Redistribution Of Care Research Articles

Interprofessional Team Diagnostics Consultation Improves Health Professions’ Practice Outcomes and Clinical Research

Background: Communication gaps in health services delivery significantly compromise quality in clinical decision making. Information generated by diagnostics professionals’ accounts for much of the objective data in the clinical record and therefore is foundational in clinical decision support. This work describes the Diagnostics Consultation Model©, a diagnostics communications portal, which supports communications among interprofessional teams, providers, and institutions. Aims: Study aims were to develop and validate a workflow prediction index (the complexity index) to assign resolution of consultation requests to diagnostics practitioners with requisite competencies based on an algorithm comprised of characteristics available at the point of consultation initiation. The complexity index functions as the entry into a workflow process directing consultation requests, first, to diagnostics practitioners for investigation and then into communication processes for tracking medical history, patient/consumer clinical information, resolution logic, conclusions, and next step recommendations among all healthcare providers. Methods: Data to develop the complexity index (N = 325 consultation cases) were collected during daily activities in the clinical diagnostics laboratory and describe consultation characteristics important in clinical decision making and available at the point of consultation initiation. The complexity index was developed and validated by comparison of regression analyses using consultation characteristics, i.e., clinical outcomes, available at the point of consultation initiation (development) and after consultation completion (validation). Results: Diagnostics Consultation Model© methodology links communication processes among all providers in all care settings, i.e., community, institutional, and referral, involved in the care paths of individual patient/consumers. This methodology also provides the capability to follow individuals’ medical histories longitudinally and, through regular consultations and practice-based clinical research, to address issues of medical effectiveness, cost efficiency, access, equity, timeliness, safety, and compliance. Conclusion: Implementation of Diagnostics Consultation Model© methods and curriculum in health professions’ daily practice has the potential to change health services delivery by the redistribution of care through interprofessional teams coordinated by standardized communication processes. Employed as a systems approach to individualized patient/consumer care, the Diagnostics Consultation Model© could provide the communications technology and methodology structure for value-based healthcare continuously optimized to address the needs of individuals, populations, and health systems throughout the continuum of care.

Care labor, intergenerational equity, and (social) sustainability

Of the three sustainability (social, environmental and economic) pillars, the social one is the least developed. The 2020/2021 COVID-19 pandemic has highlighted why assuring social sustainability requires examining the central role care labor plays in intergenerational sustainability, with attention to the potentially conflicting rights of caregivers and care receivers, as well as to gender, geographic, age, class and other inequalities. A system that focuses on recognition, reduction, redistribution, reinforcement and reward (5 Rs) is needed to further gender equality and assure that care labor receives adequate policy support. Recognition or naming the problem, efforts to reduce drudgery, redistribution of care within the family and beyond, as well as two forms of support to care givers – reinforcement and reward make up the 5 Rs. Focusing on 5Rs can also help prioritize when social, environmental and economic goals conflict.

Allocation of health care under pay for performance: Winners and losers

Many physicians receive a payment for their performance (P4P). This performance is often linked to a health target that triggers a bonus when met. For some patients the target is easily met, while others require a significant amount of care to reach the target (if ever). This study contributes to the literature by providing evidence of how P4P affects allocation of care across patients with low and high responsiveness to treatment compared to a fixed payment, such as capitation and salary, under different degrees of resource constraint. Our evidence is based on a controlled laboratory experiment involving 143 medical students in Denmark in 2019. We find that patients who have the potential to reach the health target, gain care under P4P, whereas patients with no potential to reach it, may receive less care. Redistribution of care between patients under P4P arises when physicians are resource constrained. As many physicians are currently operating under tight resource constraints, policymakers should be careful to avoid unintended inequalities in patients’ access to health care when introducing P4P. Risk-adjusting the performance target may potentially solve this issue.

A Cost-Benefit Analysis of the Legalization of an Informal Health Sector

Problem statement: The Philippines--a developing Southeast Asian country--exemplifies the co-existence of Western-oriented, medical science and indigenous, non-allopathic practices collectively known as Complementary and Alternative Medicine (CAM). The purpose of this study is to determine why and how the economics and politics of CAM’s integration with biomedical science could impede the achievement of health care redistribution in developing countries like the Philippines. Approach: Representative case studies of CAM methods and content analysis of related legislation and policy initiatives were undertaken. Results: The study shed light on the problems, challenges and opportunities in addressing the misdistribution of primary and secondary health care in the Philippines. It found that subjective considerations underlie CAM’s legitimacy. These become critical when scientific validity is at issue, information exchanged is asymmetric and political consensus is not readily available. How these considerations were valued from a cost-benefit perspective shaped actual policy outcomes. Conclusion: The study suggested that proper timing, phasing and collaborative strategies are critical to CAM's institutionalization in light of confining economic conditions and political conflicts over health policy. Both objective and subjective costs and benefits of CAM methods and products should be considered in integrating the formal (biomedical) and informal (CAM) health sectors, particularly in developing countries where health care is largely dependent on individual or household resource-based access and competitive prowess.

Transforming Nursing Practice: Acute to Community Care

This article describes the collaborative project among an educational institution, acute care hospitals, and home health agencies that led to further defining roles and ensuring employment for the region's professional nurses. The redistribution of care from the hospital to the community creates a demand for expanded skill and knowledge among nursing in community practice. Yet experienced hospital acute care nurses are finding that they have a lack of expanded skills required in community-based nursing. Home health care managers find that acute nurses require an extensive and costly orientation process to community health nursing. From this article the reader will examine the environmental factors affecting the delivery of quality home health care in the late 1990s; the knowledge and skills required for the transition from acute to community care; and a proposed collaborative program design that meets home health administrators' needs to maintain a highly skilled staff.