Care Management Training Research Articles

Effectiveness of Self - Care Management Training on Self - Efficacy among Patients with Type 2 Diabetes Mellitus

Effectiveness of Self - Care Management Training on Self - Efficacy among Patients with Type 2 Diabetes Mellitus

Intersectoral care management for older people with cognitive impairment during and after hospital stays [intersec-CM]: study protocol for a process evaluation within a randomised controlled trial

BackgroundIn the healthcare system in Germany, different institutions and actors play specific roles in the discharge and transition of patients from hospitals into primary care (Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen, Wettbewerb an der Schnittstelle zwischen ambulanter und stationärer Gesundheitsversorgung, 2012). However, there are shortcomings in these intersectoral transitions. Especially in older people with cognitive impairment (PCI), discharge management often lacks coordination and cooperation between healthcare providers. This frequently results in higher rates of unscheduled readmission. The project intersec-CM is a randomised controlled trial (RCT) that aims to explore up to what extent an intersectoral care management (ICM) can improve this transition. This ICM is delivered by nurses with special training in care management. The objective of this paper is to describe a mixed-methods process evaluation of the intersectoral care management intervention and the factors that facilitate and inhibit its implementation.MethodsDifferent study designs for process evaluations from previous literature were collected and analysed according to the dimension implementation fidelity, satisfaction with the intervention, feasible transfer into routine care, optimum point of time, frequency and execution of the intervention, and context factors.ResultsThe actor-network theory was chosen as the theoretic framework for the process evaluation. Based on this theory, a mixed-methods design was developed to combine and integrate qualitative and quantitative evaluation methods. The qualitative part includes semi-structured interviews using topic guides (phase 1) and later in-depth interviews with narrative portions (phase 3), which will be analysed by using the qualitative content analysis according to Kuckartz. The quantitative survey (phase 2) is conducted with standardised questionnaires.DiscussionChallenges in data collection include the development of interview guidelines, which require different terminologies depending on every specific actor targeted in the intervention. Conducting the interviews, there is a risk of misunderstanding the older PCI by the interviewer and vice versa. However, the combination of qualitative and quantitative approaches as different techniques of process evaluation may help to capture, integrate and analyse data on different dimensions of the intervention.ConclusionsThe results of our process evaluation may serve as an implementation guideline for intersectoral care management in the German healthcare system. Furthermore, the approach to evaluate the process of a complex intervention in health care for older PCI may serve as a stimulus to broaden the evidence base also of other complex intervention studies to improve health care for this vulnerable group.The study was ethically approved by the Ethics Committee of the Ernst-Moritz-Arndt University of Greifswald. The study has been registered at the U.S. National Library of Medicine.Trial registrationClinicalTrials.gov NCT03359408. Registered on 2 December 2017. The approximate date when recruitment to the process evaluation of the study will be completed is 31 May 2021.

Algorithm for transitional care for caregivers of dependent older adults: a validation study.

To construct and validate an algorithm for transitional care for caregivers of dependent older adults. This was a methodological study developed in three phases: a literature review, designing an algorithm, and its validation by a peer panel with twenty-seven experts selected according to pre-defined inclusion criteria. The algorithm predicted interventions in transitional care (hospital stay, at discharge, and 30 days at home post-discharge) aimed at the exercise of the caregiver role; needs assessment; training in care management of dependent older adults and management of self-care, and ensuring continuity of care (of older adults and caregivers). Agreement between expert raters and a reliability test of 0.92 indicate that the algorithm can be used by professionals to decide the transitional care interventions to be administered to the caregivers of dependent older adults. Future studies should be conducted to perform its clinical validation.

The Management Experiences, Priorities, and Challenges of Medical Directors in the Subspecialty of Consultation-Liaison Psychiatry: Results of a Needs Assessment.

Medical directors need management skills, yet few studies describe the specific tasks that directors consider most important, their confidence for these tasks, and how their confidence develops. We studied these questions among directors in the subspecialty of Consultation-Liaison Psychiatry. A needs survey was sent to 48 registrants of a new forum for Consultation-Liaison Psychiatry directors. The survey asked about 6 professional experiences, the relative importance of 14 management tasks, and the directors' confidence in managing these tasks, using 7-point Likert scales. Correlations between experiences, task importance, and task confidence were performed. Twenty-seven directors responded (56% response). The experiences that correlated most with management confidence were years in practice and health care leadership training, yet approximately half of responders were directors for ≤5 years and had received minimal training. Management tasks with the highest importance included demonstrating value of their service and roles for nonphysician clinical staff on their teams. Significant associations were identified between years in practice and confidence for leading faculty scholarship, trainee staffing ratios and roles, fee coding, measurement of faculty clinical productivity, and faculty recruitment. Leadership training correlated with confidence in demonstrating service value, measuring faculty clinical productivity, novel models of care, and growing a new service. Consultation-Liaison directors with fewer years of experience and minimal health care management training need time and support to grow into their roles. They should be pointed toward training opportunities to improve their confidence to lead the wide range of management tasks that are important to their roles.

Challenges of adopting the role of care manager when implementing the collaborative care model for people with common mental illnesses: A scoping review.

This review aimed to identify the main factors influencing the adoption of the role of care manager (CM) by nurses when implementing the collaborative care model (CCM) for common mental illnesses in primary care settings. A total of 19 studies met the inclusion criteria, reporting on 14 distinct interventions implemented between 2000 and 2017 in five countries. Two categories of factors were identified and described as follows: (i) strategies for the CCM implementation (e.g. initial care management training and supervision by a mental health specialist) and (ii) context-specific factors (e.g. organizational factors, collaboration with team members, nurses' care management competency). Identified implementation strategies were mainly aimed towards improving the nurse's care management competency, but their efficacy in developing the set of competencies needed to fulfil a CM role was not well demonstrated. There is a need to better understand the relationship between the nurses' competencies, the care management activities, the strategies used to implement the CCM and the context-specific factors. Strategies to optimize the adoption of the CM role should not be solely oriented towards the individual's competency in care management, but also consider other context-specific factors. The CM also needs a favourable context in order to perform his or her activities with competency.

Care Management: Perspectives from Managers, Professionals and Users of a Specialized Service Facility Focused on Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome

Background: Complex practices used for care management are developed to include the perspectives of professionals, healthcare organizations and patients. Therefore, to implement strategies to provide quality care, identifying gaps in these practices is crucial. This study seeks to gain a better understanding of the management of health care for people living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome by considering the perspective of health professionals, managers and patients of a specialized service facility in South Brazil that focuses on contagious diseases. Methods: This qualitative, dialogic, reflexive and interpretative study involved 16 participants. The data were derived from semi-structured interviews conducted during 2013 and 2014. Ethnograph® software was used to provide a descriptive and interpretative data analysis. Results: The results show that care management multidimensionality requires continuous attention to the way professionals think as well as reorganization of labor processes and the network of services provided. Thus emerged three categories: interdisciplinarity in care management; continuous training in care management; and strengthening of health care networks. Conclusion: From the perspective of individuals involved in managing and promoting the care and health of people living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome, changes are needed to improve the care of people living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome in terms of the three dimensions of care management.

Care Managers' Experiences in a Collaborative Care Program for High Risk Mothers with Depression

The aim of this study was to understand care managers' experiences in caring for depressed mothers in an integrated behavioral health program. As part of a quality improvement project, we conducted a focus group interview with six care managers caring for low income mothers with behavioral health needs in a safety net program in King County, WA. Using thematic analysis, codes were organized into themes that described the care managers' experiences. Two organizing themes along with associated themes emerged: (1) Assets for improving depression outcomes: patient-provider interactions, including the importance of engagement; program resources such as care coordination and (2) Barriers to improved depression outcomes: patient-provider interactions, including difficulty engaging patient; patient-related factors such as multiple stressors; program resources such as need for more psychiatric support; and difficulty accessing outside resources. Numerous potentially modifiable factors including levels of engagement, motivational interviewing, and increased psychiatric support were identified by care managers as affecting depression care and outcomes. Implications for care management training and approaches to psychiatric consultations are discussed.

Health Care Management Training Needs in Pakistan

The management of health care organisations (HCOs) significantly determines the quality and efficiency of health care delivery in developing countries like Pakistan. HCO managers are needed to plan and execute expansion and corporatisation of private HCOs and to transform public sector charity hospitals to self-sustaining efficient organisations and private clinics into profitable ventures. The objective of this study was to assess the need for health care management training in Pakistan using semi-structured interviews of key informants in different cities. We asked experts about the existing HCO management training opportunities, demand for such skills and its impact on the future of health services delivery. Unanimous support for HCO management training emerged in the wake of dissatisfaction with limited opportunities for such training in the country. The participants agreed that trained HCO managers can help introduce modern management practices in health care service delivery, thereby making the HCOs more efficient and effective. We conclude that well-reputed management schools would be performing an important service to the improvement of the health sector in Pakistan if they can design and offer effective management training programmes for HCOs.

Investing in health care management: a way to explore the future value outlook of the health care sector

PurposeThis paper aims to show the need for Europe to invest more in health care management training. It should be seen as a catalyst for accelerating the restructuring of the sector.Design/methodology/approachThe paper reports on an existing change management program developed and managed by Project Hope. The project is evaluated by investigating results achieved to date and the need for its services.FindingsEmpirical research suggests that there is considerable need for management training in health care. This is especially the case in some Central and Eastern European countries, reinforcing the need for health care management programs such as the one conducted by Project Hope.Originality/valueThe paper looks at a unique health care management training program in Central and Eastern Europe.

Applying business management models in health care.

Most health care management training programmes and textbooks focus on only one or two models or conceptual frameworks, but the increasing complexity of health care organizations and their environments worldwide means that a broader perspective is needed. This paper reviews five management models developed for business organizations and analyses issues related to their application in health care. Three older, more 'traditional' models are first presented. These include the functional areas model, the tasks model and the roles model. Each is shown to provide a valuable perspective, but to have limitations if used in isolation. Two newer, more 'innovative' models are next discussed. These include total quality management (TQM) and reengineering. They have shown potential for enabling dramatic improvements in quality and cost, but have also been found to be more difficult to implement. A series of 'lessons learned' are presented to illustrate key success factors for applying them in health care organizations. In sum, each of the five models is shown to provide a useful perspective for health care management. Health care managers should gain experience and training with a broader set of business management models.

United States: Overview of Cancer Pain and Palliative Care

The growth of the palliative care movement in the United States will have enormous impact on pain specialty in terms of the increasing need for the skills of its professional work force and demand for improved symptom management from our sickest and most vulnerable patients. In this paper, we review the need for palliative care, recent developments in this new field and implications for specialists in pain management.