Quality of integrated chronic care measured by patient survey: identification, selection and application of most appropriate instruments\ud

Objective  To identify the most appropriate generic instrument to measure experience and/or satisfaction of people receiving integrated chronic care.\ud \ud Background  Health care is becoming more user-centred and, as a result, the experience of users of care and evaluation of their experience and/or satisfaction is taken more seriously. It is unclear to what extent existing instruments are appropriate in measuring the experience and/or satisfaction of people using integrated chronic care.\ud \ud Methods  Instruments were identified by means of a systematic literature review. Appropriateness of instruments was analysed on seven criteria. The two most promising instruments were translated into Dutch, if necessary, and administered to a convenience sample of 109 people with a chronic illness. Data derived from respondents were analysed statistically. Focus-group interviews were conducted to assess the semantic and technical equivalence as well as opinions of people about the applicability and relevance of the translated instruments.\ud \ud Results  From 37 instruments identified, the Patients’ Assessment of Care for chronIc Conditions (PACIC) and the short form of the Patient Satisfaction Questionnaire III (PSQ-18) were selected as most promising instruments. Both instruments produced similar median scores across people with different chronic conditions. The overall PACIC and its subscales and the overall PSQ-18 were highly internally consistent, but not the PSQ-18 subscales. Overall, the PACIC demonstrated better psychometric characteristics. PACIC and PSQ-18 scores were found to be moderately correlated. Whereas more respondents preferred the PSQ-18, focus-group participants regarded the PACIC to be more applicable and relevant. The technical and semantic equivalence of both instruments were sufficient.\ud \ud Conclusions  Because of its psychometric characteristics, perceived applicability and relevance, the PACIC is the most appropriate instrument to measure the experience of people receiving integrated chronic care\u

Towards an international taxonomy of integrated primary care: a Delphi consensus approach

Background Developing integrated service models in a primary care setting is considered an essential strategy for establishing a sustainable and affordable health care system. The Rainbow Model of Integrated Care (RMIC) describes the theoretical foundations of integrated primary care. The aim of this study is to refine the RMIC by developing a consensus-based taxonomy of key features. Methods First, the appropriateness of previously identified key features was retested by conducting an international Delphi study that was built on the results of a previous national Delphi study. Second, categorisation of the features among the RMIC integrated care domains was assessed in a second international Delphi study. Finally, a taxonomy was constructed by the researchers based on the results of the three Delphi studies. Results The final taxonomy consists of 21 key features distributed over eight integration domains which are organised into three main categories: scope (person-focused vs. population-based), type (clinical, professional, organisational and system) and enablers (functional vs. normative) of an integrated primary care service model. Conclusions The taxonomy provides a crucial differentiation that clarifies and supports implementation, policy formulation and research regarding the organisation of integrated primary care. Further research is needed to develop instruments based on the taxonomy that can reveal the realm of integrated primary care in practice

Extending the Business-to-Business (B2B) model towards a Business-to-Consumer (B2C) model for Telemonitoring Patients with Chronic Heart Failure

Purpose: We describe and perform an initial evaluation of the extension of the Business-to-Business model to a Business-to-Consumer model for telemonitoring of patients with chronic heart failure. Design/methodology/approach: We explored the problems in implementation of telemonitoring via the B2B model by means of a root cause analysis, including the 5-whys method to help us understand the shortcomings of the B2B approach, and then the 5W1H method to explore whether the B2C is a better strategy. The extension of the model was executed in the Business Model Generation framework. By using qualitative content analysis techniques, we supported our argumentation with findings from other studies. Findings: The B2C model is based on the interplay of agents – healthcare provider, equipment manufacturer, payer/regulator and distributor/promotor – all working together to improve patient outcomes. In our opinion, the success of the extended model in telemonitoring CHF patients hinges on two entities – the Telemonitoring center and Telehealth nurses – being repositioned in the out-of-the hospital setting. Social implications: Penetration of mobile telehealth via B2C model will allow for greater availability, access and equity in healthcare. Originality/value: We introduced a fourth pillar to the existing B2B model (i.e. distributors and/or promotors). The B2C model we propose might allow for scalability, generalizability and transferability of telemonitoring currently unattained with the B2B model. &nbsp

Integrated healthcare models for rheumatoid arthritis:A descriptive systematic review

Introduction: Integrated people-centred care is a modern approach for addressing healthcare issues related to demographic changes, increasing prevalence of chronic diseases, and restricted resources. By providing an overview of integrated care models for patients with rheumatoid arthritis, we aimed to offer insight into the strategies and interventions that are being used for designing and implementing integrated models of care for this patient group, and their outcomes. Methods: We conducted a systematic literature search of peer-reviewed literature available in English and published between 2013 and 2018, using three databases: Cochrane, PubMed and EMBASE. We analysed the publications based on the Framework on integrated people-centred health services and the Triple/Quadruple Aim framework. Results: We identified 1271 records. After screening, 50 articles met the criteria for inclusion in the review. Approaches for improving patient empowerment, engagement and experience of care were most prevalent in the identified care profiles. Similarly, frequently reported outcomes were related to improvements in patients’ experience of care and their health status. Most of the studies we reviewed did not demonstrate notable improvements from the perspective of cost-effectiveness or benefits for the healthcare workforce. Conclusions: Our findings suggest that for rheumatoid arthritis, integrated care is in the early stages of development. Strategies focusing on patient outcomes and patient satisfaction were found to be prioritised. Future initiatives aiming to redesign rheumatology care should adopt systems thinking perspective to better address all of the building blocks of people-centred integrated care

An Instrument to Measure Maturity of Integrated Care: A First Validation Study

Introduction: Lessons captured from interviews with 12 European regions are represented in a new instrument, the B3-Maturity Model (B3-MM). B3-MM aims to assess maturity along 12 dimensions reflecting the various aspects that need to be managed in order to deliver integrated care. The objective of the study was to test the content validity of B3-MM as part of SCIROCCO (Scaling Integrated Care into Context), a European Union funded project. Methods: A literature review was conducted to compare B3-MM’s 12 dimensions and their measurement scales with existing measures and instruments that focus on assessing the development of integrated care. Subsequently, a three-round survey conducted through a Delphi study with international experts in the field of integrated care was performed to test the relevance of: 1) the dimensions, 2) the maturity indicators and 3) the assessment scale used in B3-MM. Results: The 11 articles included in the literature review confirmed all the dimensions described in the original version of B3-MM. The Delphi study rounds resulted in various phrasing amendments of indicators and assessment scale. Full agreement among the experts on the relevance of the 12 B3-MM dimensions, their indicators, and assessment scale was reached after the third Delphi round. Conclusion and discussion: The B3-MM dimensions, maturity indicators and assessment scale showed satisfactory content validity. While the B3-MM is a unique instrument based on existing knowledge and experiences of regions in integrated care, further testing is needed to explore other measurement properties of B3-MM

Evaluation of a digital platform that engages stakeholders in the co-creation of healthcare innovations:A mixed-methods study

Introduction: Engaging public and patients in the decision-making processes is on the agenda of many healthcare systems towards sustainable healthcare delivery. While many engagement initiatives are performed face-to-face, an increasing number is conducted online. An example of the latter is the Dutch digital platform Gezonde Mening that engages patients, healthcare professionals and other stakeholders in the co-creation of healthcare innovations. This study aimed to evaluate the effectiveness of stakeholder engagement performed on Gezonde Mening by focusing on the process of planning, execution and transition of engagement activities. Methods: A mixed-methods study was performed by conducting eight semi-structured interviews with developers and funders of Gezonde Mening and an assessment of the psychometric properties of two questionnaires administrated via Gezonde Mening to seek stakeholders’ inputs. While the interviews were analysed deductively and inductively, data from the assessment of psychometric properties were analysed in a descriptive quantitative manner. Data were interpreted through triangulation. Results: Assessment of the planning of stakeholder engagement identified needs for having more stakeholders on the platform to enable subgroup analysis and robust insights. Moreover, questionnaires administered by Gezonde Mening showed low validity and reliability. Assessment of the execution of stakeholder engagement indicated that stakeholders are sufficiently informed about engagement. Assessment of the transition of engagement activities showed needs to provide direct results to stakeholders and allow their evaluation of the platform. Conclusion: Gezonde Mening digital platform facilitates communication between innovators and stakeholders during engagement activities. However, the study identified room for improvement regarding the planning and transition activities

Factors influencing acceptance of technology for aging in place: A systematic review

Purpose To provide an overview of factors influencing the acceptance of electronic technologies that support aging in place by community-dwelling older adults. Since technology acceptance factors fluctuate over time, a distinction was made between factors in the pre-implementation stage and factors in the post-implementation stage. Methods A systematic review of mixed studies. Seven major scientific databases (including MEDLINE, Scopus and CINAHL) were searched. Inclusion criteria were as follows: (1) original and peer-reviewed research, (2) qualitative, quantitative or mixed methods research, (3) research in which participants are community-dwelling older adults aged 60 years or older, and (4) research aimed at investigating factors that influence the intention to use or the actual use of electronic technology for aging in place. Three researchers each read the articles and extracted factors. Results Sixteen out of 2841 articles were included. Most articles investigated acceptance of technology that enhances safety or provides social interaction. The majority of data was based on qualitative research investigating factors in the pre-implementation stage. Acceptance in this stage is influenced by 27 factors, divided into six themes: concerns regarding technology (e.g., high cost, privacy implications and usability factors); expected benefits of technology (e.g., increased safety and perceived usefulness); need for technology (e.g., perceived need and subjective health status); alternatives to technology (e.g., help by family or spouse), social influence (e.g., influence of family, friends and professional caregivers); and characteristics of older adults (e.g., desire to age in place). When comparing these results to qualitative results on post-implementation acceptance, our analysis showed that some factors are persistent while new factors also emerge. Quantitative results showed that a small number of variables have a significant influence in the pre-implementation stage. Fourteen out of the sixteen included articles did not use an existing technology acceptance framework or model. Conclusions Acceptance of technology in the pre-implementation stage is influenced by multiple factors. However, post-implementation research on technology acceptance by community-dwelling older adults is scarce and most of the factors in this review have not been tested by using quantitative methods. Further research is needed to determine if and how the factors in this review are interrelated, and how they relate to existing models of technology acceptance