Trends In Health Care Delivery Research Articles

Emerging trends in healthcare driven by the COVID-19 pandemic: A review from Health Informatics Perspective.

The COVID-19 pandemic is the first of its kind to hit the world in the modern information age. People working in healthcare across the globe have harnessed technological advances and modern digital tools in innovative new ways. This has brought specific, more recent trends in healthcare delivery to the forefront. In this review, we present a collection of articles that highlight some of the emerging trends in healthcare driven by the COVID-19 pandemic and that have the potential to transform healthcare in the coming decades. We provide a brief commentary on the opportunities and challenges for each trend.

Partnerships in care: qualitative analysis of different perspectives

ABSTRACT Background Even with the addition of CFTR-modulator therapies in cystic fibrosis (CF) care, engagement in home treatments by persons with CF (PwCF) and their family caregivers remains key to slowing progression of CF-related complications. Best practice guidelines for home care describe an ideal not necessarily attainable for many PwCF in real life. Effective clinical partnerships between PwCF/their families and clinicians are critical to developing feasible home treatments plans. Method A team of content and methodology experts conducted a grounded dimensional analysis of transcribed interviews from 20 clinicians and 7 parents of 9 children with CF to identify and describe social processes associated with a clinical partnership. Results The resulting theoretical framework explicates conceptualizations of partnership (i.e. mutuality and reciprocity) and conditions (i.e. quality and duration of relationship, patient’s developmental or life stage) that contribute to the enactment of successful partnerships. Parents recognize their own and clinicians’ complementary contributions to partnerships. Clinicians focus on strategies to improve outcomes – some consistent, other discrepant with their conceptualizations of partnership. Participants’ reflections of lessons learned from successful versus failed partnerships informed their subsequent enactments of partnerships. Conclusions Trends in health care delivery show a shift from well-intended, yet paternalistic, paradigms to partnership models in which the complementary expertise of patients and caregivers as well as clinicians are mutually recognized and valued. Our findings show that while parents and clinicians endorse similar philosophical principles of partnership, they differ in how they actually enact them. Transition to a partnership paradigm appears to remain a work in progress.

Assessment of the Accuracy of Using ICD-9 Diagnosis Codes to Identify Pneumonia Etiology in Patients Hospitalized With Pneumonia

Administrative databases may offer efficient clinical data collection for studying epidemiology, outcomes, and temporal trends in health care delivery. However, such data have seldom been validated against microbiological laboratory results. To assess the validity of International Classification of Diseases, Ninth Revision (ICD-9) organism-specific administrative codes for pneumonia using microbiological data (test results for blood or respiratory culture, urinary antigen, or polymerase chain reaction) as the criterion standard. Cross-sectional diagnostic accuracy study conducted between February 2017 and June 2019 using data from 178 US hospitals in the Premier Healthcare Database. Patients were aged 18 years or older admitted with pneumonia and discharged between July 1, 2010, and June 30, 2015. Data were analyzed from February 14, 2017, to June 27, 2019. Organism-specific pneumonia identified from ICD-9 codes. Sensitivity, specificity, positive predictive value, and negative predictive value of ICD-9 codes using microbiological data as the criterion standard. Of 161 529 patients meeting inclusion criteria (mean [SD] age, 69.5 [16.2] years; 51.2% women), 35 759 (22.1%) had an identified pathogen. ICD-9-coded organisms and laboratory findings differed notably: for example, ICD-9 codes identified only 14.2% and 17.3% of patients with laboratory-detected methicillin-sensitive Staphylococcus aureus and Escherichia coli, respectively. Although specificities and negative predictive values exceeded 95% for all codes, sensitivities ranged downward from 95.9% (95% CI, 95.3%-96.5%) for influenza virus to 14.0% (95% CI, 8.8%-20.8%) for parainfluenza virus, and positive predictive values ranged downward from 91.1% (95% CI, 89.5%-92.6%) for Staphylococcus aureus to 57.1% (95% CI, 39.4%-73.7%) for parainfluenza virus. In this study, ICD-9 codes did not reliably capture pneumonia etiology identified by laboratory testing; because of the high specificities of ICD-9 codes, however, administrative data may be useful in identifying risk factors for resistant organisms. The low sensitivities of the diagnosis codes may limit the validity of organism-specific pneumonia prevalence estimates derived from administrative data.

Information technology and Baumol's cost disease in healthcare services: a research agenda

PurposeThis paper advances a research agenda for service researchers at the intersection of healthcare and information technologies to improve access to quality healthcare at affordable prices. The article reviews key trends to provide an agenda for research focusing on strategies, governance and management of key service processes.Design/methodology/approachThis paper synthesizes literature in information systems, service management, marketing and healthcare operations to suggest a research agenda. The authors draw on frameworks such as the interpretive model of technology, technology acceptance model, assemblage theories and Baumol's cost disease to develop their arguments.FindingsThe paper situates strategy-related service management questions that service providers and consumers face in the context of emerging healthcare and technology trends. It also derives implications for governance choices and questions related to that.Research limitations/implicationsThe paper discusses service management challenges and concludes with an agenda for future research that touches on governance and service management issues.Practical implicationsThis paper provides implications for healthcare service providers and policymakers to understand new trends in healthcare delivery, technologies and facilities management to meet evolving customer needs.Social implicationsThis paper provides implications for managing healthcare services that touch on many social and societal concerns.Originality/valueThis conceptual paper provides background and review of the work at the intersections of information systems, marketing and healthcare operations to draw implications for future research.

Abstract IA47: Disparities in access and outcomes: Actions and consequences

Abstract Disparities in cancer care quality and outcomes are well documented, and an increasing evidence base informs a deeper understanding of the complex determinants of such disparities and their interactions. However, because the interactions are incompletely understood, work to achieve equity in cancer care has not demonstrated the desired impact in eliminating, or even meaningfully reducing, disparities at the population level. Current strategies to reduce health care disparities must take the value proposition into account, balancing the tenets of payment reform with improvements in access and quality. Coordinating the actions of policymakers and providers (including health systems and front-line clinical teams) is critical in making intentional forward progress. The impact of well-intended policies is often difficult to anticipate. This talk will highlight examples of policies and trends in health care delivery with unintended consequences on the very cancer outcomes they were meant to improve. Citation Format: Sandra L. Wong. Disparities in access and outcomes: Actions and consequences [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA47.

Lessons From the Heart: A Kinesthetic Activity for Practical Nursing Students.

Current trends in health care delivery require nursing programs to change how education is presented to nursing students. Active learning strategies, such as discovery learning through kinesthetic activities, have been associated with increases in student engagement and satisfaction. A kinesthetic learning strategy was developed and implemented at a licensed practical nursing program to increase student engagement and provide knowledge of cardiovascular function and various etiologies associated with the heart. The goals of the activity were to provide deeper understanding and improve critical thinking and clinical application for the student.

Merging current health care trends: innovative perspective in aging care.

Current trends in health care delivery and management such as predictive and personalized health care incorporating information and communication technologies, home-based care, health prevention and promotion through patients’ empowerment, care coordination, community health networks and governance represent exciting possibilities to dramatically improve health care. However, as a whole, current health care trends involve a fragmented and scattered array of practices and uncoordinated pilot projects. The present paper describes an innovative and integrated model incorporating and “assembling” best practices and projects of new innovations into an overarching health care system that can effectively address the multidimensional health care challenges related to aging patient especially with chronic health issues. The main goal of the proposed model is to address the emerging health care challenges of an aging population and stimulate improved cost-efficiency, effectiveness, and patients’ well-being. The proposed home-based and community-centered Integrated Healthcare Management System may facilitate reaching the persons in their natural context, improving early detection, and preventing illnesses. The system allows simplifying the health care institutional structures through interorganizational coordination, increasing inclusiveness and extensiveness of health care delivery. As a consequence of such coordination and integration, future merging efforts of current health care approaches may provide feasible solutions that result in improved cost-efficiency of health care services and simultaneously increase the quality of life, in particular, by switching the center of gravity of health delivery to a close relationship of individuals in their communities, making best use of their personal and social resources, especially effective in health delivery for aging persons with complex chronic illnesses.

Emergent Challenges in Determining Costs for Economic Evaluations.

This paper describes methods of determining costs for economic evaluations of healthcare and considers how cost determination is being affected by recent developments in healthcare. The literature was reviewed to identify the strengths and weaknesses of the four principal methods of cost determination: micro-costing, activity-based costing, charge-based costing, and gross costing. A scoping review was conducted to identify key trends in healthcare delivery and to identify costing issues associated with these changes. Existing guidelines provide information on how to implement various costing methods. Bottom-up costing is needed when accuracy is paramount, but top-down approaches are often the only feasible approach. We describe six healthcare trends that have important implications for costing methodology: (1) reform in payment mechanisms; (2) care delivery in less restrictive settings; (3) the growth of telehealth interventions; (4) the proliferation of new technology; (5) patient privacy concerns; and (6) growing efforts to implement guidelines. Some costs are difficult to measure and have been overlooked. These include physician services for inpatients, facility costs for outpatient services, the cost of developing treatment innovations, patient and caregiver costs, and the indirect costs of organizational interventions. Standardized methods are needed to determine social welfare and productivity costs. In the future, cost determination will be facilitated by technological advances but hindered by the shift to capitated payment, to the provision of care in less restrictive settings, and by heightened concern for medical record privacy.

A multimethod analysis of shared decision-making in hospice interdisciplinary team meetings including family caregivers

Background: Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider–patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease. Aim: We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology. Design: We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n = 100), individual interviews of family caregivers (n = 73) and hospice staff members (n = 78), and research field notes. Setting/participants: Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States. Results: Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in healthcare delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making. Conclusion: The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers.

Re-Aligning Prospective Hospital Merger Guidance: Moving Beyond Concentration to More Meaningful Approaches

Mergers and acquisitions play a key role in industries facing disruptive change and the need to restructure effectively to meet future needs; transactions provide potential opportunities for substantial benefits. Significant realignment of the U.S. healthcare delivery system is underway, driven by economic, policy, and demographic factors, with many hospitals, particularly stand-alone hospitals, financially challenged. The effects of these trends are most visible in smaller metro areas, which often have greater hospital capacity than required to meet demand. Over 500 hospital transactions have occurred in recent years; about half involved stand-alone hospitals, many in smaller communities. An anticipated increase in hospital transactions in the near term suggests the importance of clear agency guidance on the factors that will distinguish transactions that are likely to be challenged.Agency guidance about future enforcement on hospital mergers contrasts with actual enforcement practice. Guidance emphasizes concentration and Merger Guidelines thresholds, even though the vast majority of past hospital mergers, including most of those that exceeded Guidelines thresholds, went unchallenged. Academic price-concentration studies play a uniquely prominent role in statements of enforcement intentions in the healthcare industry, even though those studies are largely dated and mixed in their findings. Limited clarity exists on factors that mattered to competitive effects analysis in concentrated markets with closely reviewed yet unchallenged mergers. Moreover, the modeling used in hospital merger review may not account for current and evolving market realities of healthcare delivery and purchasing. This paper reviews healthcare delivery trends in the context of recommendations for competitive effects analyses and guidance in industries characterized by dynamic change, differentiated products, large numbers of mergers, and low incidence of actual challenges. It shows that, where concentration thresholds are poor predictors of competitive effects, greater clarity is required of the specific factors other than structure that yielded assessments that mergers in highly concentrated markets were unlikely to result in a substantial lessening of competition. The many changes in healthcare markets necessitate closer scrutiny of economic models to assure they are robust and reflect market realities, including the responsiveness of rivals and payors. Given the substantial reliance on academic studies for guidance, we review the oft-cited concentration-price literature and find that it does not support the claimed systematic quantitative relationship. We undertook independently to address these issues empirically by updating a major study using a comprehensive and current commercial claims database covering 380 metropolitan areas. We found no systematic quantifiable relationship; instead myriad market and firm specific factors account for price variation. Finally, we present some suggestions for review of future transactions.

Declining Long-term Risk of Adverse Events after First-time Community-presenting Venous Thromboembolism: The Population-based Worcester VTE Study (1999 to 2009)

IntroductionContemporary trends in health-care delivery are shifting the management of venous thromboembolism (VTE) events (deep vein thrombosis [DVT] and/or pulmonary embolism [PE]) from the hospital to the community, which may have implications for its prevention, treatment, and outcomes. Materials and MethodsPopulation-based surveillance study monitoring trends in clinical epidemiology among residents of the Worcester, Massachusetts, metropolitan statistical area (WMSA) diagnosed with an acute VTE in all 12 WMSA hospitals. Patients were followed for up to 3years after their index event. Total of 2334 WMSA residents diagnosed with first-time community-presenting VTE (occurring in an ambulatory setting or diagnosed within 24hours of hospitalization) from 1999 through 2009. ResultsWhile PE patients were consistently admitted to the hospital for treatment over time, the proportion diagnosed with DVT-alone admitted to the hospital decreased from 67% in 1999 to 37% in 2009 (p value for trend <0.001). Among hospitalized patients, the mean length of stay decreased from 5.6 to 4.8days (p value for trend <0.001). Between 1999 and 2009, treatment of VTE shifted from warfarin and unfractionated heparin towards use of low-molecular-weight heparins and newer anticoagulants; also, 3-year cumulative event rates decreased for all-cause mortality (41–26%), major bleeding (12–6%), and recurrent VTE (17–9%). ConclusionsA decade of change in VTE management was accompanied by improved long-term outcomes. However, rates of adverse events remained fairly high in our population-based surveillance study, implying that new risk-assessment tools to identify individuals at increased risk for developing major adverse outcomes over the long term are needed.

Advancing Comparative Studies of Patterns of Care and Economic Outcomes in Cancer: Challenges and Opportunities

Advancing Comparative Studies of Patterns of Care and Economic Outcomes in Cancer: Challenges and Opportunities

A Physician Hospital Organization's Approach to Clinical Integration and Accountable Care

A Physician Hospital Organization's Approach to Clinical Integration and Accountable Care

A Patient-Centered Pharmacy Services Model of HIV Patient Care in Community Pharmacy Settings: A Theoretical and Empirical Framework

Reflecting trends in health care delivery, pharmacy practice has shifted from a drug-specific to a patient-centered model of care, aimed at improving the quality of patient care and reducing health care costs. In this article, we outline a theoretical model of patient-centered pharmacy services (PCPS), based on in-depth, qualitative interviews with a purposive sample of 28 pharmacists providing care to HIV-infected patients in specialty, semispecialty, and nonspecialty pharmacy settings. Data analysis was an interactive process informed by pharmacists' interviews and a review of the general literature on patient centered care, including Medication Therapy Management (MTM) services. Our main finding was that the current models of pharmacy services, including MTM, do not capture the range of pharmacy services in excess of mandated drug dispensing services. In this article, we propose a theoretical PCPS model that reflects the actual services pharmacists provide. The model includes five elements: (1) addressing patients as whole, contextualized persons; (2) customizing interventions to unique patient circumstances; (3) empowering patients to take responsibility for their own health care; (4) collaborating with clinical and nonclinical providers to address patient needs; and (5) developing sustained relationships with patients. The overarching goal of PCPS is to empower patients' to take responsibility for their own health care and self-manage their HIV-infection. Our findings provide the foundation for future studies regarding how widespread these practices are in diverse community settings, the validity of the proposed PCPS model, the potential for standardizing pharmacist practices, and the feasibility of a PCPS framework to reimburse pharmacists services.

Evolution of the coronary care unit: Clinical characteristics and temporal trends in healthcare delivery and outcomes*

To describe long-term temporal trends in patient characteristics, processes of care, and in-hospital outcomes among unselected admissions within the contemporary coronary care unit. Hospital administrative database that records both payment and operation data. Coronary care unit of a large, academic, tertiary-care medical institution. A total of 29,275 patients admitted from January 1, 1989 through December 31, 2006. Unadjusted time-trend plots were created for all variables of interest, and multivariable modeling of coronary care unit death was performed. Temporal trends in Coronary Care Unit and in-hospital mortality, length-of-stay, demographic characteristics, discharge diagnoses, Coronary Care Unit procedures, and Charlson comorbidity scores were evaluated. Admission severity increased significantly over time (p < .001), but hospital length-of-stay decreased (p < .001). The proportion of coronary care unit admissions with non-ST-segment elevation myocardial infarction increased (p < .001), whereas ST-segment elevation myocardial infarction decreased (p < .001). The prevalence of non-cardiovascular diagnoses increased, with the rate greatest for comorbid critical illnesses, including sepsis, acute kidney injury, and respiratory failure (all p < .001). The use of non-cardiac procedures, such as mechanical ventilation and central venous catheterization, also increased over time (p < .001). Unadjusted coronary care unit and in-hospital mortality did not change during the study period, although death did decrease in the adjusted setting. Substantial changes have occurred over time in patient characteristics, diagnoses, and procedures within the coronary care unit of a large, academic medical center. In particular, there have been significant increases in noncardiovascular critical illness, the results of which may be influencing patient outcomes. These findings underscore an existing need to clarify the role of the coronary care unit in contemporary cardiovascular care and to develop strategies for optimal training, staffing, and clinical investigation.

Integrating stakeholder perspectives in outcome measurement

Outcome measurement is important in documenting the quality and effectiveness of rehabilitation services. Developers of rehabilitation outcome measures must be attuned to the needs of multiple stakeholders in the rehabilitation process as well as trends in healthcare delivery and measurement science. This paper provides a review of challenging issues that confront outcome measurement developers and solutions for integrating multiple stakeholder perspectives. The development process of the Community Participation Indicators (CPI) measure is presented as a case study to illustrate key stages in the instrument development process.

Conceptualizing a Quality Plan for Healthcare

Today, health systems around the world are under pressure to create greater value for patients and society; increasing access, improving client orientation and responsiveness, reducing medical errors and safety, restraining utilization via managed care, and implementing priority allocation of resources for high-burden health problems are examples of strategies towards this end. The quality paradigm by virtue of its strategic consumer focus and its methods for achieving operational excellence has proved an effective approach for creating higher value in many sectors. If applied in a deliberate and holistic manner, the quality paradigm can bring about a more cost-effective organization of the health systems. In this article, we apply quality concepts to healthcare in a conceptual format; we characterize the health system's customers and outputs with their quality dimensions. The product of this effort is a blueprint for a customer-driven health system which identifies six types of customers, nine types of outputs and the associated operations. As a preliminary step, a new analysis and definition of health and disease is provided. Rethinking the structure of health system in this manner and the related conceptual model can guide medical research, health sciences education, and health services policy, and help the practitioner to integrate all modern trends in healthcare delivery.

Changing Roles for Primary-Care Physicians: Addressing Challenges and Opportunities

Direct-to-consumer advertising is but one example of a process called disintermediation that is directly affecting primary-care physicians and their patients. This paper examines the trends and the actors involved in disintermediation, which threatens the traditional patient-physician relationship. The paper outlines the social forces behind these threats and illustrates the resulting challenges and opportunities. A rationale and strategies are presented to rebuild, maintain and strengthen the patient-physician relationship in an era of growing disintermediation and anticipated advancements in cost-effective office-based information systems. Primary care--as we know it--is under siege from a number of trends in healthcare delivery, resulting in loss of physician autonomy, disrupted continuity of care and potential erosion of professional values (Rastegar 2004; Future of Family Medicine Project Leadership Committee 2004). The halcyon days of medicine as a craft guild with a monopoly on (1) technical knowledge and (2) the means of implementation, reached its zenith in the mid-twentieth century and has been under pressure ever since (Starr 1982; Schlesinger 2002). While this is a trend within the US health system, it is likely to affect other delivery systems in the years ahead.

Specifying workflow process requirements for an emergency medical service.

Recent trends in healthcare delivery have led to a gradual shift in the conceptualisation of healthcare information systems towards supporting healthcare processes in a more direct way. The move towards integrated and managed care, which requires designing healthcare processes around patient needs and incorporating efficiency considerations has led to an increased interest in process-oriented healthcare information systems based on workflow technology. This means to actively deliver the tasks to be performed to the right persons at the right time with the necessary information and the application functions needed. Moreover, workflow technology promotes a component-oriented development whereby the process logic is separated from application logic. This paper presents an approach to capturing process logic requirements for healthcare workflow systems with a view to design a system that is easily adjustable to process changes and to evolving organizational structures at a reasonable cost.

The Women's Health Nurse Practitioner: Evolution of a Powerful Role

Today's women's health nurse practitioner (WHNP) role is the product of more than three decades of growth and change. As the role has evolved, both professional and public perceptions have not always kept up with the latest developments in the nature and scope of the role. It's important for nurses today to understand the differences in advanced practice roles and how advanced practice nurses will continue to shape future trends in health care delivery.