Development of an evidence-based reference framework for care coordination with a focus on the micro level of integrated care: a mixed method design study combining scoping review of reviews and nominal group technique

Health Policy ◽  
2022 ◽  
Author(s):  
Françoise Colombani ◽  
Gaëlle Encrenaz ◽  
Matthieu Sibé ◽  
Bruno Quintard ◽  
Alain Ravaud ◽  
...  
Keyword(s):  
Scoping Review ◽  
Care Coordination ◽  
Mixed Method ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Evidence Based ◽  
Reference Framework ◽  
Mixed Method Design ◽  
Review Of Reviews ◽  
Micro Level

scholarly journals Development of an evidence-based reference framework for care coordination interventions in France

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
F Colombani ◽  
G Encrenaz ◽  
B Quintard ◽  
M Sibé ◽  
A Ravaud ◽  
...  
Keyword(s):  
Care Coordination ◽  
Cancer Care ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Consensus Method ◽  
Evidence Based ◽  
Care Organization ◽  
Coordinated Care ◽  
Reference Framework ◽  
The Impact

Abstract Background Today, the high variability of practices, the lack of common definitions and underlying concepts increases the existing difficulty to standardise, to replicate, to transpose and to assess the coordinated care. This heterogeneity makes very difficult the evaluation of performance of care coordination. The aim of the first phase of Epock study is to develop a theoretical framework for care coordination interventions in the French health system that can be used for description, implementation and evaluation of care coordination intervention in any clinical situation. Methods A review of systematic reviews on care coordination interventions was conducted to identify relevant models and constitutive elements of the expected reference framework for care coordination intervention. These elements resulting from the literature review have been grouped by themes, prioritised and selected by a structured consensus method (Nominal Group Technique). Results Four dimensions of care coordination were identified: (a) Underlying conceptual models; (b) Care organization, care and facilitation activities; (c) Actors and tools; and (d) Effects classified according to WHO’s quality of care dimensions. Among these dimensions, 4 to 28 elements have been selected to build the reference components of care coordination in France. Conclusions This first reference framework for care coordination interventions in France will be used during the Epock project phase 2 as a basis for comparing practices observed in oncology. This framework could be used as of now for: practice by helping to develop job descriptions and training programmes for future care coordination professionals; piloting to measure care coordination (by developing indicators for care coordination); and research, to evaluate the impact of care coordination interventions. Key messages Epock is a challenging French national research project for the development of an evidence-based reference framework for cancer care coordination interventions considered as a complex intervention. Epock will provide key elements for cancer care coordination intervention effective implementations and for designing further medico-economic evaluation of cancer care coordination intervention impact.

scholarly journals “To guide my life and art”: A triangulated study on the behavioral competencies for effective medical practice in Nigeria

2019 ◽  
Author(s):  
Adanna Chukwuma ◽  
Uche Obi ◽  
Ifunanya Agu ◽  
Chinyere Mbachu
Keyword(s):  
Medical Students ◽  
Medical Practice ◽  
Scoping Review ◽  
Clinical Skills ◽  
Nominal Group Technique ◽  
Team Work ◽  
Nominal Group ◽  
Future Research ◽  
Group Technique ◽  
Behavioral Competencies

Abstract Background: Variation in clinical performance is attributable to factors outside academic and clinical skills. Selection processes and training programs for medical professionals should be adapted to consider these behavioral factors, which may vary across contexts. This study was conducted to identify behavioral competencies considered relevant for effective medical practice among medical students and practitioners in Nigeria.Methods: We drew on a scoping review to develop a starting list of behavioral attributes that correlate with effective service provision. Drawing on nominal group technique exercises with 17 medical students and 11 physicians, this starting list was modified with scoring and ranking of selected competencies. We compared the list of competencies and rankings between medical students, doctors, and the scoping review.Results: The scoping review identified nine articles for full-text review, resulting in a starting list of 21 behavioral competencies defined in studies conducted in non-African countries. The nominal group technique exercises conducted with medical students and doctors yielded a condensed list of 32 and 27 behavioral competencies respectively. For doctor-client interactions, the behavioral competencies considered most important included effective communication and patient-centeredness. Whereas, for doctor-colleague interactions, team work, respectfulness, and management ability were ranked highly. However, there were clear divergences between groups and with the scoping review.Conclusions: This study is one of the first to identify the perspectives of medical students and physicians on behavioral competencies considered essential for effective medical practice in an African country. We found differences in the perspectives of medical physicians and students, and in the prioritized competencies across contexts. This illustrates the need for careful consideration in identifying subject matter experts and in generalizing competencies across contexts. Future research in this field in Nigeria should examine effective ways of testing for key behavioral competencies among medical students and for residency programs. Also, investigating the perspectives of medical faculty and administrators on important competencies, and exploring the generalizability of these competencies across cultures in Nigeria should be considered.

scholarly journals Evidence-Based Guidelines for the Pharmacological Management of Acute Methamphetamine-Related Disorders and Toxicity

2017 ◽  
Vol 50 (03) ◽  
pp. 87-95 ◽  
Author(s):  
Norbert Wodarz ◽  
Anne Krampe-Scheidler ◽  
Michael Christ ◽  
Heribert Fleischmann ◽  
Winfried Looser ◽  
...  
Keyword(s):  
Pharmacological Treatment ◽  
Treatment Strategies ◽  
Nominal Group Technique ◽  
Therapeutic Interventions ◽  
Withdrawal Symptoms ◽  
Nominal Group ◽  
Evidence Based ◽  
Pharmacological Management ◽  
Acute Agitation ◽  
Evidence Based Guidelines

AbstractConsumption of methamphetamine (“crystal”) has spread dramatically over several European countries. The management of methamphetamine-induced acute disorders has become a growing challenge to the health system. Pharmacological treatment strategies for methamphetamine-induced intoxication syndromes, acute withdrawal symptoms, and methamphetamine-induced psychosis are particularly important.The development of interdisciplinary and evidence- and consensus-based (S3) German Guidelines was based on a systematic literature and guideline search on therapeutic interventions in methamphetamine-related disorders (April, June 2015). Consideration was given to 9 guidelines and 103 publications. Recommendations on pharmacological treatment strategies were drawn up using the nominal group technique.Overall, only limited evidence is available. Benzodiazepines are first-line medication for methamphetamine-induced intoxication syndromes, particularly when they present with acute agitation and aggressive behavior. There is no evidence-based medication for the treatment of methamphetamine-related withdrawal symptoms and cravings. When treating methamphetamine-induced psychosis, second-generation antipsychotics should be favored, given their more favorable side-effect profile. The indication for continuation of antipsychotic medication must be reviewed regularly. In most cases, the antipsychotic should be tapered off within 6 months.

scholarly journals The Delphi Method: An Approach for Facilitating Evidence Based Practice in Athletic Training

2008 ◽  
Vol 3 (4) ◽  
pp. 135-142 ◽  
Author(s):  
Michelle A. Sandrey ◽  
Sean M. Bulger
Keyword(s):  
Athletic Training ◽  
Delphi Method ◽  
Delphi Technique ◽  
Evidence Based Practice ◽  
Nominal Group Technique ◽  
Scientific Data ◽  
The Body ◽  
Nominal Group ◽  
Evidence Based ◽  
Consensus Methods

Objective: The growing importance of evidence based practice in athletic training is necessitating academics and clinicians to be able to make judgments about the quality or lack of the body of research evidence and peer-reviewed standards pertaining to clinical questions. To assist in the judgment process, consensus methods, namely brainstorming, nominal group technique and the Delphi method can be used. The purpose of this paper is to review the literature related to the Delphi Method and its potential implications for evidence-based practice and peer-reviewed standards in athletic training. Data Sources: We searched PubMed and MEDLINE (1978–2007), CINAHL (1993–2006), Dissertation Abstracts (1979–2006) and Google Scholar (1983–2007) using the terms “Delphi method,” “modified Delphi technique,” “consensus methods,” “Delphi technique,” and combined search terms of “Delphi method AND allied health, AND medicine AND dentistry, AND nursing. Data Synthesis: Textual support for the use of the Delphi Method in athletic training and a brief review of the literature pertaining to the: objectives; advantages; limitations commonly associated with the use of the Delphi Method; and research protocol. Conclusions/Recommendations: The Delphi Method in athletic training has been used to fulfill two objectives; the need for evidence based practice and the need to establish policies and procedures when none are in existence or it is difficult for one individual to make a decision. The Delphi Method and other consensus development methods should not be viewed as a scientific method for creating new knowledge, but rather as processes for making the best use of available information, be that scientific data or the collective wisdom of participants.

scholarly journals Exploring Behavioral Competencies for Effective Medical Practice in Nigeria

2020 ◽  
Vol 7 ◽  
pp. 238212052097823
Author(s):  
Adanna Chukwuma ◽  
Uche Obi ◽  
Ifunanya Agu ◽  
Chinyere Mbachu
Keyword(s):  
Medical Students ◽  
Medical Practice ◽  
Scoping Review ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Empirical Literature ◽  
Medical Professionals ◽  
Behavioral Factors ◽  
Group Technique ◽  
Behavioral Competencies

Introduction: Clinical performance varies due to academic, clinical, and behavioral factors. However, in many countries, selection of medical professionals tends to focus on exclusively academic ability and clinical acumen. Appropriate selection processes for medical professionals should consider behavioral factors, which may vary across contexts. This study was conducted to identify behavioral competencies considered relevant for effective medical practice in Nigeria, by medical students and doctors, and compared with other contexts. Methods: This mixed methods study draws on a scoping review and nominal group technique exercises. We undertook a scoping review to develop a list of behavioral attributes that may correlate with effective service provision in the empirical literature, across contexts. Drawing on nominal group technique exercises with 17 medical students and 11 physicians, this starting list was modified through scoring and ranking of selected competencies. We compared the list of competencies and rankings between medical students, doctors, and the scoping review. Results: The scoping review identified 9 articles for full-text review, resulting in a starting list of 21 behavioral competencies defined in studies, all of which had been conducted in non-African countries. The nominal group technique exercises conducted with medical students and doctors yielded a condensed list of 32 and 27 behavioral competencies respectively. For doctor-client interactions, effective communication and patient-centeredness were ranked highly, while for doctor-colleague interactions, teamwork, respectfulness, and management ability were ranked highly. There were also divergences in the condensed list of behavioral competencies and the scoping review, which may be explained by cultural and non-cultural factors. Discussion: This study is one of the few to examine the perspectives of medical students and physicians on behavioral competencies for effective medical practice in an African country. We found differences in the perspectives of medical physicians and students, and in the prioritized competencies across countries. Our study illustrates the need for careful consideration in identifying subject matter experts and in generalizing competencies across contexts. Future research in this field in Nigeria should examine effective ways of testing for key behavioral competencies among medical students and for residency programs. Also, investigating the perspectives of medical faculty and administrators on important competencies, and exploring the generalizability of these competencies across cultures in Nigeria should be considered.

scholarly journals European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease – the SHARE initiative

Rheumatology ◽  
2018 ◽  
Vol 58 (4) ◽  
pp. 672-682 ◽  
Author(s):  
Nienke de Graeff ◽  
Noortje Groot ◽  
Seza Ozen ◽  
Despina Eleftheriou ◽  
Tadej Avcin ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Treatment Options ◽  
Nominal Group Technique ◽  
Access Point ◽  
Paediatric Rheumatology ◽  
Diagnosis And Treatment ◽  
Nominal Group ◽  
Evidence Based ◽  
Treatment Regimens ◽  
Resistant Disease

AbstractObjectivesThe European Single Hub and Access point for paediatric Rheumatology in Europe initiative aimed to optimize care for children with rheumatic diseases. Kawasaki disease (KD) is the most common cause of acquired heart disease in children and an important cause of long-term cardiac disease into adulthood. Prompt diagnosis and treatment of KD is difficult due to the heterogeneity of the disease but is crucial for improving outcome. To date, there are no European internationally agreed, evidence-based guidelines concerning the diagnosis and treatment of KD in children. Accordingly, treatment regimens differ widely. The aim of this study is to provide consensus-based, European-wide evidence-informed recommendations for diagnosis and treatment of children with KD.MethodsRecommendations were developed using the EULAR’s standard operating procedures. An extensive systematic literature search was performed, and evidence-based recommendations were extrapolated from the included papers. These were evaluated by a panel of international experts via online surveys and subsequently discussed in three consensus meetings, using nominal group technique. Recommendations were accepted when ⩾80% agreed.ResultsIn total, 17 recommendations for diagnosis and 14 for treatment of KD in children were accepted. Diagnostic recommendations included laboratory and imaging workup for complete as well as incomplete KD. Treatment recommendations included the importance of early treatment in both complete and incomplete KD, use of intravenous immunoglobulin, aspirin, corticosteroids for high-risk cases, and other treatment options for those with resistant disease.ConclusionThe Single Hub and Access point for paediatric Rheumatology in Europe initiative provides international evidence-based recommendations for diagnosing and treating KD in children, facilitating improvement and uniformity of care.

scholarly journals Comparing the Experiences of Birth Experiences Women With Remifentanil Analgesia and Elective Cesarean Section and Providing Improver Strategies: A Sequential Explanatory Mixed Method Study

2020 ◽  
Author(s):  
rana dousti ◽  
sevil Hakimi ◽  
Hojjat Pourfathi ◽  
Roghayeh Nourizadeh ◽  
Niloufar Sattarzadeh Jahdi
Keyword(s):  
Mixed Method ◽  
Mixed Methods Research ◽  
Nominal Group Technique ◽  
Target Population ◽  
Nominal Group ◽  
Elective Cesarean Section ◽  
Care Providers ◽  
Private Hospitals ◽  
Sequential Explanatory ◽  
Tabriz City

Abstract BackgroundIdentifying methods that are effective and safe while also compatible with maternal needs and improving the delivery experience is important. Since pharmacological interventions provide better pain alleviation for women during labor when compared to nonpharmacological interventions, in case the former also improves women satisfaction with the labor experience, care providers can propose this method for mitigating the women's pain during labor. The aim of this study is to compare the experience of parturient women between remifentanil analgesia and elective C-section, as well as proposing ameliorating strategies in Tabriz city, Iran.MethodThe present research is of mixed methods research type with a sequential explanatory approach. The first stage is quantitative and longitudinal. The target population consists of parturient women receiving elective C-section and vaginal labor through remifentanil analgesia in the private hospitals of Tabriz city. The sampling will be performed from all private hospitals of Tabriz city as available sampling. They will be chosen from each hospital based on specific rations in relation to the eligible women according to the inclusion criteria, and then assigned into two groups (elective C-section and parturient women receiving remifentanil). Demographic characteristics as well as Edinburgh's depression test during pregnancy questionnaires plus labor agentry scale (LAS) as well as the checklist of maternal and neonatal outcomes within 24 hours postdelivery will be completed by the researcher. The subjects will be followed up for up to 30 days postdelivery in order to complete the Edinburgh depression questionnaire. The second stage of study is qualitative performed to interpret parturient women's perception about elective C-section and Remifentanil anesthesia regarding different aspects and the factors associated with delivery experience. The sampling will continue until data saturation, i.e. no new information or code is received. Based on the results of the total mean score of delivery experience, which will be obtained in the quantitative section, the extreme cases will be chosen. For this purpose, at both ends of the total score spectrum of the delivery experience, the women acquiring the 10% upper and lower extreme total score of delivery experience will be chosen as the extreme cases. Purposeful sampling will be done on mothers belonging to extreme cases and who are willing as well as able to express their experiences. In the third stage, in order to provide ameliorating strategies for delivery experience, after combining the quantitative and qualitative studies, a review of the literature and then nominal group technique will be used.DiscussionBy comparing the experience of parturient women receiving Remifentanil analgesia and elective C-section, evidence-based improving strategies using a culturally sensitive approach can be provided. Presentation of the results obtained from this study using the mixed method may help in better understanding the issue. Also, the obtained results can be used to enhance the quality of midwifery care to be examined by health policymakers and planners.Ethical codeIR.TBZMED.REC.1399. 521

scholarly journals Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus

2018 ◽  
Vol 46 (2) ◽  
pp. 190-197 ◽  
Author(s):  
Alberto Martini ◽  
Angelo Ravelli ◽  
Tadej Avcin ◽  
Michael W. Beresford ◽  
Ruben Burgos-Vargas ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Data Collection ◽  
Pediatric Rheumatology ◽  
Nominal Group Technique ◽  
Large Data ◽  
Consensus Conference ◽  
Classification Criteria ◽  
Nominal Group ◽  
Evidence Based ◽  
International Consensus

Objective.To revise the current juvenile idiopathic arthritis (JIA) International League of Associations for Rheumatology (ILAR) classification criteria with an evidence-based approach, using clinical and routine laboratory measures available worldwide, to identify homogeneous clinical groups and to distinguish those forms of chronic arthritis typically seen only in children from the childhood counterpart of adult diseases.Methods.The overall project consists of 4 steps. This work represents Step 1, a Delphi Web-based consensus and Step 2, an international nominal group technique (NGT) consensus conference for the new provisional Pediatric Rheumatology International Trials Organization JIA classification criteria. A future large data collection of at least 1000 new-onset JIA patients (Step 3) followed by analysis and NGT consensus (Step 4) will provide data for the evidence-based validation of the JIA classification criteria.Results.In Step 1, three Delphi rounds of interactions were implemented to revise the 7 ILAR JIA categories. In Step 2, forty-seven questions with electronic voting were implemented to derive the new proposed criteria. Four disorders were proposed: (a) systemic JIA; (b) rheumatoid factor–positive JIA; (c) enthesitis/spondylitis-related JIA; and (d) early-onset antinuclear antibody–positive JIA. The other forms were gathered under the term “others.” These will be analyzed during the prospective data collection using a list of descriptors to see whether the clustering of some of them could identify homogeneous entities.Conclusion.An international consensus was reached to identify different proposed homogeneous chronic disorders that fall under the historical termJIA. These preliminary criteria will be formally validated with a dedicated project.

Tätigkeiten und Rollen von neu graduierten Bachelorabsolvent_innen der Pflege im akutstationären Setting

Pflege ◽  
2021 ◽  
pp. 1-10
Author(s):  
Annemarie Strobl ◽  
Nadja Nestler ◽  
Irmela Gnass
Keyword(s):  
Scoping Review ◽  
Mixed Method ◽  
Mixed Method Design

Zusammenfassung. Hintergrund: Institutionen im deutschsprachigen Gesundheitswesen sind trotz Bedarf nicht auf Bachelorabsolvent_innen von berufsqualifizierenden Pflegestudiengängen vorbereitet, da keine Tätigkeits- und Rollenprofile zu deren Einsatz in bestimmten Settings vorliegen. Ziel: Ziel ist ein nationaler und internationaler Überblick über Tätigkeiten und Rollen von neu graduierten Bachelorabsolvent_innen im akutstationären Setting. Methoden: Deutsch- und englischsprachig publizierte Studien wurden zwischen 2010 und 2021 in den Datenbanken CINAHL und MEDLINE gesucht und unabhängig ihres Studiendesigns in das Scoping Review aufgenommen. Ergebnisse: Die acht eingeschlossenen Studien folgen qualitativen (n = 5), einem Querschnitt (n = 2) und Mixed-Method Design (n = 1). Sie wurden überwiegend im skandinavischen (n = 3) und nordamerikanischen Raum (n = 3) durchgeführt. Die Ergebnisse zeigen einen Mix an Tätigkeiten und Rollen, in dem Absolvent_innen in der primären pflegerischen Versorgung als Edukator_innen (inkl. Lehrende) und im Medikamentenmanagement bei allen Altersgruppen genauso eingesetzt werden wie für fortgeschrittene pädiatrische Lebensrettung, Überwachung und Wartung von Geräten zur Beurteilung und Diagnostik und als Manager_innen von Bereichspflegeteams. Schlussfolgerungen: Die Entwicklung von Tätigkeits- und Rollenprofilen für spezifische Versorgungssettings, die sich aus Kompetenzzuschreibungen ableiten, sind notwendig. Darauf basierende Traineeprogramme unterstützen die Einarbeitung und fördern die Sicherung einer qualitativen interprofessionellen Versorgung.

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