225,294 research outputs found

    Improving Access and Delivery of Mental Health Care to Veterans Through a Care Coordination Pilot at a Texas Department of Veterans Affairs Hospital

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    Background: Mental health (MH) disorders are among the leading cause of disabilities in adults, with an even greater prevalence among Veterans who served in combat. Forty percent of troops returning from combat zones report suffering from post-traumatic stress disorder (PTSD) or depression and 33% report trouble accessing MH care. Access to care is directly influenced by care coordination procedures in health care systems. If care coordination is poor or lacking, patients remain in settings that are inappropriate for their level of care. Implementing a care coordination program can improve care transitions, provide the necessary support for patients to successfully transition, and improve access to specialty MH for patients who need a higher level of care. Project Design: The purpose of this project was to 1) review the literature to determine best practices for health care transitions, 2) develop a pilot quality improvement program based on the best evidence, 3) implement the pilot, and 4) obtain feedback from facilitators and participants to enhance care transitions and sustain project interventions. The intervention was to implement a nurse-led standardized care coordination pilot program in the MH department to facilitate effective care transitions from MH to Primary Care (PC), specifically aiming to improve the process and patient experience. Results: Results demonstrated that the interventions improved Veterans’ experience of care, provided them with the necessary education and support, and facilitated the continuation of care in a setting appropriate to meet their needs. Further inquiry is needed to identify best practices in translating the term “care coordination” into the providers’ standard medical language to improve their awareness and understanding of this model of care. Recommendations: The results of the project demonstrated that care coordination programs can be useful in MH and PC and can be adopted in other health care settings where care transitions occur. It is essential to develop partnerships with organizational leaders and staff to design a multidisciplinary approach for care transitions to be effective. Care coordination activities that focus on timely communication and shared decision-making will ensure the continuation of care across settings and promote positive patient outcomes. Conclusion: Effective care transitions require collaboration among health care professionals. A care coordination model can improve patient outcomes. The care coordination pilot established guidance related to care coordination activities needed for successful care transitions to occur, improved care transitions between MH and PC, supported patients in managing their health care during care transitions, and provided a framework for future improvement work

    Lower fragmentation of coordination in primary care is associated with lower prescribing drug costs-lessons from chronic illness care in Hungary

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    Improved patient care coordination is critical for achieving better health outcome measures at reduced cost. Better integration of primary and secondary care in chronic illness care and utilizing the advantages of better collaboration between general practitioners and specialists may support these conflicting goals. Assessing patient care coordination at system level is, however, as challenging as achieving it. Based on prescription data from a private data vendor company, we develop a provider-level care coordination measure to assess the function of primary care at system level. We aim to provide empirical evidence for the possible impact of patient care coordination in chronic illness care—we investigate whether the type of collaborative relationship general practitioners have built up with specialists is associated with prescription drug costs. To our knowledge, no large-scale quantitative study has ever investigated this association. We find that prescription drug costs for patients treated by general practitioners who build up strong collaborative relationships with specialists are significantly lower than for patients treated by general practitioners characterized by fragmented collaborative structures. If future system-level studies in other settings confirm that total healthcare costs are indeed lower for patients treated in strong collaborative structures, then healthcare strategists need to advocate a healthcare system with lower care fragmentation on the interface of primary and secondary care. Regulating access to secondary care might result in significant cost savings through improved care coordination

    IUPUI Center for Cancer Population Analytics and Patient-Centered Informatics

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    poster abstractAbstract: More than 30,000 Indiana residents are diagnosed with cancer each year. Cancer is the second leading cause of death in the state, claiming more than 12,000 lives annually. More than $1 billion was spent in Indiana on direct costs of treating the cancer population in 2003. Indirect costs to cancer patients and their families are also of great importance. Cancer care coordination has the potential to reduce costs and improve quality in cancer care delivery. Coordination may occur both among (1) multiple cancer care providers caring for populations of cancer patients, and (2) between providers and individual patients with cancer The IUPUI Center for Cancer Population Analytics and Patient-Centered Informatics was established in 2013. The center’s mission is to develop team science that combines innovative health information technologies with rigorous health services research methods in order to create knowledge that will have an impact upon the health and health care of patients and populations with cancer in the state of Indiana and the U.S. The center’s goals are (1) to build collaborative, multidisciplinary scientific teams to create national leaders in the state of Indiana in the fields of cancer health services research and informatics, and (2) to perform top-tier national cancer health services research and “big data” analytics to improve the quality, efficiency, coordination, and outcomes of cancer care The Center Cores: To build our research portfolio, we have the following 2 main cores of activity: I. Cancer Population Analytics Core: Data sources from multiple health care organizations throughout central Indiana are being joined together to answer important clinical/epidemiologic questions regarding the quality of cancer care, and design population-based, system interventions to improve the lives of Indiana cancer patients. Further support has been leveraged for this work, namely, the IU Cancer Center has provided a pilot grant to link the Indiana state cancer registry with data from the Regenstrief Institute’s Indiana Network for Patient Care in order to study the utilization of high-cost imaging among cancer survivors. Furthermore, support from a Regenstrief/Merck collaboration will facilitate assessment of the quality of the data linkage at the level of both the patient and cancer case. II. Cancer Patient-Centered Informatics Core: Multiple platforms are being leveraged to develop and test patient-centered technologies to enable individuals to track health care received and communicate with providers. Utilizing OpenMRS, a personal health record (PHR) module was created for colorectal cancer patients including treatment summary information, evidence-based decision support regarding surveillance, and online communication tools. Additional development is being focused upon updating the user interface, creating patient social networks, and providing tools to support patient well-being. Support has also been obtained from the Walther Cancer Foundation to collect information about patient symptoms and from the Regenstrief/Merck collaboration to collect patient-reported outcome measures. Finally, an NIH proposal has been developed for the SUrvivorship Care Plan-PERsonal Health Record Intervention Trial (SUPER-IT), a randomized controlled trial designed to test the effect of this new technology upon both the quality of care received and patient-centered outcomes

    Wrap-around services to older adults with dementia: collaboration, education, and prevention as a model for integration of primary care and neurobehavioral health

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    Background: Medical care in the Rio Grande Valley (RGV) is fragmented and difficult to navigate, especially for older adults with cognitive decline and dementia. The communities are eager to have a new healthcare delivery system that integrate community-based aging services to provide integrated, team collaborative better health care in our communities. The University of Texas RGV School of Medicine, in collaboration with its affiliates in the regional healthcare systems, is a partner providing comprehensive care across the life-cycle bridging science, social services and patient care. Our interprofessional team collaborative emphasizes safe, appropriate, and effective neurobehavioral care, employing evidence-based medicine in collaboration with the patient’s preferences and culture. Methods: Different strategies are being deployed to create, enhance and target system-wide cross-organisational care pathways to support persons with dementia (PwD) and their caregivers. The initial focus of integration is the referral network management (inter-organizational care pathways). Additional mechanisms for care integration are the use of a mobile community health integrative care hub to improve access and prevention in the South Texas Colonias; a dedicated program for older adults care that may be triply diagnosed (general-neuro-behavioral); and, an innovative curriculum to achieve improvements in population health outcomes through AD-RCMAR programs emphasizing collaboration and prevention. Results: Small-scale testing has revealed that multidisciplinary teams, both within and across organizations, emerged as the most important single care coordination mechanism. Operationally this translates in identification of tasks and roles and in the agreement over one overall care plan per patient, not defined by each profession but patient-centered. Different barriers to integration include those related to IT infrastructure and limited access to services due to ‘gatekeeping’ rules that determine referral capabilities and geographical isolation. Conclusions: Wrap-around services to older adults with dementia are expected to have a direct impact on the care of the patients and families in the RGV and to be associated with better health outcomes and better satisfaction for all. A better understanding of factors determining integration is needed in order to develop more cost-effective pathways of care for PwD and their caregivers

    Private Health Insurance Participation for Universal Coverage in the National Health Insurance Era in Denpasar, Bali

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    Background: National health insurance is a government program that aims at fulfilling the basic needs of the citizens, particularly health. It aims at achieving universal coverage in Indonesia. In order to speed the attainment of the universal coverage and to enhance the service capacity, the Implementation Body of Social Insurance (BPJS) have collaborated with private health insurance agencies. The purpose of this study was to investigate the participation of private health insurance agency in the attainment of universal coverage in the national health insurance era. Subjects and Method: This was a qualitative study carried out in Bali, in July 2015. As many as 22 informants were recruited for this study, consisting of managers and agents of some private health insurance agencies. Data were collected by in-depth interview and analyzed by thematic analysis. Results: Most of the informants were keen in establishing good collaboration with BPJS. Private health insurance agencies were enthusiastic in collaborating for the attainment of universal health coverage through the so-called Coordination of Benefit (CoB). One of the common readily available advantageous feature in this collaboration was that health insurance agency and BPJS operate the similar system of health service delivery-that is managed care. This collaboration was expected to increase the number of participants, as it allows the participants to use the various health benefit products provided by the private health insurance agencies that have collaborated with BPJS. An obstacle being faced by private health insurance was that the CoB participants did not follow the service delivery pathway as implemented by the private health insurance. Consequently the benefits provided by the private health agencies had not been uptaken optimally. The health insurance agencies do not feel threatened, since they have separate segments of participant different from the national health insurance. Conclusion: Private health insurance agencies support the existence of national health insurance. In addition, they do not feel threatened, since they have separate segments of participant different from the national health insurance. They are optimistic that they will grow with BPJS along with the increasing public awareness on the importance of health insurance. Keywords: private health insurance, national health insurance, universal coverage, coordination of benefi

    Use of a Telephone Triage Protocol to Support Nurses and Enhance Cancer Care Coordination

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    The United States is facing challenges in cancer care delivery due to aging population, growing demand for care, rising costs, shortage of adequately trained workforce, and increasing complexity of treatment. Given the complexity and costs of cancer care today, patients need considerable help navigating the course from diagnosis to survivorship or end of life. Efforts must be focused on means to produce quality care outcomes, conserve precious health care resources, and ensure positive patient experiences. Well-supported, well-designed cancer care coordination can improve outcomes for patients and providers alike. However, when unclear roles, scope of practice, and inefficient work processes are present within a system, provider satisfaction and patient outcomes can suffer. This systems change project (SCP) was developed to evaluate and amend current care coordination practices at the University of Minnesota Masonic Cancer Center (MCC). The current telephone triage system in the MCC is inadequate due to inefficient and non-standardized practices that affect care coordinator and triage nurse role clarity, workflow, time management, and overall ability to deliver care. The purpose of this SCP was to support MCC nurses by identifying and addressing their barriers to delivering best quality care. This project consisted of an informal focus group with MCC nurses, collaboration with key clinic staff and providers, and development, implementation, and evaluation of a standardized clinic telephone triage protocol. It was intended that implementation of the protocol would improve triage workflow, time management, documentation, clarity of nurse scope of practice in this role, and comfort with performing triage care. Although this project was not statistically significant in its entirety, it did demonstrate some unique, interesting, and clinically relevant outcomes that provide insight into and implications for present and future practice, research, and social justice

    The challenges of reshaping disease specific and care oriented community based services towards comprehensive goals: a situation appraisal in the Western Cape Province, South Africa

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    Similar to other countries in the region, South Africa is currently reorienting a loosely structured and highly diverse community care system that evolved around HIV and TB, into a formalized, comprehensive and integrated primary health care outreach programme, based on community health workers (CHWs). While the difficulties of establishing national CHW programmes are well described, the reshaping of disease specific and care oriented community services, based outside the formal health system, poses particular challenges. This paper is an in-depth case study of the challenges of implementing reforms to community based services (CBS) in one province of South Africa. A multi-method situation appraisal of CBS in the Western Cape Province was conducted over eight months in close collaboration with provincial stakeholders. The appraisal mapped the roles and service delivery, human resource, financing and governance arrangements of an extensive non-governmental organisation (NGO) contracted and CHW based service delivery infrastructure that emerged over 15–20 years in this province. It also gathered the perspectives of a wide range of actors – including communities, users, NGOs, PHC providers and managers - on the current state and future visions of CBS. While there was wide support for new approaches to CBS, there are a number of challenges to achieving this. Although largely government funded, the community based delivery platform remains marginal to the formal public primary health care (PHC) and district health systems. CHW roles evolved from a system of home based care and are limited in scope. There is a high turnover of cadres, and support systems (supervision, monitoring, financing, training), coordination between CHWs, NGOs and PHC facilities, and sub-district capacity for planning and management of CBS are all poorly developed. Reorienting community based services that have their origins in care responses to HIV and TB presents an inter-related set of resource mobilisation, system design and governance challenges. These include not only formalising community based teams themselves, but also the forging of new roles, relationships and mind-sets within the primary health care system, and creating greater capacity for contracting and engaging a plural set of actors - government, NGO and community - at district and sub-district level.Web of Scienc

    Colocating Health Services: A Way to Improve Coordination of Children's Health Care?

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    Based on a literature review and interviews, outlines the benefits, costs, and issues of pediatric practices' co-location with other providers and services. Examines strategies, structures, and levels of integration, as well as barriers to implementation
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