Information Sharing for Care Coordination

Teamwork and care coordination are of increasing importance to health care delivery and patient safety and health. This paper describes our initial work on developing agents that are able to make intelligent information sharing decisions to support a diverse, evolving team of care providers in constructing and maintaining a shared plan that operates in uncertain environments and over a long time horizon.Engineering and Applied Science

Analysis of Care Coordination for Children with Special Health Care Needs: A Parent\u27s Perspective

Introduction. Care coordination involves organizing patient care activities and sharing information among all of the participants concerned with a patient\u27s care to achieve improved outcomes, a recent national focus. Compared to the national average, a higher percentage of Vermont children are cared for in an office that meets medical home criteria. However, there is limited research on medical home and care coordination for children with special health care needs (CSHCN) in the state of Vermont. Objectives. The goal of this study was to assess family perceptions, knowledge, and attitudes about how well care coordination is working for Vermont families with CSHCN. Methods. A paper and an electronic anonymous survey was developed for Vermont families with CSHCN. The surveys were then distributed by Vermont Family Network and the UVMMC Department of Pediatrics. Focus group interviews were also conducted at Vermont Family Network to provide family insight to explain the quantitative data. Results. 30 participants responded to the survey; only 20 completed it. The overall composite satisfaction score is 54%. This score takes into account 4 questions regarding care coordination satisfaction. Each question was formatted into a numerical value ranging from zero to five, with an overall score of 20 equating to 100% satisfaction. Discussion. Findings indicate that families with CSHCN are not satisfied with the level of care coordination currently provided. Respondents reported many barriers regarding care coordination, including lack of communication among health care providers, insurance coverage, and lack of support during transitional periods in care. Recommended improvements were identified.https://scholarworks.uvm.edu/comphp_gallery/1251/thumbnail.jp

United States-China Trade War and the Emergence of Global Covid-19 Pandemic

This paper asserts that the retaliatory trade wars between the United States and China contributed to the emergence of the global COVID-19 pandemic because the trade wars hindered the collaboration, coordination, and transparent information sharing about infectious diseases that could have adverse effects on the global economy. The retaliatory trade wars between the two largest economies in the world turned the symmetric information sharing about global infectious diseases to asymmetric information sharing, thus the inability to prepare for the emergence of the current global COVID-19 pandemic shock. In the first two decades of the 21st century, the World Health Organization (WHO) in collaboration, coordination, and transparent information sharing with global health care systems managed to curtail the outbreaks of the severe acute respiratory syndrome (SARS) in 2002-2003, H1N1 in 2009, Ebola in 2014, Zika in 2015, Dengue in 2016, and other deadly infectious diseases. We maintain that the symmetric information sharing enabled the WHO and the other global health care systems to build the firewall against these deadly infectious diseases. The absence of collaboration, coordination, and the symmetric information sharing due to the trade wars forced both countries to resort to information distortions; therefore, the inability to prepare for the global COVID-19 pandemic. Using conceptual economics, we show that the confluence of the retaliatory trade wars and COVID-19 pandemic has significant negative ramifications on economies worldwide

Unlocking information for coordination of care in Australia: a qualitative study of information continuity in four primary health care models

BACKGROUND Coordination of care is considered a key component of patient-centered health care systems, but is rarely defined or operationalised in health care policy. Continuity, an aspect of coordination, is the patient's experience of care over time, and is often described in terms of three dimensions: information, relational and management continuity. With the current health policy focus on both the use of information technology and care coordination, this study aimed to 1) explore how information continuity supports coordination and 2) investigate conditions required to support information continuity. METHODS Four diverse Australian primary health care initiatives were purposively selected for inclusion in the study. Each has improved coordination as an aim or fundamental principle. Each organization was asked to identify practitioners, managers and decision makers who could provide insight into the use of information for care coordination to participate in the study. Using in-depth semi-structured interviews, we explored four questions covering the scope and use of information, the influence of governance, data ownership and confidentiality and the influence of financial incentives and quality improvement on information continuity and coordination. Data were thematically analyzed using NVivo 8. RESULTS The overall picture that emerged across all four cases was that whilst accessibility and continuity of information underpin effective care, they are not sufficient for coordination of care for complex conditions. Shared information reduced unnecessary repetition and provided health professionals with the opportunity to access records of care from other providers, but participants described their role in coordination in terms of the active involvement of a person in care rather than the passive availability of information. Complex issues regarding data ownership and confidentiality often hampered information sharing. Successful coordination in each case was associated with responsiveness to local rather than system level factors. CONCLUSIONS The availability of information is not sufficient to ensure continuity for the patient or coordination from the systems perspective. Policy directed at information continuity must give consideration to the broader 'fit' with management and relational continuity and provide a broad base that allows for local responsiveness in order for coordination of care to be achieved.This study was supported by a grant from the Ian Potter Foundation to the Menzies Centre for Health Policy. The Australian Primary Health Care Research Institute is supported by a grant from the Australian Government Department of Health and Ageing. The Menzies Centre for Health Policy is supported by a grant from the Sir Robert Menzies Memorial Foundation

Doctor of Philosophy

dissertationInadequate care coordination has been identified as a significant problem in patient care, resulting in diminished satisfaction, increased cost, and reduced quality of care. Comprising an estimated 15.6% (approximately 11 million) of the pediatric population, children and youth with special health care needs (CYSHCN) are "those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally". Caring for CYSHCN is often highly complex, time-, effort-, and resource-intensive, due to complex healthcare conditions, comorbidities, and age of patients. Current electronic health record (EHR) and personal health record (PHR) systems do not adequately support the needs of care coordination. The reasons for this include lack of appropriate tools to support complex care coordination tasks, poor usability, and gaps in information essential for providing team-based patient care. The issues are further amplified while coordinating care for CYSHCN because their health records tend to be voluminous, involve a large care team, and are distributed over multiple systems typically with little to no interoperability. To develop tools that promote effective and efficient care coordination, designers must first understand what information is needed, who needs it, when they need it, and how it can be made available. Our first study focused on identifying and describing information needs and associated goals related to coordinating care for CYSHCN. We found that a critical information goal for care coordination is care networking, which includes building a patient's care team; knowing team member identities, roles, and contact information; and sharing pertinent information with the team to coordinate care. In our second study, we designed and developed two versions of a patient-, family-, and clinician-facing tool to support care networking. We then conducted a formative evaluation and compared the usability, usefulness, and efficiency of the two versions. To enable such tools to help with management of information critical to care coordination, information for care networking needs to be obtained from all information sources involved in the patient's care. In our third study, we identified and assessed prevalent and emerging national data standards to support electronic exchange and extraction of patient care team related data. The findings and innovations from this research are envisioned to help guide the design and development of next generation clinician- and patient-/family-facing applications to support care coordination of complex pediatric patients

Improving Care Coordination between Accountable Care Organizations and Community Partners: Early Findings from the Massachusetts Delivery System Reform Incentive Payment (DSRIP) Program

Research Objective: The Massachusetts’ Medicaid and Children’s Health Insurance Program (MassHealth/MH) initiated the Delivery System Reform Incentive Payment (DSRIP) program in 2017, as part of its section 1115 Demonstration, to coordinate care for Medicaid members, reduce healthcare costs and improve patient outcomes. Central to this program was a requirement that Accountable Care Organizations (ACOs) develop relationships with all behavioral health and at least 2 long-term care service MH contracted Community Partner agencies (CPs) operating in their service areas to be responsible for coordinating care and developing care plans for members. This presentation will describe barriers and facilitators to developing ACO-CP relationships identified in the first 1.5 years of program implementation. Study Design: This paper focuses on ways in which ACOs and CPs are responding to new contracting requirements and programmatic expectations related to the MA 1115 DSRIP. Semi-structured interviews were conducted with individuals in leadership positions at all 17 ACOs and 27 CPs by pairs of trained interviewers, in person, or via video or teleconference. Interview data were analyzed qualitatively, using a framework approach informed by the literature, the program logic model, and the evaluation design. Population Studied: ACOs/CPs nominated 2 to 3 individuals best positioned to speak to implementation topics including governance and organizational structure, workforce development, ACO-CP relationships, provider engagement, care coordination, quality improvement, and environmental factors including the role of MassHealth. Ninety-four interviews were conducted with 99 interviewees across the 44 organizations. The majority of interviewees were female and typically held managerial roles, ranging from program managers to executives. A majority were with their organizations prior to or at the time of DSRIP inception. Principal Findings: Communication and information sharing were identified as key ingredients to coordinating member health care between ACOs and CPs; the absence of effective means to communicate and share information were identified as major barriers. Strategies for enhancing communication included scheduling regular meetings to discuss shared patients (i.e., within and between organizations), designating points of contact (e.g., staff liaisons), and clarifying roles regarding member-facing activities. Information sharing was found to be most effective when organizations agreed on processes, particularly around the use of electronic medical records or other information exchange technologies. ACO and CP interviewees indicated that successful communication and information sharing led to the development of stronger and more positive partner relationships (e.g., between an ACO and the CPs with which they share information and coordinate care well). Participants also described ways in which MassHealth has actively responded to challenges within the original design of the ACO-CP relationship to improve coordination and member experience. Conclusions: Designated points of contact, well-conceived and executed communication strategies, and effective information exchange are essential for developing relationships and coordinating care between ACOs and community-based organizations. Implications for Policy or Practice: States need to consider the complexity of coordinating care with multiple community-based agencies and the importance of standardized processes for effective information sharing when promoting care coordination between health care and human service entities. States should also incorporate means of ongoing technical support and rapid cycle feedback to allow for continuous policy improvement in Medicaid delivery systems

Resilient managed competition during pandemics: lessons from the Italian experience during COVID-19

In the last decades, several European health systems have abandoned their vertically integrated health care in favour of some form of managed competition (MC), either in a centralised or decentralised format. However, during a pandemic, MC may put health systems under additional strain as they are designed to follow some form of 'organisational self-interest', and hence face reduced incentives for both provider coordination (e.g. temporary hospital close down, change in the case-mix), and information sharing. We illustrate our argument using evidence for the Covid-19 pandemic outbreak in Italy during March and April 2020, which calls for the development of 'coordination mechanisms' at times of a health emergency

National programme for rare diseases 2019–2023

It is estimated that six out of one hundred Finns have a rare disease, injury, syndrome or malformation. It can sometimes be challenging and time-consuming to identify them. It may be difficult to provide care, rehabilitation and everyday support for people with rare diseases, and there may be large regional variation in services. Therefore, the regional coordination for the prevention, diagnostics, care and rehabilitation of rare diseases has been centralised to five university hospitals in Finland. Measures descibed in this programme are still required to improve the inclusion and everyday coping of people with rare diseases, as well as their equity in access to services. The working group also proposes strengthening the national coordination and means for increasing competence and information. Participation of Finnish university hospitals in European reference networks makes expertise available to ever more people with rare diseases. Funding is needed for research on rare diseases. Limited resources for producing and sharing information can be used more effectively by cooperation, in order to provide information about rare diseases in easily understandable form in the native languages of Finland

Perceptions of shared care among survivors of colorectal cancer from non-English-speaking and English-speaking backgrounds: A qualitative study

Background: Colorectal cancer (CRC) survivors experience difficulty navigating complex care pathways. Sharing care between GPs and specialist services has been proposed to improve health outcomes in cancer survivors following hospital discharge. Culturally and Linguistically Diverse (CALD) groups are known to have poorer outcomes following cancer treatment but little is known about their perceptions of shared care following surgery for CRC. This study aimed to explore how non-English-speaking and English-speaking patients perceive care to be coordinated amongst various health practitioners. Methods: This was a qualitative study using data from face to face semi-structured interviews and one focus group in a culturally diverse area of Sydney with non-English-speaking and English-speaking CRC survivors. Participants were recruited in community settings and were interviewed in English, Spanish or Vietnamese. Interviews were recorded, transcribed, and analysed by researchers fluent in those languages. Data were coded and analysed thematically. Results: Twenty-two CRC survivors participated in the study. Participants from non-English-speaking and English-speaking groups described similar barriers to care, but non-English-speaking participants described additional communication difficulties and perceived discrimination. Non-English-speaking participants relied on family members and bilingual GPs for assistance with communication and care coordination. Factors that influenced the care pathways used by participants and how care was shared between the specialist and GP included patient and practitioner preference, accessibility, complexity of care needs, and requirements for assistance with understanding information and navigating the health system, that were particularly difficult for non-English-speaking CRC survivors. Conclusions: Both non-English-speaking and English-speaking CRC survivors described a blend of specialist-led or GP-led care depending on the complexity of care required, informational needs, and how engaged and accessible they perceived the specialist or GP to be. Findings from this study highlight the role of the bilingual GP in assisting CALD participants to understand information and to navigate their care pathways following CRC surgery

Validation of the Work Observation Method By Activity Timing (WOMBAT) method of conducting time-motion observations in critical care settings: an observational study

<p>Abstract</p> <p>Background</p> <p>Electronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs.</p> <p>Methods</p> <p>Observers used PDAs running the Work Observation Method By Activity Timing (WOMBAT) software to record the tasks performed by HCPs in advance of the introduction of a Critical Care clinical Information System (CCIS) to quantify amounts of time spent on tasks and interruptions encountered by HCPs in ICUs.</p> <p>Results</p> <p>We report the percentages of time spent on each task category, and the rates of interruptions observed for physicians, nurses, respiratory therapists, and unit clerks. Compared with previously published data from Australian hospital wards, interdisciplinary information sharing and communication in ICUs explain higher proportions of time spent on professional communication and documentation by nurses and physicians, as well as more frequent interruptions which are often followed by professional communication tasks.</p> <p>Conclusions</p> <p>Critical care workloads include requirements for timely information sharing and communication and explain the differences we observed between the two datasets. The data presented here further validate the WOMBAT method, and support plans to compare workflows before and after the introduction of electronic documentation methods in ICUs.</p