Care Coordinator Role Research Articles

Nurses’ roles in patient care in tertiary level hospitals in Bangladesh

Background: Nurses are hands-on caregivers that make major healthcare contributions. The study was aimed to assess nurses’ roles in providing care to the patients admitted in tertiary level hospitals in Bangladesh.
 Methods: This descriptive, cross-sectional study was conducted among the registered nurses, during the period of June 2015 - October 2016 in five tertiary level hospitals located Dhaka, from government and private sectors. Using convenience sampling technique, 225 registered nurses were selected. Data were collected using a pretested structured self-administered questionnaire.
 Results: More than 64.0% of the respondents were in the age group of 31- 50 years and only 5.7% belonged to oldest age (51-60 years) group. Ninety one percent respondents were female, 64.0% were Muslim and 81.0% were married. Sixty seven percent were diploma nurses and 89.0% worked as senior staff nurse and 52.0% had working experience between 11-30 years. All the respondents played the role of care provider and administering medication. More than 90.0% of them have played the role of decision maker, communicator and care coordinator. As educator, manager and supervisor 80.0%, 71.0% and 67.0% of the respondents respectively carried out their responsibility. Only 44.0% of the respondents played the role of administrator, and 30.0% played the role as a patient advocator. Ninety nine percent provided bed side care. Documentation, admission, transfer and discharge related activities and patient teaching activities performed by the nurses were found to be respectively 98.0%, 92.0% and 90.0%. Eighty eight percent made round after taking over charge from previous nurse, 81.0% did planning for nursing care and 78.0% communicate and coordinate with others. Only 15.0% respondents were involved in research and 53.0% with policy making. About half of the respondents had no idea regarding evidence based health service practice (EBHSP).
 Conclusion: Nurses in tertiary level hospitals carry out their assigned roles and responsibilities quite satisfactorily. However, due to lack of facilities and knowledge they rarely take part in research. Almost half of the respondents did not have idea about evidence based practices. Appropriate policy and strategy needs to be undertaken by the competent authority to involve nurses in research field and policy making issues. Nurses should be trained on evidence based nursing practice.
 Bangladesh Med Res Counc Bull 2018; 44: 138-144

Alone in a Crowd? Parents of Children with Rare Diseases' Experiences of Navigating the Healthcare System.

A disorder is considered a rare disease if it affects 1 in 2000, hence, while independently unique, collectively, these conditions are quite common. Many rare diseases are diagnosed during childhood, and therefore parents become primary caregivers in addition to their parental role. Despite the prevalence of rare diseases among children, there has been little research focused on parents' experiences of navigating the healthcare system, a gap we begin to address in this study. Guided by an interpretive description methodology, participants were recruited through online listservs and posting flyers at a pediatric hospital in Western Canada. Sixteen parents (15 mothers and 1 father) participated in in-depth, semi-structured interviews between April 2013 and March 2014. Data were analyzed inductively, generating the main study themes. Findings illuminated the challenges parents' experienced on their child's diagnostic journey-from seeking, to receiving, to adjusting to the rare disease diagnosis. Following diagnosis, gaps, and barriers to services resulted in parents pursuing services that could support their child's unique care needs, which often resulted in out-of-pocket payments and changes to employment. Parents found peer support, both online and in person, to be an effective resource. This study illustrates the common challenges experienced by parents of children with rare diseases as they navigate the healthcare system. Parents' role as "expert caregiver" was rarely acknowledged by healthcare providers, pointing to the need to foster more egalitarian relationships. As well, parents were burdened with the additional role of care coordinator, a role that could be filled formally by a healthcare provider. Lastly, peer support was a key resource in terms of information and emotional support for parents who often begin their journey feeling isolated and alone. Policies and programs are needed that validate the invisible care work of parents and ensure adequate formal supports are in place to mitigate potential sources of inequity for these families. Furthermore, genetic counselors can play a key role in ensuring parents' informational needs are addressed at the time of diagnosis and in connecting families who share common experiences regardless of the rare disease diagnosis.

Advance care decision making and planning

Advance care planning (ACP) is an important component of quality care for patients with chronic and advanced diseases. General practititoners are ideally placed to initiate ACP because of their role in care coordination of chronic and advanced diseases, and the longstanding relationship they develop with patients. This paper outlines the key barriers to general practice involvement in ACP and describes useful strategies for incorporating ACP into patient care. Barriers to ACP are many and involve health professionals, patients and the healthcare system. To successfully incorporate ACP into patient care, there should be: (i) a commitment from the whole practice to incorporate ACP into patient care; (ii) a focus on building capacity for ACP in the practice; and (iii) efforts to implement and optimise the process of ACP. The outcomes of ACP (eg Advance Care Directives) should be disseminated appropriately to enable them to improve patient care.

Correlation of leadership and care coordinator performance among primary care physicians.

PurposePrimary care physicians have to deal with many aspects of the patients’ health problem, which needs cooperation with other health professionals or even nonhealth individuals. To achieve effective results, the primary care physicians should have leadership and coordinating skills, especially when dealing with the health challenges in Asia Pacific region. The care coordinator role of primary care physicians is important to create the bridge between population and health. This study aims to determine the correlation between care coordinator performance and leadership factors among primary care physicians.Materials and methodsA cross-sectional study was conducted, and data collection involved a total of 84 primary care physicians who were randomly selected from a total of 44 subdistricts and worked in 40 randomly selected village government-owned primary healthcare facilities in Jakarta. Pearson’s correlation, independent t-test, and one-way ANOVA were used to measure the correlation between care coordination and clinical leadership, transformational leadership, commitment, job satisfaction, and organizational culture, as well as the sociodemographics of the physicians and the professional practice factors. Multiple regressions were conducted to determine the most important factors influencing care coordinator performance.ResultsRespondents were mainly female (94%) with an average age of 36 years and were mostly medical doctors without any additional postgraduate degrees (95.2%). There was no correlation between care coordinator scores and organizational culture or commitment. There were positive and significant correlations between care coordinator scores and clinical leadership score (r=0.66; P<0.001), transformational leadership score (r=0.54; P<0.001), job satisfaction score (r=0.31; P=0.004), physician’s age (r=0.34; P=0.002), length of time since graduation (r=0.30; P=0.005), duration of employment at their health center (r=0.33; P=0.003), training in family medicine (P=0.04), and employment status (P=0.005). The most important factors in care coordinator performance were clinical leadership (r=0.53; P<0.001) and transformational leadership (r=0.23; P=0.03), with the total R2 being 0.47.ConclusionClinical leadership and transformational leadership were the most important factors for care coordinator performance. Therefore, the leadership skills of primary care physicians are important to be considered as a certain competency in practice to manage various resources and coordinate with related healthcare providers for controlling patients’ illness as well as dealing with the challenges and managing the overall health.

Moving beyond the fragmented and reductionist model of aged care: Evaluation of a process to create an aged care worker of the future

Introduction: Globally health care for older people is transitioning from a traditional reductionist biological and dependency focussed model to a consumer driven approach that maintains functional ability and promotes health while ageing 1,2. The Australian government’s response to these challenges has been to introduce major reforms within the national aged care system where older people will be increasingly empowered to make choices and give direction to their individual needs to support their health 3. The World Health Organisation 2 recognised the emergence of this new consumer-driven social-ecological approach to ageing acknowledging the need to move from traditional health disciplines, and develop a new worker with skills to navigate and support consumer decision-making within a seamless and integrated service model. In 2016 the University of Newcastle in Australia worked with the aged care industry to develop an Associate Degree in Integrated Aged Care. The degree was designed to allow individuals who had gained workplace and vocational experience in aged care to gain higher level tertiary preparedness and skills to work within a social-ecological and integrated model of service delivery. A 12 month evaluation of the program was undertaken in 2017 to examine the academic transition, preparedness, progression and satisfaction of vocational students with relevant work experience to undertake studies in the new program. Method: Mixed methods collected data from students and included surveys at orientation and at the completion of each teaching term, and 1:1 interviews after 6 months. Results/Discussion: Transition: 83% enrolled held certificate qualifications in aged care. The prevailing reason for enrolment was to upskill. At orientation the students were concerned about managing work/study commitments and using the computer. Many of the students described finding the transition to university difficult. Preparedness: Most described themselves as being the first in their family to undertake university study. They had to obtain a computer and develop computer skills to undertake this program. Progression: 22 students enrolled into the program and 86 % remained enrolled at mid-year and 72% at the end of the year. Students who withdrew did so because the program did not meet their expectations or was too difficult. Time management continued to be their biggest challenge. During this first year of the program 25% of the students have been promoted within their organisations to undertake a more skilled role in care coordination. Satisfaction: Students stated that the program was meeting their expectations and the educators have been supportive. Student survey feedback for all courses were all above the university mean. Conclusions: Students with vocational qualifications now have an avenue to upskill in new integrated aged care models. The aged care industry is already recruiting these students to work in more advanced roles where the consumer driven approach is required.

Women Veterans' Experiences with Department of Veterans Affairs Maternity Care: Current Successes and Targets for Improvement.

Little is known about women veterans' experiences accessing and using Department of Veterans Affairs (VA) maternity care, which is nearly all purchased from non-VA providers. To understand women veterans' experiences, preferences, and challenges using VA maternity care. We conducted 27 semistructured interviews with women veterans who used VA maternity care during fiscal year 2016. To capture a wide variety of experiences, we randomly sampled veterans from urban and rural VA facilities with higher and lower volumes of VA paid deliveries. All interviews were recorded and transcribed verbatim. Transcripts were analyzed using inductive and deductive content analysis. Themes included experiences initiating prenatal care, obtaining prenatal and lactation classes, the role of maternity care coordinators, mental health care, and satisfaction with care. Women described challenges obtaining authorization for care and establishing care with non-VA providers. First-time mothers appreciated the availability of prenatal and lactation classes. VA maternity care coordinators helped women veterans to navigate the challenges related to VA maternity care, ranging from finding non-VA providers to billing. The majority of participants were engaged with mental health care before pregnancy and continued this care during pregnancy. Women's satisfaction with VA maternity care was impacted by access to supportive, knowledgeable providers; care coordinators; woman-centered labor and delivery experiences; and billing issues. Our findings provide a portrait of the current state of VA maternity care from the perspectives of women veterans and highlight areas, such as care coordination and woman-centered models for labor and delivery, that can improve satisfaction with care.

Care Coordination as Imagined, Care Coordination as Done: Findings from a Cross-national Mental Health Systems Study.

Introduction:Care coordination is intended to ensure needs are met and integrated services are provided. Formalised processes for the coordination of mental health care arrived in the UK with the introduction of the care programme approach in the early 1990s. Since then the care coordinator role has become a central one within mental health systems.Theory and methods:This paper contrasts care coordination as work that is imagined with care coordination as work that is done. This is achieved via a critical review of policy followed by a qualitative analysis of interviews, focusing on day-to-day work, conducted with 28 care coordinators employed in four NHS organisations in England and two in Wales.Findings:Care coordination is imagined as a vehicle for the provision of collaborative, recovery-focused, care. Those who practise care coordination are concerned with the quality of their relationships with service users and the tailoring of services, but limits exist to collaboration and open discussion. Care coordinators describe doing necessary work connecting people and the system of care. However, this work also brings significant administrative demands, is subject to performance management which distorts its primary purpose, and in a context of scarce resources promotes generic professional roles.Conclusion:Care coordination must be done. However, it is not consistently being done in the way policymakers imagine, and in the real world of work can be done differently.

Short Communication: Role of Leadership in Doctor-Patient Relationship &amp; Execution on Patient’s Case Management in Primary Care

Primary care physicians (PCP) needs to plan, organize, implement, and evaluate as care director and coordinator. In primary care there is need to implement leadership model in health sector and medicine. Transformational leadership can be described as style of leadership which is appropriate for health sector. It is alike to the approach which is patient centered. Case management must be well organized, prepared, arranged and described as per needs of patient. The same must be agreed and implemented with suitable individual roles. Leaders are required to do numerous aspects linked to management, managerial and decision making process to carry out the requisite actions. Same process and procedures are also required be completed by Primary care physicians for achievement of patient’s targeted administration, supervision and management. Such happenings and actions contain from preparation, planning, development till structuring networks. Primary care physicians are anticipated to possess transformational leadership capabilities and to assist their performance in role of care coordinators. This all can be attained through integrated, holistic, continuous, comprehensive approach and by building relations with all stakeholders.

Policies Make Coherent Care Pathways a Personal Responsibility for Clinicians: A Discourse Analysis of Policy Documents about Coordinators in Hospitals.

Introduction:In response to increase of patients with complex conditions, policies prescribe measures for improving continuity of care. This study investigates policies introducing coordinator roles in Norwegian hospitals that have proven challenging to implement.Methods:This qualitative study of policy documents employed a discourse analysis inspired by Carol Bacchi’s ‘What‘s the problem represented to be?’. We analysed six legal documents (2011–2016) and selected parts of four whitepapers presenting the statutory patient care coordinator and contact physician roles in hospitals.Results:The ‘problem’ represented in the policies is lack of coherent pathways and lack of stable responsible professionals. Extended personal responsibility for clinical personnel as coordinators is the prescribed solution. Their duties are described in terms of ideals for coherent pathways across conditions and contexts. System measures to support and orchestrate the individual patient’s pathway (e.g. resources, infrastructure) are scarcely addressed.Conclusions and Discussion:We suggest that the policies’ construction of the ‘problem’ as a responsibility issue, result in that neither diversity of patients’ coordination needs, nor heterogeneity of hospital contexts regarding necessary system support for coordinators, is set on the agenda. Adoption of rhetoric from diagnosis-specific standardized pathways obscures unique challenges in creating coherent pathways for patients with complex needs.

The role of care coordination and out‐of‐home placement in youth dental and vision care visits

Care coordination has been proposed as an approach to promote access to services for youth with complex health and mental health needs. Youth with behavioral health needs are at increased risk of out‐of‐home placement, an experience which may also impact service utilization. Using a sample of administrative and public health insurance record data for youth with mental health needs, we assessed the relationships between care coordination and out‐of‐home placement on service utilization of dental and vision care. Findings suggest that placement is significantly associated with increased likelihood of accessing dental and vision care. The onset of care coordination is associated with a small but significant increase in vision care use. Regulatory and policy directives for out‐of‐home care providers in the USA may be facilitating access to dental and vision care services for youth in placement.Key Practitioner Message: • Youth in placement were more likely to have dental and vision care visits; • Onset of care coordination was not associated with increased dental and vision care.

Using social media to assess care coordination goals and plans for leukemia patients and survivors.

Care coordination has been shown to have a positive effect on the management of chronic disease. Specific to the management of leukemia, coordination may occur between primary care physician, medical and radiation oncologists, surgeons, cardiologists, and genetics specialists. Experiencing gaps in communication and care coordination, many health consumers seek instrumental support in their social circles, including online forums and networks. The goal of this theory-guided study was to provide an in-depth assessment of how individuals use online forums to deliberate about their goals and plans for leukemia care coordination. Guided by the planning theory of communication, the data were collected from the American Cancer Society Cancer Survivors Network and included 125 original posts and 1,248 responses. Thematic analysis and axial coding were applied to analyze the data. Goal-related themes included overcoming the diffusion of care coordination and achieving health management cohesion. Planning themes included social health management, communication self-efficacy, and role deliberation. Online patient forums provide an interactive platform for patients and caregivers to engage in active conversations, which in turn can serve as identifiers of care coordination needs. Communication with those who share similar experiences allows cancer patients and survivors to accumulate functional health literacy, gain communication self-efficacy, and articulate a care coordination role acceptable to them.

The Connected Care Program - changing the way we care for Queensland’s most vulnerable children with acute healthcare needs

Introduction: In 2013, Children’s Health Queensland Hospital and Health Service implemented the Connected Care Program (CCP), a statewide network of care coordinators to support children with medical complexity and their families. The coordinators, as part of the CCP, have worked in partnership with families, caregivers and health care teams across Queensland to improve communication and coordination of care, ensuring a child’s care program is managed seamlessly across the various services, specialists and facilities. Eligibility for CCP is children &lt;16 for new patients or &lt;18 for continuing patients, or until discharged from paediatric care. Eligibility criteria are based on chronicity, complexity, fragility and intensity of care needs. A referral is required from a clinical specialist.Practice Changes, Aims: The aim of the CCP is to coordinate access to health care providers and support services families need for their child, from their local hospital and health service (HHS) and, if required, across the state. CCP provides a single point of contact for families for support and assistance, which is done locally by a care coordinator or centrally by a team of coordinators for each child enrolled in the CCP. All medical specialists regularly involved in the care of the child are engaged as part of the child’s care team, including a General Practitioner. The creation of the care coordinator role, in partnership with lead specialists has enhanced clinical and family decision-making.Highlights: In the last two years of operations (2015-17), this statewide service delivered the following sustained improvements to patients’ care outcomes:56.5% reduction in total aggregated length of stay across all admissions;56.6% reduction in average inpatient length of stay;19.48% reduction in unplanned emergency department presentations;61.7% improvement in coordinated scheduling of Outpatient Department appointments;6% increase in patient visits to Lady Cilento Children’s Hospital (LCCH) where &gt;2 outpatient services were combined;The 2015 pilot evaluation also identified the following outcomes:25.25% reduction patients needing to fly from regional, rural or remote communities to LCCH to access specialist paediatric services;18% increase in pharmacist medication reviews (eLMS)35% increase in pharmacy liaison support with local pharmacies to deliver local solutions;95% patient/family satisfaction; and92% Care Coordinator role satisfaction.Format/Model Structure: Through the CCP’s hub-and-spoke model, all 16 Queensland HHSs have access to the service via in-situ care coordinators or outreach provided by the LCCH Hub.20 FTE Care Coordinators (Clinical Nurses) located across Queensland1 FTE Senior Allied Health Coordinator1 FTE Welfare Officer (statewide support)1 FTE Senior Pharmacist (statewide support)1 FTE Allied Health Assistant1 FTE Indigenous Health Liaison Officer Conclusions/Learnings/Take away:Care coordination across Queensland can be delivered in a centrally-managed hub-and-spoke model to effect positive health outcomes for children with medical complexity.Local coordination can improve the way statewide services deliver care from a patient outcome and satisfaction perspective.How rewarding the work can be for health professionals when patient outcomes and satisfaction are realised through coordinating enhanced patient and family-centred services.Patients and families from across Queensland are highly satisfied with the model.

Palliative Nursing Summit: Nurses Leading Change and Transforming Care: The Nurse's Role in Coordination of Care and Transition Management.

The Hospice and Palliative Nurses Association Palliative Nursing Summit (Summit) "Nurses Leading Change and Transforming Care" brought nurses from numerous specialties together to discuss collaboration in advancing primary palliative nursing. Nursing leadership was highlighted, and the future of integrating primary palliative care was emphasized. Three workshop groups held discussions on key collaborative topics of communication/advance care planning, pain and symptom management, and coordination of care/transition management (CCTM). Nursing has historically led the way in CCTM, especially in acute- and long-term-care settings. The philosophy and principles of CCTM are in direct alignment with the values and guidelines for quality palliative care. Goals of CCTM include the achievement of optimal health, equal access to care, and appropriate utilization of health care resources, balanced with the patient's right to self-determination. This article presents an overview of the patient and family outcomes and nursing actions identified by the group regarding CCTM.

Care coordination: Identifying and connecting the most appropriate care to the patients.

Although nurses are increasingly expected to fulfill the role of care coordinator, the knowledge and skills required to be an effective care coordinator are not well understood. The purpose of this study was to describe the knowledge and skills required in care coordination practice using an interpretive phenomenological approach. Fifteen care coordinators from 10 programs were interviewed over a 6-month period. Semi-structured face-to-face interviews were audio recorded, transcribed, and analyzed using interpretive phenomenology. The central theme of care coordination practice was bridging the patient and the healthcare systems. To bridge, care coordinators needed to have knowledge of the patient and healthcare system as well as the skills to identify and negotiate treatments appropriate for the patient. The most salient finding and new to this literature was that care coordinators who used their medical knowledge about available treatment options to discern and negotiate for the most appropriate care to the patient made differences in patient outcomes. Nurses with medical and healthcare system knowledge, combined with the skills to navigate and negotiate with others in an increasingly complex healthcare system, are well situated to be care coordinators and generate optimal outcomes. Further investigations of critical care coordinator competencies are needed to support nurses currently enacting the role of care coordinator and to prepare future nurses to fulfill the role.

Physician Assistants and Nurse Practitioners in Head and Neck Surgery.

This chapter explores the role of advanced practice clinicians (APCs) and patient care coordinators in the head and neck cancer setting. APCs, which include physician assistants (PAs) and nurse practitioners (NPs), are licensed professional healthcare providers who diagnose and treat illnesses, order and interpret diagnostic tests, and prescribe pharmaceutical and non-pharmaceutical therapies. Although the training, education, and licensure differ between PAs and NPs, their roles are quite similar in head and neck surgery. They collaboratively participate in the medical and surgical management and coordination of head and neck cancer patients in a variety of settings including outpatient clinic, inpatient, and in the surgical suite. APCs can function autonomously in an outpatient clinic with the medical management of postoperative visits and new consults. In an inpatient setting, they perform daily inpatient rounds and manage patient care preoperatively and postoperatively. In head and neck surgery, registered nurses (RNs) usually function in the role of patient care coordinators. They serve as a liaison between the patient and all members of the multidisciplinary team. APCs and patient care coordinators work closely with medical oncologists, radiation oncologists, surgeons, and other allied health professionals to provide high-quality care and achieve optimal patient outcomes in the head and neck cancer setting.

A history of Irish Acute Medicine Nursing Developments

Background: Nursing accounts for 560 full time equivalents working in Acute Medical Units in Ireland. The National Acute Medicine Programme (NAMP), was launched in 2010. It is a multidisciplinary initiative focusing on acute hospitals, providing leadership and direction for the development, reconfiguration and establishment of Acute Medicine in Ireland. Its aim is to optimise, standardise and improve management of acutely ill medical patients throughout the Irish Healthcare system, providing immediate and early specialist management of adult patients with a wide range of medical conditions who present to the hospital or from within the hospital, and who require urgent or emergency care and are discharged to an appropriate setting. Problem: Acute medicine nurses plays a central role in the immediate triage, assessment, planning, implementation and co-ordination of care across multiple settings from primary care, acute floor, diagnostics, in-patient settings and back into the community. Being a new speciality acute medicine nursing staff were drawn from a range of in-patient and specialist medical settings. There was a need to establish a structure at national level to harness and maximise the contribution of nurses to medical assessment and ambulatory medical care. Hilights: This contribution outlines the history of the development of acute medicine nursing over a six year period 2011-2017, hilighting key milestones in the contribution to interdisciplinary care, patient flow across the care continuum, unit management, and role definition. It also identifies national structures and processes implemented to support clinical skills and role development in acute medicine nurses at core, enhanced / specialist and advanced nurse practice levels. Transferability: The approach adopted has laid a foundation for sound needs based decision making informing education provision and development of advanced practice roles on a national basis. Conclusion: Establishing a structure to support nurses working within a national clinical care programme has facilitated consistency of approach aimed at promoting broad based scopes of practice promoting: enhanced access to services, hospital avoidance, reduced length of in-patient stay, clinical decision making and integrated care processes for acutely unwell medical patients. Skills and competencies developed through a national educational programme are transferable across all acute medical units. Interaction with third level education providers ensures consistency of approach to developing the role of acute medicine nurses. The structures have created career pathways not previously in place for nurses in the speciality of acute medicine.

The Effectiveness of the Nurse Care Coordinator Role on Patient-Reported and Health Service Outcomes: A Systematic Review.

This systematic review examined the effectiveness of nurse care coordinator (CC) roles on patient-reported and health service outcomes. Multiple electronic databases (Medline, CINAHL, and EMBASE) were searched and the Cochrane Risk of Bias Assessment Tool was applied by two independent reviewers. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess the quality of evidence. A total of 45 articles (reporting on 36 studies) were included. The majority of studies (n = 28, 78%) were conducted in the United States and published after 2009 (n = 24, 67%). Thirteen studies (36%) used a randomized controlled trial design. A total of 17 studies evaluated patient-reported outcomes and 29 studies reported health service outcomes. The individual components of nurse CC roles that were evaluated ranged considerably. The impact of nurse care coordination on patient-reported and health service outcomes was inconsistent. There was an indication from higher quality studies that nurse care coordination roles were more likely to result in improved patient and health service outcomes where they involved frequent, in-person interactions, had ongoing follow-up with monitoring of disease status, and involved transition care and the application of behavior change principles.

The Role of Care Coordination in Meeting Quality Performance Measures in Ambulatory Care Settings

The accountable care organization (ACO) is a delivery reform initiative that was devised to focus on care, health, and cost; quality of care within these organizations is determined by a set of defined performance measures. The primary goal of this study was to investigate how a care coordination intervention, targeted to patients assigned to the organization’s ACO, affected patients’ likelihood of meeting performance measures. This is a retrospective longitudinal analysis using a pre post with non-equivalent control group research design. The sample included Medicare patients, age 66 and older, receiving care in a traditional clinic setting (n=718). The intervention took place in 2013, and data from the prior year were used to assess the change in patients’ performance over time. Grouped logistic regression was used in this analyses. The results of these analyses show a positive association between care coordination and meeting defined performance measures for 1) all measures, 2) process measures, and 3) outcome measures. When comparing the impact of care coordination on process measures and outcome measures, process measures were more readily impacted by this care coordination intervention. Care coordination was positively associated with patients meeting defined performance measures.

Coordinating Care Across Health Care Systems for Veterans With Gynecologic Malignancies: A Qualitative Analysis.

Veterans concurrently using both Veterans Affairs (VA) and community providers and facilities have increased coordination needs related to bridging their care across health care settings. Women Veterans commonly require a combination of VA and community care if they have women-specific specialty care needs, such as gynecologic malignancies. We assessed VA women's health providers' and administrators' perceptions of coordination challenges for Veterans' gynecologic cancer care, and potential approaches for addressing these challenges. We carried out semistructured qualitative interviews with field-based key informants (VA gynecologists, women's health medical directors, and other staff directly involved in women's health care coordination) at 15 VA facilities. Transcripts were summarized in a template to capture key points. Themes were identified and iteratively revised (inductively/deductively) via a collaborative decision-making process utilizing matrices to compare content across interviews. Key informants (n=23) noted that services for patients with gynecologic cancers are provided through a combination of VA and community care with wide variation in care arrangements by facility. Care coordination challenges included care fragmentation, lack of role clarity and care tracking, and difficulties associated with VA and community provider communication, patient communication, patient records exchange, and authorizations. Care coordination roles suggested for addressing challenges included: care tracker, provider point-of-contact, patient liaison, and records administrator. Experiences in coordinating care for women Veterans with gynecologic malignancies receiving concurrent VA and community cancer care reveal challenges inherent in delivering care across health care systems, as well as potential approaches for addressing them.

Family Presence During Resuscitation (FPDR): Observational case studies of emergency personnel in Victoria, Australia

IntroductionFamily Presence During Resuscitation (FPDR), although not a new concept, remains inconsistently implemented by emergency personnel. Many larger metropolitan emergency departments (ED) have instigated a care coordinator role, however these personnel are often from a non-nursing background and have therefore limited knowledge about the clinical aspects of the resuscitation. In rural emergency departments there are simply not enough staff to allocate an independent role. A separate care coordinator role, who is assigned to care for the family and not take part in the resuscitation has been well documented as essential to the successful implementation of FPDR. MethodsOne rural and one metropolitan emergency department in the state of Victoria, Australia were observed and data was collected on FPDR events. The participants consisted of resuscitation team members, including; emergency trained nurses, senior medical officers, general nurses and doctors. The participants were not told that the data would be recorded around interactions with family members or team discussions regarding family involvement in the resuscitation, following ethical approval involving limited disclosure of the aims of the study. ResultsSeventeen adult presentations (Metro n=9, Rural n=8) were included in this study and will be presented as resuscitation case studies. The key themes identified included ambiguity around resuscitation status, keeping the family informed, family isolation and inter-professional communication. ConclusionDuring 17 adult resuscitation cases, staff were witnessed communicating with family, which was often limited and isolation resulted. Family were often uninformed or separated from their family member, however when a family liaison person was available it was found to be beneficial. This research indicated that staff could benefit from a designated family liaison role, formal policy and further education.