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The Veterans Healthcare Administration (VHA) has promoted Specialty Care Neighborhoods (SCN) to enhance the coordination of services between primary and specialty care. Care coordination agreements (CCAs) were included as a critical element in the SCN program. The purpose of this paper is to examine the role of these documents in the successful implementation of SCNs.

Content, quality, and perceived usefulness of CCAs from 19 SCN sites were evaluated. CCA content was defined as the presence or absence of eight key components: contact information, process for urgent consults, process for e-consults, content of consults, primary and specialty care responsibilities, expected response time, discharge criteria, and review criteria. CCA quality was based on a qualitative assessment of CCA content; and perceived usefulness was based on a qualitative assessment of interview responses from CCA users. CCA characteristics were compared to SCN implementation levels using descriptive statistics. SCN implementation level was defined and measured by VHA Specialty Care Services.

Participating sites with medium-high or high SCN implementation levels had CCAs with more key components and of higher quality than sites with medium-low to medium SCN implementation levels. Perceived usefulness of CCAs was not associated with implementation level.

Since this study built on a quality improvement effort to facilitate care coordination, a rigorous research approach was not used. Specific CCA components could not be examined nor could specific hypotheses be tested due to the small and diverse sample. Findings presented are only preliminary.

The examination of CCAs suggests that these documents may be helpful to improve communication among primary and specialty care providers by explicitly stating agreed upon processes, mechanisms and criteria for referrals, roles and responsibilities for the co-management of patients, and timelines for review of CCAs.

This small study suggests that high-quality CCAs, which include a number of key components, can facilitate the implementation of coordinated care. Key characteristics of CCAs are identified in this study, including measures of CCA content, quality, and usefulness, which can be used in future efforts to develop and evaluate efforts to improve care coordination.

The authors aim to present findings from their research on the implementation of Unified Assessment (UA) policy and the work of care coordinators who oversee the delivery of support to older people with complex needs.

A mixed methods approach included staff interviews (n=95) and focus groups (n=3).

The care coordinator role is controversial and the lack of common terminology across health and social care obscures its importance. It is seen as a social care responsibility. Limited ownership amongst healthcare professionals leads to tensions in practice. The challenges of breaking down silo thinking embedded in established professional practices are highlighted as are infrastructural and capacity deficits. Disparities between policy intentions and practice means that UA is failing to meet core objectives relating to the delivery of seamless support.

Further research is needed to develop and evaluate evidence‐informed interventions that test solutions to the problems faced in practice and support the delivery of more effective arrangements.

Practice development may be supported by: guidelines that are more prescriptive and include a formal role definition; joint training to promote shared understanding of key concepts; investment in administrative and IT infrastructures; and more coordinated direction at strategic level.

Over a decade has elapsed since the publication of UA Policy Guidance; however, there is limited published evidence on the effectiveness of UA policy and its translation into practice.

Healthcare alliances are a mechanism for developing collaborative and integrated care governance and service delivery arrangements. Yet is not known how widespread alliance arrangements are in Organisation for Economic Co-operation and Development (OECD) countries, how alliances function or how effective they are. The purpose of this paper is to provide an overview of alliances in OECD countries, including key areas covered and how performance is measured.

A structured narrative review of literature published between 2010 and 2018 was undertaken, focussed on OECD countries. The literature included peer-reviewed articles as well as publications from key policy analysis organisations.

Many OECD countries have implemented integrated care models but only a small number had explicitly adopted health alliances that link primary and secondary providers under joint governance arrangements. Most alliances are pilot initiatives and not broadly adopted. Most had not adopted a unified performance measurement framework.

Policy makers and service providers interested in joint governance arrangements that support integration must consider the range of potential options overviewed in this paper, as well as how to create supportive performance measurement frameworks.

This is the first narrative review of alliance arrangements in OECD countries. It provides an overview of arrangements, while illustrating that there is considerable scope for further alliance development.

This study was aimed to evaluate the implementation of an integrated antenatal care (ANC) scheme through a retrospective document study using a checklist for measuring the adequacy of the cohort ANC register documented by midwives in an urban area and to describe the barriers for the midwives during the ANC record process.

An exploratory descriptive study using a sequential mixed method was utilised where a quantitative method was employed by collecting secondary data of 150 entries of the cohort ANC register and followed by in-depth interviews among midwives and community health workers.

The results show that the cohort registry indicators for integrated care such as laboratory and management were poorly recorded. Several barriers were found and categorised during the implementation of the integrated ANC, namely (1) governance and strategy, (2) process of care, (3) organisation and management support.

The contribution of this present research is that it provides empirical data of the integrated ANC implementation in primary health care (PHC) which has the responsibility to deliver an integrated level of care for ANC using a cohort registry for pregnancy registration monitoring which facilitates the continuity and quality of care.

Practical implication of the finding is that functional integration such as the clinical information system to facilitate an efficient and effective approach during the implementation of integrated ANC in primary care should be considered to support the clinical, professional, organisational, system and normative integration.

Since only limited studies have been conducted to assess the quality of the cohort ANC registry and to investigate the barriers against integrated ANC implementation in Indonesia, the research findings are valuable information for the national and local governments to improve the ANC service in Indonesia.

The purpose of this paper is to develop a framework for the application of evidence-based management to chronic disease healthcare.

Chronic healthcare is specially characterized by recursive patient-physician interactions in which evidence-based medicine (EBM) is applied. However, implementing evidence-based solutions to improve healthcare quality requires managers to effect changes in many different areas: organizational structure, procedures, technology and in physician/provider behaviors. To complicate matters further, they must achieve these changes using the tools of resource allocation or incentives. The literature contains many systematic reviews evaluating the question of physician and patient behavior under various types and structures of incentives. Similarly, systematic reviews have also been done regarding specific changes to the healthcare process and their effectiveness in improving patient outcomes. Yet, these reviews uniformly lament a lack of appropriate data from well-organized studies on the question of “Why?” solutions may work in one instance while not in another. The authors present a new theoretical framework that aids in answering this question.

This paper presents a new theoretical framework (Influence Model of Chronic Healthcare) that identifies: the critical areas in which managers can effect changes that improve patient outcomes; the influence these areas can have on each other, as well as on patient and physician behavior; and the mechanisms by which these influences are exerted. For each, the authors draw upon, and present the evidence in the literature. Ultimately, the authors recognize that this is a complex question that has not yet been fully researched. The contribution of this model is twofold: first, the authors hope to focus future research efforts, and second, provide a useful heuristic to managers who must make decisions with only the lesser-quality evidence the literature contains today.

This model can be used by managers as a heuristic either ex ante or ex post to determine the effectiveness of their decisions and strategies in improving healthcare quality. In addition, it can be used to analyze why actions or decisions taken achieved a given outcome, and how best to proceed to effect further improvements on patient outcomes. Last, the model serves to focus attention on specific questions for further research.

The purpose of this paper is to propose an analytical approach that allows capturing a variety of outcomes of health care reforms. Specifically, by means of employing neo-institutional perspective, it is suggested that scholars need to take a step back and analyze the interrelation between regulatory, organizational and professional norms (dimensions). This approach improves our understanding of the complex outcomes of health care reforms. To illustrate this point, the case of coordination reform in Norway is discussed. This reform has been one of the most complex health care reforms with ambitious goals of achieving perfectly integrated care between hospitals and municipalities. The analysis through the three sets of institutional norms (dimensions) provides more comprehensive understanding of the various outcomes of the reform. The conclusion is that in order to understand the vast complexity of the outcomes of different health care reforms, we need to carefully study the institutional characteristics of rules, clinical codes of conduct, organizational characteristics as well as interplay between them. Analysis based on the three dimensions, shows that the neo-institutional approach, is of highest relevance to understand the outcomes of the complex health reforms.

Discussion in this paper is inspired by author’s PhD dissertation that comprised a study of juridification, understood as legal regulation, in treatment practice in the field of specialized health services. Three dimensions described in this paper are derived from the analysis of two types of empirical material: legal regulations and administrative guidelines in the area of patients’ rights interviews with psychiatrists and psychologists in the region of Western Norway about how they practice the regulations. The aim of this empirical study was to explore the implications the new regulations have had for clinical practice after the patients’ rights regulations became binding for clinical reasoning in Norway. This paper presents a viewpoint that applies the three dimensions derived from the empirical analysis to the discussion about the outcomes of one of the most complex Norwegian health reforms, i.e. coordination re-form. It is argued that the observations can be relevant for the analysis of the implication of health reforms in general.

The observations presented in the discussion of the possible implications of regulations of coordination reform indicate the complexity and sometimes contradictory outcomes of health regulations. There is a complex interplay between the different kinds of regulatory tools, which might have different implications at different levels. The same regulations can both strengthen and weaken established institutional order. Implications of such processes need to be empirically explored and neo-institutional approach still is of highest relevance in helping scholars understand the complex outcomes of health regulations.

Outcomes of regulations will depend on the balance between regulations and other institutional dimensions. The significant aspect of it is that this balance between the dimensions is not a zero sum equation, which means that all dimensions can be strengthened or weakened simultaneously.

The institutional dimensions can be in different balance relation with each other. The point of departure in this paper is that the legal regulations have been strengthened, i.e. expanded with regard to the coordination in health services. This development has been called juridification. The outcomes of it will depend on the balance between regulations and other institutional dimensions at work. The significant aspect of it is that this balance is not a zero sum equation, which means that all dimensions can be strengthened or weakened simultaneously.

The provision of information and advice for older people arranging their own care is a policy objective. The purpose of this paper is to explore the range and scope of web-based information about care coordination activities for older people in the non-statutory sector in England.

Non-statutory organisations were identified through a structured internet search. Services were screened to identify those providing at least one care coordination activity. A postal survey of services was conducted in 2014 and results compared with the initial findings of the web search.

Almost 300 services were identified, most of which were provided by three organisations: Age UK; Alzheimer’s Society; and the British Red Cross. Brokerage was the most frequently reported care coordination activity; the majority of services focussed on help to stay at home; and carers and older people (including those with dementia) were the target groups most often identified. Comparison of the two information sources revealed a significant agreement between two care coordination’s activities: compiling support plans and monitoring and review.

Findings are based on a purposive sample of organisations and therefore care must be exercised in generalising from them.

This study is one of the first to systematically explore the nature and extent of information about care coordination activities provided by the non-statutory sector in England. It was conducted when policy advocated both an increased role for the non-statutory sector and an increase in self-directed support.

Integration between primary and secondary healthcare services and institutions has been at the core of health policy in Scandinavian countries over the last decade. This paper is based on an explorative case study of recent reforms in the healthcare sector and their outcomes in Denmark, Norway and Sweden. We discuss the possibilities of and problems for integrating the healthcare sector through the coordination mechanisms of hierarchy, market and network. The paper also discusses whether the institutional logic of the healthcare field is moving from a dual logic of ‘cure’ and ‘care’ towards a unifying logic of ‘integrated care’. We find that although the organisational principles that regulate the relationship between actors in the healthcare field in the three countries have changed, the challenge of achieving a mix of coordinative mechanisms that promote, rather than weaken, integration remains. However, the new organisational and regulative arrangements are an arena for increased interaction and collaboration between the actors, and thus a foundation for change towards the institutional logic of integrated health care.

The purpose is to analyse the relationship between democratic accountability and how sustainable governance is achieved by horizontally integrating care services for older people through collaboration in a coordination body of key leaders from across the health and social care system.

The data and measures come from two surveys with coordination body members in Sweden (politicians, administrators, professionals) from a sample of 73 bodies in 2015 (n = 549) and the same/corresponding 59 bodies in 2019 (n = 389).

The governance of integrating care scale and the accountability scales repeatedly show consistency among individual members. Systematic progress is found among large coordination bodies: the greater the average perception of governance of horizontally integrating care in 2015, the greater it was in 2019 – and regardless of the period, the stronger the internal administrative or political monitoring and reviewing of the coordination body, the greater its governance (while the relationship to the external monitoring and reviewing is weak). However, the growing importance of external accountability is indirect, shown by stronger correlations between the internal political and external monitoring and reviewing, regardless of size.

The scales are based on self-reported perceptions that cannot be objectively verified, but they can be linked to changes in outcomes and user experiences in the later stages of the research.

Repeatedly verified scales of internal and external accountability for analysing and evaluating governance of integrating care services horizontally, which is useful for improving strategic coordination of integrated care.

The purpose of this paper is to investigate how and with which mechanisms health care professionals in practice design for collaboration to solve collective hospital tasks, which cross occupational and departmental boundaries.

An in-depth multiple-case study of five departments across four hospitals facing fast to slow response task requirements was carried out using interviews and observations. The selected cases were revealing as the departments had designed and formalized their daily hospital operations differently to solve collaboration and performance issues.

Local collaboration across occupational and departmental boundaries requires bundles of behavioral formalization elements (e.g. standardized plans, resource allocation decisions, assigned formal roles, and handoff routines), and liaison devices (e.g. huddles, boards, and physical proximity), which are used in parallel or sequence. The authors label this “designed collaboration bundles.” These bundles supplement the central organizational structures, processes, and support systems less capable of ensuring fluent coordination at the front line.

Health care professionals and hospital managers can consider designing bundles of organizational design features to proactively develop and ensure collaboration capable of solving collective tasks and bridging departmental and occupational silos to improve health care delivery.

This research paper addresses the fundamental organizational challenge of how to achieve efficient collaboration by studying how formal structures and processes are used in combination on the hospital floor, thereby going beyond previous research that studies these mechanisms individually.