and 12-months post-enrolment, the proportion of children requiring ≥1 asthma ED presentations reduced by 43 and 61% in Phase I and 41 and 66% in Phase II. Similarly, the proportion of children requiring ≥1 asthma hospital admissions at 6- and 12-months post-enrolment reduced by 40 and 47% in Phase I and 62 and 69% in Phase II.ConclusionOur results support that care coordinator led integrated model of asthma care which enables integration of acute and primary care services and provides families with asthma resources and education can reduce asthma hospital presentations in children.

Hospital Case Management: A Review: 2019-2022.

In June 2019, a Case Management Society of America (CMSA) task force published "The Practice of Hospital Case Management: A White Paper." This was an important first step to outline the value of hospital case managers (HCMs) and to put forward recommendations for how to operationalize a major change in most hospitals for how case managers can practice.The SARS-CoV2 (COVID-19) pandemic drastically changed the practice of all interdisciplinary work within hospitals. The White Paper recommended that HCMs follow a select patient population through the hospital. Hospital case manager leaders realized that HCMs can work remotely and communicate with patients because meeting them in person was not an option. Hospital case managers are still resistant to leaving the hospital unit-based model, even after they experienced the value of this concept during the height of the pandemic. Acute care hospitals. The White Paper recommended separating HCMs from utilization management. One unintended consequence is the loss of necessary knowledge and competencies. These are related to compliance with the Centers for Medicare & Medicaid Services Conditions of Participation and regulatory mandates that can affect patient care and financial well-being. Hospital case manager leaders must stay current with these government requirements for hospitals and for all levels of care and keep the case managers informed, proficient, and fluent when coordinating the care of patients. Hospital case manager practice is evolving; change is the single constant in health care. This review of the CMSA Hospital Case Management Whitepaper demonstrates that in just three short years, the landscape of health care can change dramatically.Today's HCM leader must proactively address a multigenerational workforce, lack of title protection, and the COVID-19-induced "Great Resignation." The value of the HCM has never been more apparent as during the pandemic as the need to "empty beds" is critical, and the HCM is the professional who has the skill to provide efficient and patient-centered care coordination. The HCM leader practices positive leadership techniques that benefit the leader, the HCM, and most importantly the patient.

Invited Commentary: Role of the Radiologist in Pregnancy-associated Cancer.

Invited Commentary: Role of the Radiologist in Pregnancy-associated Cancer.

Implementing patient navigation programs: Considerations and lessons learned from the Alliance to Advance Patient-Centered Cancer Care.

Six multidisciplinary cancer centers were selected and funded by the Merck Foundation (2017-2021) to collaborate in the Alliance to Advance Patient-Centered Cancer Care ("Alliance"), an initiative to improve patient access, minimize health disparities, and enhance the quality of patient-centered cancer care. These sites share their insights on implementation and expansion of their patient navigation efforts. Patient navigation represents an evidence-based health care intervention designed to enhance patient-centered care and care coordination. Investigators at 6 National Cancer Institute-designated cancer centers outline their approaches to reducing health care disparities and synthesize their efforts to ensure sustainability and successful transferability in the management of patients with cancer and their families in real-world health care settings. Insights are outlined within the context of patient navigation program effectiveness and supported by examples from Alliance cancer center sites: 1) understand the patient populations, particularly underserved and high-risk patients; 2) capitalize on the existing infrastructure and institutional commitment to support and sustain patient navigation; and 3) build capacity by mobilizing community support outside of the cancer center. This process-level article reflects the importance of collaboration and the usefulness of partnering with other cancer centers to share interdisciplinary insights while undergoing intervention development, implementation, and expansion. These collective insights may be useful to staff at other cancer centers that look to implement, enhance, or evaluate the effectiveness of their patient navigation interventions.

A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination personnel

Introduction & Importance: Effective, patient-centered care coordination has been shown to improve outcomes for children with special healthcare needs (CSHCN), who often have complex, long-term involvement with multiple service providers. Traumatic brain injury (TBI) can result in long-term physical, intellectual, social, and emotional disabilities that persist long after acute treatment. Yet, even though it is a chronic condition, TBI remains an area with scarce standardization and research surrounding the complex, long-term care coordination need in this population. The purpose of this scoping review is to summarize current research on outcomes in CSHCN after implementation of care coordinators, whether individual or teams, to inform future research for youth with TBI. Methods: OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination and CSHCN. Results: 31 articles met inclusion criteria. Outcomes for children and families were grouped into 5 major categories: healthcare utilization, cost of care, disease status, parent and child quality of life, and healthcare satisfaction and perception of care. Discussion: Implementation of care coordinators, whether in the form of individuals, dyads, or teams, resulted in overall positive outcomes for CSHCN and their families across all 5 major outcome domains. Future research should be focused on the efficacy of care coordinators differing in profession, qualifications, and educational attainment specifically for the unique needs of children with TBI. Additionally, the application of care coordination within medical homes should be further investigated to increase proactive, preventative care of children with TBI and further reduce reactive, need-based treatment only.

Assessment of Patient Experience of Care in Home Dialysis Around the World: Enhancing the Patient’s Voice in Home Dialysis Care and Research

With the global growth in the use of home dialysis modalities, there is a need to better understand patients’ experiences with their home dialysis care. Patient-reported experience measures or PREMs, are standardized survey questionnaires that allow patients to provide input on processes and experiences of care in a confidential and validated manner. Until recently, no validated PREM has been available for assessment of patient-reported experience of care for home dialysis modalities, including peritoneal dialysis or home hemodialysis. The Home Dialysis Care Experience instrument (Home-DCE) is a newly developed and content-valid PREM for use among patients treated with home dialysis modalities. The survey instrument includes 26 core survey questions and 20 demographic questions, and is now available in English, Spanish, and French. Domains of care assessed in the Home-DCE include staff education and patient-centered communication, care coordination, patient safety, concern and helpfulness of the care team, and staff care proficiency. Worldwide use of the Home-DCE will allow incorporation of patients’ experiences and preferences in initiatives to enhance quality of care for home dialysis patients globally. Translation and deployment of a PREM in additional languages should be done using established cultural adaptation methods, the gold standard for which is termed linguistic validation. Translation and linguistic validation are hurdles to global use of the Home-DCE, but challenges that should be met to enhance home dialysis patients’ voice in clinical kidney care.

A Quality Improvement Initiative Advancing CLL Care Practices across Four US Health Systems

▪Background: National initiatives for quality improvement (QI) are intended to promote safe, effective, coordinated, and affordable healthcare practices, yet reports of QI programs involving hematologic malignancies are lacking. To address quality-related gaps and needs of hematology-oncology teams in US health systems, we conducted a QI study that focused on clinical assessment practices, patient counseling, and care coordination for patients with chronic lymphocytic leukemia (CLL).Methods: Participants in the IRB-approved study were 20 hematologists-oncologists and their clinical teams of nurses, nurse practitioners, physician assistants, and case managers at 20 centers. The teams practiced in 4 health systems in different US regions: a large corporate system (n = 5 teams), 2 private regional hematology-oncology centers (n = 9 teams), and a large public health system (n = 6 teams). At baseline, 10 consecutive charts of patients with a confirmed diagnosis of CLL were retrospectively reviewed per provider for documentation of diagnostic and prognostic assessments, patient counseling, and care coordination. The chart variables align with national clinical practice guidelines, quality measures for CLL-specific and patient-centered care, and requirements of healthcare reform programs including the Oncology Care Model and the Medicare Access and CHIP Reauthorization Act.After the baseline charts were reviewed, chart audit feedback was presented to the physicians and their teams by external independent CLL experts. The audit-feedback webinar intervention focused on improving the CLL clinical assessment, patient-centered care, and care coordination practices that were central to the QI program, and was designed according to principles of plan-do-study-act (PDSA) models, engaging participants in identifying gaps in care quality and developing written targeted action plans for improvement. Six months after the interventions, consecutive randomized charts were reviewed according to the methods of the baseline review. Chi-square tests were conducted to assess the reliability of baseline and post-intervention differences in rates of documentation for the chart variables. A P-value less than .05 was considered significant.Results: We reviewed 200 baseline charts and 200 post-intervention charts. The baseline and post-intervention samples were similar in age, years since CLL diagnosis, gender, and Rai stage 0/1 and 3/4 (Table). A significantly greater proportion of patients in the post-intervention sample was at Rai stage 2 (+10%) and had received CLL treatment (+13%). Rates of chart documentation were significantly higher in the post-intervention versus baseline samples for Rai staging (+23%), flow cytometry (+22%), FISH testing for genetic abnormalities (+26%), and assessment of functional status using the Eastern Cooperative Oncology Group (ECOG) scale (+10%). A significantly greater proportion of charts in the post-intervention sample were documented for care coordination (+17%) and for patient counseling on CLL treatment options (+20%) and treatment risks and benefits (+18%). The teams' written action plans included strategies for adjusting electronic medical records to facilitate performance and documentation of key quality measures, initiating periodic review of QI-related data, incorporating new workflow processes to obtain and utilize prognostic marker testing results in decision-making for uniform care delivery, and involving team members for care coordination and patient counseling.Conclusion: This study demonstrates positive outcomes of a team-based QI program on clinical assessment practices, patient counseling, and care coordination for patients with CLL across 4 oncology group settings. The study methods and findings are especially relevant in the context of national initiatives for improving clinical and patient-centered care practices. Moreover, the findings reflect process improvements that are essential for accurately diagnosing CLL, making appropriate guideline-directed treatment decisions that account for genetic status, and promoting patient engagement in CLL care. Persistent gaps were noted in communication with patients about their preferences and treatment goals and counseling about side effects, highlighting the need for continuing education. [Display omitted] DisclosuresDavids:Astra-Zeneca: Consultancy; InCyte: Membership on an entity's Board of Directors or advisory committees; Merck: Consultancy; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead: Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Consultancy; Infinity: Consultancy, Research Funding; Pharmacyclics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Mato:Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead Sciences, Inc.: Membership on an entity's Board of Directors or advisory committees; DTRM: Research Funding; AstraZeneca: Consultancy; AbbVie: Consultancy, Research Funding; Regeneron: Research Funding; Portola: Research Funding; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy; Acerta: Research Funding; Pharmacyclics: Research Funding; Kite: Consultancy. Pagel:Gilead: Consultancy; Pharmacyclics: Consultancy.

Real-World Gaps in Chart Documentation and Patient-Centered Care Inform Team-Based Action Plans for Relapsed/Refractory DLBCL: Results from a Quality Improvement Study

Background Using shared decision-making (SDM) to define therapeutic goals and shape individualized treatment plans for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) can profoundly improve patient-reported outcomes. However, unique barriers within oncology systems can impede patient-centered care coordination and delivery. In this quality improvement (QI) initiative, we assessed barriers to patient-centered R/R DLBCL care in 2 community oncology systems and conducted team-based audit-feedback (AF) sessions within each system to facilitate improved care coordination. Methods Between 12/2019 and 1/2020, 33 hematology/oncology healthcare professionals (HCPs) completed team-based surveys designed to assess barriers to quality R/R DLBCL care in 2 community oncology systems (Table 1). In addition, we retrospectively audited electronic medical records (EMRs) of 75 patients with R/R DLBCL to compare documented practice patterns with self-reported survey results. To address identified gaps, 31 HCPs practicing within the 2 systems participated in AF sessions; together, clinical teams developed action plans guided by survey insights and EMR findings. Additional surveys completed before and after the AF sessions measured changes in participants' beliefs and confidence in care delivery. A planned prospective follow-up EMR audit of 75 patients will assess changes in documentation and practice behavior. Results Team Surveys and EMR Audit: Using a 5-point Likert scale (0 = extremely unlikely; 5 = extremely likely), HCPs indicated a high likelihood of using prognostic scores (mean score, 3.8) and cell of origin (mean score, 3.9) to inform DLBCL treatment decisions. However, despite documentation of individual prognostic factors, only 30% of EMRs included the calculated International Prognostic Index (IPI) risk score and only 8% included cell of origin. No EMRs included an age-adjusted IPI, stage-modified IPI, or NCCN-IPI score (Figure 1). Despite only 6% of HCPs identifying engaging patients in SDM as a major practice challenge, SDM resources were consistently underutilized (Figure 2). Only 30% of HCPs estimated using SDM in more than half of their patients; 23% of HCPs reported using SDM with none of their patients with R/R DLBCL. Moreover, while 63% of HCPs reported routinely asking the patient what role he/she wishes to play (active, passive, collaborative), fewer HCPs integrated other SDM tools: using visual aids to communicate treatment benefits/risks (59%), referring patients to online education resources (53%), including the patient's spouse/family members in decisions (47%), and discussing financial toxicity (38%). Small-Group AF Sessions: When asked to identify a single aspect of R/R DLBCL care in greatest need for improvement in their systems, HCPs most commonly selected care coordination (34%) and adverse event recognition/management (20%), followed by individualizing treatment (16%) and prognostic scoring (14%). As part of their action plans, HCPs prioritized 3 practice behaviors to address with their clinical teams: individualizing treatment decisions based on patient- and disease-related factors (40%), improving communication during care transitions (40%), and providing adequate patient education about treatment options and potential side effects (20%). As a result of participating in the AF sessions, HCPs reported a meaningful shift in beliefs about collaborative care: 84% of HCPs agreed or strongly agreed that collaboration across the extended oncology care team is essential for achieving DLBCL treatment goals, an increase from 64% prior to the AF sessions. Further, HCPs reported increased confidence in their ability to perform each of 6 aspects of evidence-based, collaborative, patient-centered care (Figure 3). Conclusions Key system-based barriers to providing individualized R/R DLBCL care include adequate documentation of prognostic factors, care coordination, and effective SDM. After participating in this QI initiative, HCPs demonstrated improved commitment to team-based collaboration and increased confidence in delivering patient-centered care. Remaining practice gaps and challenges can inform future QI programs. Study Sponsor Statement The study reported in this abstract was funded by an independent educational grant from Genentech. The grantor had no role in the study design, execution, analysis, or reporting. Disclosures No relevant conflicts of interest to declare.

Patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs: An importance-performance analysis.

To analyse the importance and performance of key elements in patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs. In four Belgian non-academic hospitals, the importance and performance of a set of 82 key elements was cross-sectionally evaluated by primary and secondary healthcare professionals and by patients. These key elements were divided in 6 themes: coordination of care, style and content of patient contacts, medication counseling at treatment initiation, follow-up of treatment, psychosocial support, and involvement of family and friends. Participants were asked to indicate for each key element if it was implemented in the current care process for patients on oral anticancer drugs ('yes', 'no', 'I don't know') and if they considered it important that the component was implemented or would be in the future ('yes' or 'no'). Three levels of performance were defined, based on the number of participants who had answered 'yes' or 'no': 'systematically performed' (≥90% of participants), 'not systematically performed' (≥75% and <90%) and 'not performed' (<75%). Importance-rates were based on the number of 'yes' or 'no'. In total, 85 participants evaluated the key elements. More than half of key elements, 13/82 (15.9%) and 35/82 (42.6%) respectively, were considered as 'not' or 'not systematically performed'. The majority of these elements concerned coordination of care, medication counseling at treatment initiation and follow-up of treatment. Especially key elements on involving primary care and on discussing adherence had low performance rates. Nearly all key elements were assigned an importance score of ≥90%. Performance of key elements of patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs proved moderate. Our findings suggest that strategies are needed to prioritize and operationalize key elements to coordinate transmural care and to provide effective education and counseling.

Patient perspectives on primary care and oncology care coordination in the context of multiple chronic conditions: A systematic review.

Patients' views on the optimal model for care coordination between primary care providers (PCPs) and oncologists in the context of cancer and multiple chronic conditions (MCC) are unclear. Thus, the purpose of this systematic review is to evaluate the perceptions of patients with both cancer and MCC regarding their care coordination needs. Following PRISMA guidelines, the literature was systematically searched through PubMed, CINAHL, and PsycINFO for articles pertaining to patients' perspectives, experiences, and needs regarding care coordination between PCPs and oncologists during the cancer care continuum, in the context of patients with cancer and MCC. English-language articles were included if they met the following criteria: 1) published between 2008 and 2018; 2) peer-reviewed study; 3) patients aged 18 years or older diagnosed with any type or stage of cancer; 4) patients have one or more chronic comorbid condition; 5) inclusion of patient perceptions, experiences, or needs related to care coordination between PCPs and oncologists; and 6) ability to extract results. Data extraction was performed with a standardized form, and themes were developed through qualitative synthesis. A grounded theory approach was used to qualitatively evaluate data extracted from articles and create a framework for providers to consider when developing patient-centered care coordination strategies for these complex patients. Risk of bias within each study was assessed independently by two authors using the Mixed Methods Appraisal Tool. A total of 22 articles were retained, representing the perspectives of 8,114 patients with cancer and MCC. Studies were heterogeneous in the patients' respective phases of cancer care and study design. From qualitative synthesis, four themes emerged regarding patients' needs for cancer care coordination and were included as constructs to develop the Patient-centered Care Coordination among Patients with Multiple Chronic Conditions and Cancer (PCP-MC) framework. Constructs included: 1) Communication; 2) Defining provider care roles; 3) Information access; and 4) Individualized patient care. Care navigators served as a communication bridge between providers and patients. Findings highlight the importance that patients with both cancer and MCC place on communication with and between providers, efficient access to understandable care information, defined provider care roles, and care tailored to their individual needs and circumstances. Providers and policymakers may consider the developed PCP-MC framework when designing, implementing, and evaluating patient-centered care coordination strategies for patients with both cancer and MCC.

Mixed-methods research to evaluate a novel patient-centered cancer care coordination instrument.

280 Background: Effective care coordination (CC) is a critical component of high-quality cancer care; however, efforts to improve cancer care coordination are hampered by limited patient-centered measures. This mixed-methods research reports on patients’ feedback and the utility of a novel care coordination instrument (CCI) designed to assess cancer care coordination. Methods: 7 focus group discussions were conducted with 68 cancer patients receiving active therapy to evaluate validity of the CCI. Subsequently, the CCI was modified and administered to additional 200 cancer patients derived from community-based private and hospital clinics. The CCI is a 29-item, multiple-choice questionnaire and includes subscales that evaluate CC in 3 domains (Communication, Navigation, Operational) across 4 areas of CC (patient-physician; between providers; during inpatient-to-ambulatory care transitions; during transitions across phases of care). Results: Qualitative analysis of focus group discussions demonstrated that the CCI has good face and content validity. Content analysis identified the following themes: Survey, Education/Knowledge, Navigator, Communication, Support, Access, Providers, and Team. Questions with unclear wording or high proportions of not applicable or missing responses were refined or removed. Results of the revised survey indicated that the CCI is able to distinguish patient- and practice characteristics associated with optimal/poor CC. Specifically, cancer types (leukemia, myeloma) and having a patient navigator predicted high overall patients’ ratings of CC ( p &lt; .05). Marginally significant differences were found for practice setting ( p = .085). A multiple regression model with all predictors entered simultaneously revealed that the presence of a family/friend caregiver significantly predicted better CC ( p &lt; .001); however, the benefits of a patient navigator were no longer significant. Conclusions: This study demonstrates the utility of the CCI for assessing patients’ perspectives of cancer CC. Use and integration of this instrument in oncology practices/clinics can identify areas of potential interventions for CC improvement and lead to a better quality of care.

Patient-centered care coordination in population health case management

Patient-centered care coordination in population health case management

Purchased Behavioral Health Care Received by Military Health System Beneficiaries in Civilian Medical Facilities, 2000-2014.

IntroductionBehavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014.Materials and MethodsMedical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study.ResultsFrom 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78.8%) and care was most often received in EDs (56%). Most commonly treated diagnoses included mood, tobacco use, and alcohol use disorders. ED visits were associated with being treated for anxiety (excluding post-traumatic stress disorder; Adjusted odds ratio [AOR]: 9.14 [95% confidence interval (CI): 8.26, 10.12]), alcohol use disorders (AOR = 1.67 [95% CI: 1.53, 1.83]), tobacco use (AOR = 1.16 [95% CI: 1.06, 1.26]), nondependent cocaine abuse (AOR = 5.47 [95% CI: 3.28, 9.12]), nondependent mixed/unspecified drug abuse (AOR = 7.30 [95% CI: 5.11, 10.44]), and psychosis (AOR = 1.38 [95% CI: 1.20, 1.58]). Compared with adults age 60 yr and older, adolescents (ages 12–17 yr), and adults under age 60 yr were more likely to be treated for suicidal ideation, adjustment, mood, bipolar, post-traumatic stress disorder, nondependent cocaine, and mixed/unspecified drug abuse. Adults under age 60 yr also had increased odds of being treated for tobacco use disorders, alcohol use disorders, and opioid/combination opioid dependence compared with adults age 60 yr and older.ConclusionsOver the past 15 yr, purchased behavioral health care received by MHS beneficiaries in acute care facilities increased significantly. MHS beneficiaries received the majority of purchased behavioral health care for mental health disorders and were treated most often in the ED. Receiving behavioral health care in civilian EDs raises questions about access to outpatient behavioral health care and patient-centered care coordination between civilian and military facilities. Given the influx of new Veterans Health Administration users from the MHS, findings have implications for military, veteran, and civilian facilities providing behavioral health care to military and veteran populations.

Multidisciplinary teams and ICT: a qualitative study exploring the use of technology and its impact on multidisciplinary team meetings

BackgroundMultidisciplinary teams (MDTs) are an integral component in the delivery of health care. This is particularly evident in the delivery of cancer care, where multidisciplinary teams are internationally recognized as the preferred method for service delivery. The use of health information systems and technology are key enabling factors for building the capacity of MDTs to engage in improvement and implementation projects but there is scant research on how MDTs make use of technology and information systems or the kinds of systems needed for them to undertake improvement and implementation research. This paper reports findings on how seven MDTs in cancer care utilized technological and information systems and the barriers and enabling factors that impacted on their uptake.MethodsSeven multidisciplinary teams from two large metropolitan hospitals participated in the study. Qualitative methods including structured observations and semi structured interviews that explored how teams engaged in research and improvement activities were utilized. Participants were also observed and interviewed in relation to their use of data and health information systems. Findings were subject to content analysis and key themes were identified. Interviews were transcribed and de-identified and key themes were subsequently discussed with participants to allow for member checking and further clarification of findings.ResultsA total of 43 MDT meetings across seven tumor streams were observed. Of these, observation notes from 13 meetings contained direct references to emerging technologies and health information systems. Findings from 15 semi-structured interviews were also analyzed in relation to how MDTs used technology in weekly meetings, and the perceived impact of technology. Three broad themes emerged: (1) methods for data collection and use by MDTs, (2) the impact of technology on the MDT meeting environment, and (3) the impact of technology and information systems on clinical decision making.ConclusionThe study demonstrates that real time data collection and imaging may improve patient centered care coordination. However, ICTs can be used sub-optimally by teams. We therefore urge additional research to identify the enabling factors that support better collection and use of outcome data from ICT.

The Associations of Ward Head Direction and Incentive with Nurse Performance at Arun LNG Hospital, Lhokseumawe, Aceh

Background : The current transformation in the hospital care industry demands greater coordination of care across providers and across settings so as to improve quality care, improve outcomes, and reduce spending. Nurses contribute to the transformative changes by being a fully contributing member of the inter-professional team. It requires an enhanced set of knowledge, skills, attitudes, and performance among nurses around wellness and population care with a renewed focus on patient-centered care, care coordination, data analytics, and quality improvement. This study aimed to analyze the associations of ward head direction and incentive with nurse performance at Arun LNG Hospital, Lhokseumawe, Aceh. Subjects and Method : This was a cross-sectional study carried out at Arun LNG Hospital, Lhokseumawe, Aceh. A sample of 74 nurses was selected for this study by exhaustive sampling. The dependent variable was nurse performance. The independent variables were ward head direction and incentive. The data were collected by questionnaire and analyzed by a multiple logistic regression. Results : Nurse performance improved with high motivation (OR= 11.12; 95% CI= 2.66 to 46.49; p= 0.001), explicit ward head direction (OR= 4.37; 95% CI= 1.05 to 18.17; p= 0.043), and existence of incentive (OR= 5.84; 95% CI= 1.30 to 26.17; p= 0.021). Conclusion : Improved nurse performance is associated with explicit ward head direction and existence of incentive. Keywords: nurse performance, ward head direction, incentive Correspondence : Irwadi. Masters program in Public Health, Universitas Sumatera Utara, Medan, North Sumatera. Email: wadieadi655@gmail.com. Mobile: 08126922595. Journal of Health Policy and Management (2018), 3(2): 114-117 https://doi.org/10.26911/thejhpm.2018.03.02.08