Patient Healthcare Quality Research Articles

The Hippocratic Oath: Misreading and Rereading an Ancient Text.

The Hippocratic oath is such an enduring icon of medical morality that physicians in Nazi Germany invoked it to protest Euthanasie, the systematized killing of weak or sick children, people with incurable diseases, hospitalized criminals (a category applicable to gays), geriatric patients, long-term patients, patients not of German blood (Jews and Romani), and people with disabilities. Several expert witnesses at the 1945 Nuremberg Medical Trial also cited the oath to condemn Nazi physicians' abuse of human research subjects. Noting these invocations, in 1947 the physicians who founded the World Medical Association modernized the Hippocratic oath to convey to future medical students its foundational precepts: benefitting the sick, not harming them, not breaching confidentiality, and not treating patients unjustly, irrespective of their gender or social status. This article presents a historically accurate reading of the oath's strange-seeming passages to show that it does not prohibit abortion, euthanasia (medical aid in dying), or surgery. The article also contends that oath-swearing remains an important asset in teaching clinicians their role responsibilities, and that its ethics supports women's rights to reproductive health care and can valorize challenges to venture-capitalist and for-profit managements that prioritize profitability over providing quality health care for patients.

Impact of Digital Interventions on the Treatment Burden of Patients With Chronic Conditions: Protocol for a Systematic Review.

There is great potential for delivering cost-effective, quality health care for patients with chronic conditions through digital interventions. Managing chronic conditions often includes a substantial workload required for adhering to the treatment regimen and negative consequences on the patient's function and well-being. This treatment burden affects adherence to treatment and disease outcomes. Digital interventions can potentially exacerbate the burden but also alleviate it. The objective of this review is to identify, summarize, and synthesize the evidence of how digital interventions impact the treatment burden of people with chronic conditions. The search, selection, and data synthesis processes were designed according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015. A systematic search was conducted on October 16, 2023, from databases PubMed, Scopus, Web of Science, ACM, PubMed Central, and CINAHL. Preliminary searches have been conducted, and screening has been started. The review is expected to be completed in October 2024. As the number of patients with chronic conditions is increasing, it is essential to design new digital interventions for managing chronic conditions in a way that supports patients with their treatment burden. To the best of our knowledge, the proposed systematic review will be the first review that investigates the impact of digital interventions on the treatment burden of patients. The results of this review will contribute to the field of health informatics regarding knowledge of the treatment burden associated with digital interventions and practical implications for developing better digital health care for patients with chronic conditions. PROSPERO CRD42023477605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=477605. DERR1-10.2196/54833.

A Health Service Transition to Adult Patient Care for Sickle Cell Disease

This paper explores the challenges related to long-term conditions, focusing on sickle cell disease (SCD) as a case study. Long-term conditions, characterized by the need for ongoing management, present a substantial burden on healthcare systems globally. A careful transition from pediatric to adult healthcare is needed for SCD. The discussion extends to the broader health service transition to adult patient care in SCD, emphasizing the World Health Organization’s definition of care transitions and the necessity for an integrated healthcare service. The emphasis is on a multidisciplinary approach to medical, mental health, and educational problems. A person-centered model of care should be used more consistently to resolve these long-term condition-related challenges. To evaluate the effectiveness of new interventions in improving the transition of care from pediatrics to adult patients with SCD, continuous quality improvement strategies should be implemented and prospectively measured in younger patients. In conclusion, this study highlights the critical importance of an effective transition from pediatric to adult healthcare. The continued research of effective transition practices is essential for the future and there is still a requirement to develop pragmatic approaches to enhance research on the transition to improve the quality of healthcare for patients with long-term conditions.

The FlaQuM-Quickscan: A starting point to include primary care professionals’ perspectives in the evaluation of hospital quality priorities

IntroductionToday, primary care professionals’ (PCPs) perspectives on hospital quality are unknown when evaluating hospital quality priorities. The aims of the present study were to identify key healthcare quality attributes from PCPs’ perspective, to validate an instrument that measures PCPs’ experiences of healthcare quality multidimensionally and to define hospital quality priorities based on PCPs’ experiences. Material and methodsFocus groups with PCPs were conducted to identify quality attributes through a qualitative in-depth analysis. A multicentre study of 18 hospitals was used to quantitatively assess construct, discriminant and criterion validity of the FlaQuM-Quickscan, an instrument that measures ‘Healthcare quality for patients and kin’ (part 1) and ‘Healthcare quality for professionals’ (part 2). To set quality priorities, scores on quality domains were analyzed descriptively and between-hospital variation was examined by evaluating differences in hospitals’ mean scores on the quality domains using one-way Analysis of Variance (ANOVA). ResultsIdentified key attributes largely corresponded with Lachman's multidimensional quality model. Including ‘Communication’ as a new quality domain was recommended. The FlaQuM-Quickscan was completed by 550 PCPs. Confirmatory factor analyses showed reasonable to good fit, except for the Root Mean Square Error of Approximation (RMSEA) in part 2. The ‘Equity’ domain scored the highest in parts 1 and 2. Domains ‘Kin-centred care’ and ‘Accessibility and timeliness’ scored the lowest in part 1 and ‘Resilience’ and ‘Partnership and co-production’ in part 2. Significant variation in hospitals’ mean scores was observed for eleven domains in part 1 and sixteen domains in part 2. ConclusionsThe results gained a better understanding of PCPs’ perspective on quality. The FlaQuM-Quickscan is a valid instrument to measure PCPs’ experiences of hospital quality. Identified priorities indicate that hospital management should focus on multifaceted quality strategies, including technical domains, person-and kin-centredness, core values and catalysts.

FlaQuM-Quickscan: an instrument to measure healthcare quality experiences across patients, kin and professionals in hospitals and primary care settings.

Background: Healthcare quality is multidimensional and should be measured from a multistakeholder perspective. Experiential knowledge from patients, kin and professionals is increasingly recognised as contributions in quality management considering the trend towards value-based, co-produced healthcare systems. To address this gap in existing research, we aimed to develop and validate a new instrument.
 Methods: Content validity was established using a multidimensional quality model validated by four focus groups with patients and kin and two with primary care professionals. To obtain face validity, a multistakeholder group (n=41), including patients, kin and professionals, pilot-tested the mirrored instrument ‘FlaQuM-Quickscan’ measuring ‘Healthcare quality for patients and kin’ (part 1) and ‘Healthcare quality for professionals’ (part 2). Each instrument part contains 15 quality items and 3 global ratings. A multicentre study with 17 Flemish (Belgian) hospitals was conducted to perform other validity tests, including construct validity by factor analyses across type of respondents, criterion validity by item-to-general-items correlations and a process evaluation by conducting semi-structured interviews.
 Results: In total, 13,615 respondents (N Patients/kin = 5,891, N Professionals = 7,724 and N Primary care = 454) completed the FlaQuM-Quickscan. The confirmatory factor analyses showed reasonable to very good fit for part 1 ‘Healthcare quality for patients and kin’ (scored by patients/kin: CFI = 0.961, TLI = 0.951 and RMSEA = 0.084, scored by professionals: CFI = 0.950, TLI = 0.938 and RMSEA = 0.080, scored by primary care: CFI = 0.948, TLI = 0.935 and RMSEA = 0.101) and for part 2 ‘Healthcare quality for professionals’ (scored by patients/kin: CFI = 0.969, TLI = 0.962 and RMSEA = 0.085, scored by professionals: CFI = 0.946, TLI = 0.932 and RMSEA = 0.091, scored by primary care: CFI = 0.922, TLI = 0.902 and RMSEA = 0.129). The configural and scalar invariance were demonstrated across type of respondents and their characteristics. Correlations supported the associations between 15 instrument items and 3 global ratings for both instrument parts. The process analyses showed that addressing individuals directly and supportive technical structures to immediately complete the instrument were most effective to motivate respondents. 
 Conclusion: The FlaQuM-Quickscan is assessed as a valid instrument to measure healthcare quality experiences from a multistakeholder perspective. Integrating different perspectives gives the opportunity to analyse and gain understanding in experiences of stakeholders and reinforces a more holistic, well-informed approach towards quality. 
 Practice implications: This new instrument offers unique and detailed data from a multistakeholder perspective to co-produce a shared quality vision in organisations, to build a future sustainable quality management system and to set priorities on managerial and board level.
 Next steps: Future research will assess the transferability to other healthcare systems, examine variation between stakeholder groups and organisations and support to set quality priorities on managerial and board levels.

Measuring in-hospital quality multidimensionally by integrating patients’, kin’s and healthcare professionals’ perspectives: development and validation of the FlaQuM-Quickscan

BackgroundMeasuring quality is essential to drive improvement initiatives in hospitals. An instrument that measures healthcare quality multidimensionally and integrates patients’, kin’s and professionals’ perspectives is lacking. We aimed to develop and validate an instrument to measure healthcare quality multidimensionally from a multistakeholder perspective.MethodsA multi-method approach started by establishing content and face validity, followed by a multi-centre study in 17 Flemish (Belgian) hospitals to assess construct validity through confirmatory factor analysis, criterion validity through determining Pearson’s correlations and reliability through Cronbach’s alpha measurement. The instrument FlaQuM-Quickscan measures ‘Healthcare quality for patients and kin’ (part 1) and ‘Healthcare quality for professionals’ (part 2). This bipartite instrument mirrors 15 quality items and 3 general items (the overall quality score, recommendation score and intention-to-stay score). A process evaluation was organised to identify effective strategies in instrument distribution by conducting semi-structured interviews with quality managers.ResultsBy involving experts in the development of quality items and through pilot testing by a multi-stakeholder group, the content and face validity of instrument items was ensured. In total, 13,615 respondents (5,891 Patients/kin and 7,724 Professionals) completed the FlaQuM-Quickscan. Confirmatory factor analyses showed good to very good fit and correlations supported the associations between the quality items and general items for both instrument parts. Cronbach’s alphas supported the internal consistency. The process evaluation revealed that supportive technical structures and approaching respondents individually were effective strategies to distribute the instrument.ConclusionsThe FlaQuM-Quickscan is a valid instrument to measure healthcare quality experiences multidimensionally from an integrated multistakeholder perspective. This new instrument offers unique and detailed data to design sustainable quality management systems in hospitals. Based on these data, hospital management and policymakers can set quality priorities for patients’, kin’s and professionals’ care. Future research should investigate the transferability to other healthcare systems and examine between-stakeholders and between-hospitals variation.

Understanding Variation in Health Care Quality Experiences of Three Stakeholders: Patients and Kin, Professionals, and Hospitals

Summary As quality of care increasingly becomes a strategic topic for hospitals, understanding variation between stakeholders’ experiences is essential. A framework can be used by managers, researchers, and policy makers to account for these variations and set priorities to ensure an environment of trust among all stakeholders — including patients and kin. To measure perceptions of quality from a multidimensional view, researchers at the Leuven Institute for Healthcare Policy established four objectives. The first was to explore whether patients and kin (collectively), and professionals experience quality as a multidimensional concept. The second was to examine the between-stakeholder variation across health care quality experiences of patients/kin and professionals. The third was to examine between-hospital variation in health care quality experiences among the 19 hospitals studied. The fourth was to set quality priorities for hospital management and policy makers based on multistakeholder and multicenter data. To collect information, researchers used the Flanders Quality Model (FlaQuM)-Quickscan tool, which is a two-part instrument that measures quality from a multidimensional view. It includes a series of statements on health care quality for patients and kin (part 1) and a corresponding series of statements on health care quality for professionals (part 2), each consisting of 15 quality domains and three global ratings; all respondents were required to address both parts 1 and 2. To explore whether quality is experienced as a multidimensional concept, intraindividual variation was examined by analyzing stakeholders’ differences between minimum and maximum scores on the instrument domains. Between-stakeholder variation was examined by evaluating differences in mean scores of the two stakeholder groups on the quality domains using unpaired t-tests. Between-hospital variation was examined by evaluating differences in hospitals’ mean scores on the quality domains using one-way analysis of variance (ANOVA). In total, 14,977 respondents (6,590 patients/kin and 8,387 professionals) completed the FlaQuM-Quickscan during the study period between May 2021 and June 2022. Respondents used a Likert scale, where 0 is full disagreement with the statement and 10 is full agreement. Analyses revealed important intraindividual variation in experiences of respondents across quality domains. Researchers also observed that patients/kin scored all domains (in parts 1 and 2) significantly higher than professionals, except for the Equity domain in part 2. Significant between-hospital variation in the mean scores was observed for all domains. Of note, by combining the correlation of the overall quality scores with the quality domains, the difference in mean scores on domains, and the variation between hospitals’ mean scores, priorities can be identified. Overall, researchers found that patients/kin and professionals do experience quality as a multidimensional concept. The multidimensional priorities identified based on the FlaQuM-Quickscan results indicate the need for future multifaceted quality strategies at the meso and macro levels that can have an impact at the patient care level. Hospital management and policy makers need to support the integration between executive/management-level and frontline-level initiatives.

Construct a gender-friendly medical environment

<p>本文主要探究如何藉由我國推動性別主流化政策，以性別觀點去評估立法、政策與方案等具計畫性的行動，尤以深具醫學、科學、科技等專業領域的醫療環境中能夠去如何落實、推動、實踐性別主流化，皆為醫療場域配合國家重要政策，甚至這是與國際世界各國互相接軌、密不可分的過程與趨勢。再者，文中探討在現行醫療場域如何可以透過性別主流化的六大工具，包括性別統計、性別分析、性別預算、性別影響評估、性別意識培力與性別平等機制運作的執行，藉此發現淺藏於不同醫療場域可能造成性別刻板印象或是欠缺性別意識的情況下而影響到醫療環境下出現性別差異。其次，我們能夠思考透過性別主流化方式改善醫療場域中性別盲點，不僅能夠提升對於病人健康照護品質提升，進一步能夠幫助弱勢族群能享有更加便利與友善的醫療專業服務，使醫療資源能成為全民共享的服務，甚至極力達成性別平等目標，讓醫療現場亦能成為性別友善的優質環境。</p> <p> </p><p>This article mainly explores how to promote gender mainstreaming policies in China and evaluate planned actions such as legislation, policies and programs from a gender perspective, especially how to implement them in medical environments with deep expertise in medicine, science, technology and other fields. , promote and practice gender mainstreaming, all of which are in line with important national policies in the medical field. This is even a process and trend that is inseparable from the international standards and countries around the world. Furthermore, the article explores how six major tools of gender mainstreaming can be used in the current medical field, including gender statistics, gender analysis, gender budgeting, gender impact assessment, gender awareness training and the implementation of gender equality mechanism operations. It was found that being hidden in different medical fields may cause gender stereotypes or a lack of gender awareness, thus affecting the emergence of gender differences in the medical environment. Secondly, we can think about improving gender blind spots in the medical field through gender mainstreaming, which will not only improve the quality of patient health care, but also help disadvantaged groups enjoy more convenient and friendly medical professional services, so that medical resources can become The service is shared by all and even strives to achieve the goal of gender equality, making the medical site a high-quality gender-friendly environment.</p> <p> </p>

How Best to Implement Climate-smart Actions in Clinical Urologic Care

We highlight the need for multidisciplinary teamwork, education, practical sustainability actions, informed choices for devices, and research in urologic care to reduce its environmental impact while maintaining quality health care for patients.

Perception of Health Care Professionals Toward Hospital Accreditation at Johns Hopkins Aramco Healthcare.

The quality of health care relies on achieving the best quality and patient safety goals, and accreditation plays a fundamental role in achieving these goals through compliance with standards that guide excellence. Accreditation also helps streamline operations and supports evidence-based quality improvement plans. This study aims to evaluate the perception of health care professionals on the accreditation process and its impact on the quality of health care and patient safety. This is a cross-sectional questionnaire survey distributed via the SuccessFactors website and made accessible to all hospital staff. The online questionnaire was completed by 2047 participants, representing 51% of the entire hospital staff at Johns Hopkins Aramco Healthcare (JHAH). Overall analysis indicated a positive perception of accreditation benefits among health care employees (as indicated by participation in accreditation activities and/or preparation for the survey visits) and reflected on patient health care quality and safety dimensions, with an overall Likert median score of 4.0 (interquartile range = 3.7-5.0; P < .05). The outcomes of our study confirm that JHAH employees perceived a positive impact of accreditation on health care quality improvement and patient safety. Also, the study supports considering accreditation as a fundamental requirement to improve health care system processes. However, it is critical to sustain quality of services over time during accreditation cycles.

A new theory to promote self-management of symptom clusters and healthcare quality in patients with decompensated cirrhosis.

Patients with decompensated cirrhosis, a symptomatic phase of cirrhosis, commonly experience multiple symptoms concurrently, referred to as symptom clusters. Effective self-management of symptoms is known to improve outcomes in various chronic diseases. However, a theory for self-management of symptom clusters in decompensated cirrhosis is lacking. In this study, we applied grounded theory research methodology to construct a new theory of self-management of symptom clusters in these patients. This qualitative study prospectively enrolled 20 patients with decompensated cirrhosis within 1 week after hospital admission. Data related to patients' experiences, needs, perspectives, and abilities related to their symptoms were collected via a semi-structured, in-depth interview and analyzed with Nvivo version 20 software. Grounded theory methodology with 3 coding steps (open, axial, and selective coding) was applied to generate a theory of self-management of symptom clusters. From the step-by-step coding process, 2 core categories or major themes were identified: patients' experiences with symptoms and coping with symptoms. The first major theme included symptom clustering, multidimensionality, recurrence, and specificity, while the second consisted of endogenous motivation, endogenous resistance, and external support needs. A new theory of self-management of symptom clusters was then constructed and delineated to enhance self-management among patients with decompensated cirrhosis. Using patient experience data, we developed a new theory of self-management of symptom clusters in patients with decompensated cirrhosis. Use of this theory has the potential to promote patient self-management and guide healthcare providers in planning optimal treatments and implementing timely interventions, ultimately improving in patient outcomes.

Networks in Healthcare: A Systematic Review

Networks form the backbone of any healthcare system. Various databases were searched with relevant keywords, data were abstracted, and numerous papers were appraised for this synthesis. This compiled systematic review gives a comprehensive overview of various networks that are found in healthcare, with a special reference to the treatment, referral, and best-practice care of patients. Special support networks, such as Clinical decision support systems, Physician collaboration networks, Telemedicine networks, and Shared healthcare record access, are also described, as these support networks play a pivotal role in improving the quality of healthcare for patients.

The Effect of a Multifaceted Intervention Including Classroom Education and Bariatric Weight Suit Use on Medical Students’ Attitudes toward Patients with Obesity

Introduction: Weight bias refers to negative attitudes toward individuals because of their weight. Evidence-based strategies to successfully reduce weight bias in medical students are lacking. The purpose of this study was to investigate the impact of a multifaceted intervention on medical students’ attitudes toward patients with obesity. Methods: Third and fourth year medical students (n = 79), who enrolled in an 8-week graduate course focusing on the various epidemiologic, physiological, and clinical aspects of obesity, including a gamification task with bariatric weight suits (BWSs), were asked to complete the Nutrition, Exercise and Weight Management (NEW) Attitudes Scale questionnaire pre- and post-course. The inclusion period was between September 2018 and June 2021 and covered 4 consecutive groups of students. Results: The overall NEW Attitudes Scale scores did not change significantly pre- versus post-intervention (pre-course: 19.59, post-course: 24.21, p value = 0.24). However, the subgroup of 4th year medical students showed a significant improvement in their attitudes (pre-course: 16.4, post-course: 26.16, p value = 0.02). The Thurstone rating of 9 out of 31 individual survey items changed significantly from pre- to post-course with a moderate strength (Cramer’s V >0.2), including 5 items showing weight bias reduction. The disagreement with the statement “overweight/obese individuals lack willpower” increased from 37 to 68%. Conclusion: These findings suggest that in medical students with a low level of weight bias at baseline, a semester course on obesity combined with BWS use affects only a limited number of items of the NEW Attitudes Scale questionnaire. The sensitization of medical students to weight stigma has the potential to improve quality of healthcare for patients with obesity.

Routine Practice Data for Health Care Analyses: Part 3 of the Manual

Analyses of health and health care (hereafter referred to as "health care analyses") usually aim to make transparent the structures, processes, results and interrelationships of health care and to record the degree to which health care systems and their actors have achieved their goals. Health care-related data are an indispensable source of data for many health care analyses. A prerequisite for the examination of a degree of goal achievement is first of all an agreement on those goals that are to be achieved by the system and its substructures, as well as the identification of the determinants of the achievement of the objectives. Primarily it must be examined how safely, effectively and patient-centred systems, facilities and service providers are operating. It also addresses issues of need, accessibility, utilisation, timeliness, appropriateness, patient safety, coordination, continuity, and health economic efficiency and equity of health care. The results of health care include system services (outputs), on the one hand, and results (outcomes), on the other, whereby the results (patient-reported outcomes) and experiences (patient-reported experiences) reported are of particular importance. Health care analyses answer basic questions of health care research: who does what, when, how, why and with which resources and effects in routine health care. Health care analyses thus provide the necessary findings and key figures to further develop health care in order to improve the quality of health care. The applications range from capacity analyses to following innovations up to the concept of regional and supra-regional monitoring of the quality of care given to the population. Given the progress of digitalisation in Health Care, direct data from the care processes will be increasingly available for health care research. This can support care givers significantly if the findings of the studies are applied precisely and correctly within an adequate methodological frame. This can lead to measurable improved health care quality for patients. Data from the process of health care provision have a high potential. Their use needs the same scientific scrutiny as in all other scientific studies.

How the Quadruple Aim Widens the Lens on the Transition to Residency.

How the Quadruple Aim Widens the Lens on the Transition to Residency.

Impact of Nursing Informatics on the Quality of Patient Care

Currently, nursing informatics is a part of nursing professional activities. Electronic health records have enhanced the nursing field by bridging the gap from nursing to nursing as a science. Additionally, nursing informatics actively reinforces nursing by providing standard language systems, decision-making support, technological advancements, and enhanced relationships between patients and clinical professionals. As data science continues permanenting in the healthcare systems, nursing informatics promotes the quality of healthcare provided to the patient when applied to routine hospital activities. Notably, nursing informatics has improved data handling and improvement initiatives among the nursing staff. This article aims at assessing the impact of nursing informatics on the quality of patient healthcare. Several benefits are evident, including but not limited to minimization of medical errors, timely diagnosis, and the efficiency of care services, improved communication between the healthcare providers and the patients, and drivers for research and integration of more advanced technologies aiming at improving healthcare quality.

Leveraging digital technologies for information technology-enabled healthcare transformation at SingHealth

Singapore Health Services, or SingHealth in short, is Singapore’s largest public health organisation. SingHealth was established in the year 2000 with ‘the aim to deliver consistently high-quality care that is appropriate and accessible to patients’. Since its inception, SingHealth has introduced numerous digital innovations to strengthen its business model and healthcare delivery. These include investments in mobile applications such as HealthBuddy and MyCare, which are widely used by patients in Singapore to manage their medical appointments, order their medication and monitor their health, which can all be done remotely. With the Covid-19 pandemic, SingHealth introduced Swabot which helped carry out automated nasal swabs at Covid-19 testing sites; Doctor Covid, which is a chatbot hosted on Telegram, an online messaging application that helps to improve care for Covid-19 patients in community care settings; and an AI-based tool called the Community-Acquired Pneumonia and Covid-19 AI Predictive Engine, which can determine the severity of pneumonia in Covid-19 patients based on chest x-ray images. SingHealth’s investments in information systems and technologies have enabled SingHealth to improve its operations, provide better healthcare delivery to patients, better manage doctors’ and nurses’ workload, and address the various challenges posed by the Covid-19 pandemic. This case examines how digital technologies revolutionised SingHealth’s workflows and processes, resulting in better quality healthcare for patients, and will be helpful for healthcare organisations looking to leverage on technology and health informatics for optimum healthcare delivery.

Individual and management factors in public health associated with failures and complications in patients with hemophilia in Colombia

The management of public health in Colombia reflects inequities in health and a great lag in the development of capacities at the national level. The stewardship of the health system presents serious difficulties associated with the decentralization process, as well as institutional weaknesses in the territorial entities as determining factors in the proper functioning of the system. To date, comprehensive health care models with a territorial approach, enshrined in current regulations, have not been implemented to guarantee quality health care for patients with hemophilia and other coagulopathies in Colombia. Orphan diseases such as hemophilia and other coagulopathies, although they have a low prevalence, are chronically debilitating, serious and highly complex to manage, so they require comprehensive approaches that guarantee access, quality, timeliness and efficiency in the management of institutions responsible. In addition, HCV and HIV coinfection is a relevant health problem in these patients.

Balancing standardisation and individualisation in transitional care pathways: a meta-ethnography of the perspectives of older patients, informal caregivers and healthcare professionals

BackgroundTransitional care implies the transfer of patients within or across care settings in a seamless and safe way. For frail, older patients with complex health issues, high-quality transitions are especially important as these patients typically move more frequently within healthcare settings, requiring treatment from different providers. As transitions of care for frail people are considered risky, securing the quality and safety of these transitions is of great international interest. Nevertheless, despite efforts to improve quality in transitional care, research indicates that there is a lack of clear guidance to deal with practical challenges that may arise. The aim of this article is to synthesise older patients, informal caregivers and healthcare professionals’ experiences of challenges to achieving high-quality transitional care.MethodsWe used the seven-step method for meta-ethnography originally developed by Noblit and Hare. In four different but connected qualitative projects, the authors investigated the challenges to transitional care for older people in the Norwegian healthcare system from the perspectives of older patients, informal caregivers and healthcare professionals. In this paper, we highlight and discuss the cruciality of these challenging issues by synthesising the results from twelve articles.ResultsThe analysis resulted in four themes: i) balancing person-centred versus efficient care, ii) balancing everyday patient life versus the treatment of illness, iii) balancing user choice versus “What Matters to You”, and iv) balancing relational versus practical care. These expressed challenges represent tensions at the system, organisation and individual levels based on partial competing assumptions on person-centred-care-inspired individualisation endeavours and standardisation requirements in transitional care.ConclusionsThere is an urgent need for a clearer understanding of the tension between standardisation and individualisation in transitional care pathways for older patients to ensure better healthcare quality for patients and more realistic working environments for healthcare professionals. Incorporating a certain professional flexibility within the wider boundary of standardisation may give healthcare professionals room for negotiation to meet patients’ individual needs, while at the same time ensuring patient flow, equity and evidence-based practice.

Applying Implementation Mapping to Expand a Care Coordination Program at a Federally Qualified Health Center.

BackgroundA large and growing percentage of medically underserved groups receive care at federally qualified health centers (FQHCs). Care coordination is an evidence-based approach to address disparities in healthcare services. A partnered FQHC established a care coordination model to improve receipt and quality of healthcare for patients most at risk for poor health outcomes. This care coordination model emphasizes identification and support of behavioral health needs (e.g., depression, anxiety) and two evidence-based behavioral health programs needs were selected for implementation within the context of this care coordination model. Implementation Mapping is a systematic process for specifying the implementation strategies and outcomes. The current case study describes the application of Implementation Mapping to inform the selection and testing of implementation strategies to improve implementation of two behavioral health programs in a Care Coordination Program at a partnered FQHC.MethodsWe applied Implementation Mapping to inform the development, selection and testing of implementation strategies to improve the implementation of two evidence-based behavioral health programs within a care coordination program at a partnered FQHC.ResultsResults are presented by Implementation Mapping task, from Task 1 through Task 5. We also describe the integration of additional implementation frameworks (The Consolidated Framework for Implementation Research, Health Equity Implementation Framework) within the Implementation Mapping process to inform determinant identification, performance and change objectives development, design and tailoring of implementation strategies and protocols, and resulting evaluation of implementation outcomes.ConclusionsThe current project is an example of real-world application of Implementation Mapping methodology to improve care outcomes for a high priority population that is generalizable to other settings utilizing similar care models and health equity endeavors. Such case studies are critical to advance our understanding and application of innovative implementation science methods such as Implementation Mapping.