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Article
Publication date: 3 July 2017

Sherry Ball, Michelle Montpetite, Christine Kowalski, Zach Gerdes, Glenn Graham, Susan Kirsh and Julie Lowery

The Veterans Healthcare Administration (VHA) has promoted Specialty Care Neighborhoods (SCN) to enhance the coordination of services between primary and specialty care

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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.

Originality/value

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.

Details

Journal of Integrated Care, vol. 25 no. 3
Type: Research Article
ISSN: 1476-9018

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Book part
Publication date: 21 October 2008

Ethel G. Nicdao, Seunghye Hong and David T. Takeuchi

Objective: Our study examines the association between social support and use of mental health services in Asian American men and women. Specifically, we report on the…

Abstract

Objective: Our study examines the association between social support and use of mental health services in Asian American men and women. Specifically, we report on the association between types of social support and types of health services used (general medical care and specialty mental health care).

Method: We use data from the National Latino and Asian American Study, a nationally representative survey of the US household population of Latino and Asian Americans. Our present study is based on data from the sample of Asian Americans (N = 2,095).

Results: Overall, our findings suggest that Asian Americans use general medical care services more than specialty mental health care. Our findings also showed variations in levels of social support, and the use of health services among different Asian subgroups (Vietnamese, Filipino, Chinese, and Other Asian) and nativity status (US-born versus foreign-born Asians). Specific types of social support influenced the use of specialty mental health care services, while other types of social support inhibited use of specialist services.

Conclusion: Compared to using generalist services, Asian Americans demonstrated lower rates of using specialist services. Our results emphasize the importance of considering other social factors to explain between group differences as well as factors contributing to the underutilization of specialty mental health services by Asian Americans.

Details

Care for Major Health Problems and Population Health Concerns: Impacts on Patients, Providers and Policy
Type: Book
ISBN: 978-1-84855-160-2

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Book part
Publication date: 30 December 2004

Thomas T.H. Wan, Yen Ju Lin and Bill B.L. Wang

The relationships of physician practice characteristics, care management effectiveness, autonomy, and managed care involvement, and physicians’ practice and career…

Abstract

The relationships of physician practice characteristics, care management effectiveness, autonomy, and managed care involvement, and physicians’ practice and career satisfaction were investigated. A panel sample (N=660) of 6800 physicians was made up of eleven physicians randomly selected from each of the sixty communities. Three latent constructs include care management effectiveness, practice autonomy, and openness in private practice. Multilevel modeling was performed. A statistically insignificant association was found between the perceived effectiveness of care management and physician satisfaction, holding the practice characteristics and other perception factors constant. The study demonstrated direct effects of practice characteristics and care management effectiveness on the practice of gate-keeping functions and on earnings. Only two contextual variables, managed care penetration and median income in the study communities, were related to physicians’ practice.

Details

Chronic Care, Health Care Systems and Services Integration
Type: Book
ISBN: 978-1-84950-300-6

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Article
Publication date: 1 December 2003

Mary Nettleman and Leanne Yanni

In the USA, primary care is usually defined as comprehensive or coordinated care that is delivered by physicians practicing general internal medicine, family practice, or…

Abstract

In the USA, primary care is usually defined as comprehensive or coordinated care that is delivered by physicians practicing general internal medicine, family practice, or pediatrics. Obstetrics and gynecology is sometimes included under the auspices of primary care since many women, particularly during the childbearing years, rely on these physicians for preventive services. Over the last 50 years, the funding models for primary care in the USA have been inconsistent and fragmented, resulting in a complex and inadequate funding system. Although many countries have developed government‐sponsored, universal health care plans, the USA did not choose this route. Rather, significant change in US medicine has been the intended or unintended result of legislation and market‐forces.

Details

Clinical Governance: An International Journal, vol. 8 no. 4
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 18 May 2015

Genevieve Elizabeth O'Connor

The purpose of this paper is to identify how need for service, enabling factors and pre-disposing characteristics influences access to service. In addition, the authors…

Abstract

Purpose

The purpose of this paper is to identify how need for service, enabling factors and pre-disposing characteristics influences access to service. In addition, the authors seek to examine the moderating influence of pre-disposing variables on the relationship between insurance and health services utilization.

Design/methodology/approach

The authors utilize data from a major metropolitan hospital in the USA to test and extend the behavioral model of health care.

Findings

Results indicate that insurance and pre-disposing variables have a direct impact on type of health service utilization. However, the insurance effect is found to vary by demographic factors.

Research limitations/implications

This paper is limited to secondary data. Future work can incorporate both attitudinal and behavioral measures to obtain a more comprehensive evaluation of services access.

Practical implications

The research offers a tactical framework for management to segment consumer markets more effectively.

Social implications

Through the framework, management will have the requisite knowledge to target segmented populations based on need, insurance, and pre-disposing variables which will help improve access to services and clinical outcome.

Originality/value

The findings of this paper will serve as a basis for future research exploring the influence of insurance on access to services.

Details

International Journal of Bank Marketing, vol. 33 no. 3
Type: Research Article
ISSN: 0265-2323

Keywords

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Book part
Publication date: 16 October 2014

Larry R. Hearld, Kristine R. Hearld and Tory H. Hogan

Longitudinally (2008–2012) assess whether community-level sociodemographic characteristics were associated with patient-centered medical home (PCMH) capacity among primary…

Abstract

Purpose

Longitudinally (2008–2012) assess whether community-level sociodemographic characteristics were associated with patient-centered medical home (PCMH) capacity among primary care and specialty physician practices, and the extent to which variation in PCMH capacity can be accounted for by sociodemographic characteristics of the community.

Design/methodology/approach

Linear growth curve models among 523 small and medium-sized physician practices that were members of a consortium of physician organizations pursuing the PCMH.

Findings

Our analysis indicated that the average level of sociodemographic characteristics was typically not associated with the level of PCMH capacity, but the heterogeneity of the surrounding community is generally associated with lower levels of capacity. Furthermore, these relationships differed for interpersonal and technical dimensions of the PCMH.

Implications

Our findings suggest that PCMH capabilities may not be evenly distributed across communities and raise questions about whether such distributional differences influence the PCMH’s ability to improve population health, especially the health of vulnerable populations. Such nuances highlight the challenges faced by practitioners and policy makers who advocate the continued expansion of the PCMH as a means of improving the health of local communities.

Originality/value

To date, most studies have focused cross-sectionally on practice characteristics and their association with PCMH adoption. Less understood is how physician practices’ PCMH adoption varies as a function of the sociodemographic characteristics of the community in which the practice is located, despite work that acknowledges the importance of social context in decisions about adoption and implementation that can affect the dissemination of innovations.

Details

Population Health Management in Health Care Organizations
Type: Book
ISBN: 978-1-78441-197-8

Keywords

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Book part
Publication date: 25 July 2012

Christopher G. Worley

Purpose – This chapter argues that the concept of agility is an effective robust framework for designing sustainable health care systems.Design/methodology/approach – This…

Abstract

Purpose – This chapter argues that the concept of agility is an effective robust framework for designing sustainable health care systems.

Design/methodology/approach – This case study of Alegent Health was based on 7 years of data collection. It includes observations of meetings, large-group interventions, and other activities; site visits to different hospitals in the system to observe changes in practice; interviews with Alegent Health executives, primary care physicians, hospital presidents, specialist physicians and physician groups, and health systems staff and nurses; and a variety of archival data including meeting minutes, video tapes, conference proceedings, and web site material.

Findings – The Alegent Health system has evolved over time according to the principles of agility. It built a series of new capabilities that contribute to improved clinical outcomes, sustained financial results, and more socially and ecologically responsible results. Designing health care systems based on agility is a more effective and sustainable approach than relying on legislative or other criteria.

Originality/value – The discussion of sustainability in health care has focused primarily on specific projects or how to respond to specific technological, regulatory, or clinical changes. Alegent Health's experience provides important lessons, opportunities, and challenges that can help advance our understanding of effective health care and use organizational agility to create more sustainable health care systems. This chapter provides health care system administrators an alternative design option.

Details

Organizing for Sustainable Health Care
Type: Book
ISBN: 978-1-78190-033-8

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Article
Publication date: 3 August 2015

Jing Shi, Ergin Erdem, Yidong Peng, Peter Woodbridge and Christopher Masek

Telephone response system is the frontline of hospital operations. The purpose of this paper is to analyze a representative telephone response system of Veterans Affairs…

Abstract

Purpose

Telephone response system is the frontline of hospital operations. The purpose of this paper is to analyze a representative telephone response system of Veterans Affairs (VA) hospitals, address the existing inefficiency issues such as long call waiting time, and improve system resilience to changes.

Design/methodology/approach

Resource sharing schemes are proposed to improve the system performance in answering calls related to appointment booking and medication renewal. Discrete event simulation is adopted to model the current system and the resource sharing schemes.

Findings

The resource sharing schemes dramatically improve system performance reflected by the decrease of call waiting time and queue, as well as the extreme high utilization of agents in a key unit. Compared with the less desired alternative of hiring additional employees to mitigate the performance issues, the resource sharing schemes perform at par or even better. Sharing more resource during the peak hours can further balance the agent workload.

Practical implications

The resource sharing schemes could alleviate staffing shortage, long waiting time, and high-abandonment rate in the bottle-beck unit of the system, and lead to better utilization of scarce resources on the hospital floor. The concept reflects localized centralization efforts in traditionally highly decentralized telephone operations in hospital systems.

Originality/value

This research provides a structured approach to analyze the operations of a VA telephone response system. The developed simulation model is validated, and this provides a valuable tool for management to analyze the complicated telephone operations of the telephone systems of other VA and non-VA hospitals. Resource sharing constitutes a cost-effective solution for improving system performance and resilience.

Details

International Journal of Operations & Production Management, vol. 35 no. 8
Type: Research Article
ISSN: 0144-3577

Keywords

Content available
Article
Publication date: 4 December 2017

Bita A. Kash, Paul Ogden, Elizabeth Popp, Melissa Shaffer and Jane Bolin

The purpose of this study is to identify best practices for innovative primary care models and to describe a potential future primary care (PC) model for Texas to address…

Abstract

Purpose

The purpose of this study is to identify best practices for innovative primary care models and to describe a potential future primary care (PC) model for Texas to address the burden of chronic disease in a population-based approach.

Design/methodology/approach

A systematic literature review was conducted and identified 1,880 published records through PubMed using 26 search terms. After abstract and full-text review, 70 articles remained as potential models.

Findings

Although there is already a severe shortage of physicians in Texas, emerging practice patterns and choices among physicians are likely to erode access to primary care services in the state. Health-care leaders are encouraged to consider models such as complex adaptive systems for team-based care, pharmacist hypertension care management program and combined nurse-led care management with group visit structure.

Research limitations/implications

As with any study, this research has its limitations; for example, models that might work in one state, or under a unique state-funded academic medical center, might not be “do-able” in another state within the nuances of a different funding mechanism.

Practical implications

Results of this research provide a model for implementing IPCM for the state of Texas first and will guide IPCM planning and implementation in other states.

Originality/value

This study is “land grant-centric” and focused on carrying out the mission of a major, top-tier research university with an emerging college of medicine at an academic medical center.

Details

International Journal of Innovation Science, vol. 9 no. 4
Type: Research Article
ISSN: 1757-2223

Keywords

Content available
Article
Publication date: 23 January 2009

Wally R. Smith

Abstract

Details

Clinical Governance: An International Journal, vol. 14 no. 1
Type: Research Article
ISSN: 1477-7274

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