Health System Operations and Point-of-Care Coordination

Abstract Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings.

Download Full-text

Evaluating Shared Governance: Measuring Functionality of Unit Practice Councils at the Point of Care

Creative Nursing ◽

10.1891/1078-4535.17.2.87 ◽

2011 ◽

Vol 17 (2) ◽

pp. 87-95 ◽

Cited By ~ 5

Author(s):

Beverly Fray

Keyword(s):

Health System ◽

Shared Governance ◽

Point Of Care ◽

Measurement Tool ◽

Rare Occurrence ◽

The Way

Measuring the functionality of Unit Practice Councils (UPCs) in institutions on the Magnet journey is a rare occurrence. The Jackson Health System Unit Practice Council Functionality Measurement Tool is one of the first such attempts to provide an objective way to assess whether UPCs function in the way they were envisioned to perform.

Download Full-text

Fragmentation of Care Among Black Women With Breast Cancer and Comorbidities: The Role of Health Systems

JCO Oncology Practice ◽

10.1200/op.20.01089 ◽

2021 ◽

Vol 17 (5) ◽

pp. e637-e644 ◽

Cited By ~ 1

Author(s):

Michelle Doose ◽

Janeth I. Sanchez ◽

Joel C. Cantor ◽

Jesse J. Plascak ◽

Michael B. Steinberg ◽

...

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Black Women ◽

Health System ◽

Health Systems ◽

Care Coordination ◽

Surgical Care ◽

Primary Care Visit ◽

Practice Setting ◽

Care Fragmentation

PURPOSE: Black women are disproportionately burdened by comorbidities and breast cancer. The complexities of coordinating care for multiple health conditions can lead to adverse consequences. Care coordination may be exacerbated when care is received outside the same health system, defined as care fragmentation. We examine types of practice setting for primary and breast cancer care to assess care fragmentation. MATERIALS AND METHODS: We analyzed data from a prospective cohort of Black women diagnosed with breast cancer in New Jersey who also had a prior diagnosis of diabetes and/or hypertension (N = 228). Following breast cancer diagnosis, we examined types of practice setting for first primary care visit and primary breast surgery, through medical chart abstraction, and identified whether care was used within or outside the same health system. We used multivariable logistic regression to explore sociodemographic and clinical factors associated with care fragmentation. RESULTS: Diverse primary care settings were used: medical groups (32.0%), health systems (29.4%), solo practices (23.7%), Federally Qualified Health Centers (8.3%), and independent hospitals (6.1%). Surgical care predominately occurred in health systems (79.8%), with most hospitals being Commission on Cancer–accredited. Care fragmentation was experienced by 78.5% of Black women, and individual-level factors (age, health insurance, cancer stage, and comorbidity count) were not associated with care fragmentation ( P > .05). CONCLUSION: The majority of Black breast cancer survivors with comorbidities received primary care and surgical care in different health systems, illustrating care fragmentation. Strategies for care coordination and health care delivery across health systems and practice settings are needed for health equity.

Download Full-text

P041 How is the value of point-of-care tests for STIs negotiated in the context of a nationalised health system?

10.1136/sextrans-2019-sti.247 ◽

2019 ◽

Author(s):

Agata Pacho ◽

Emma Heming De-Allie ◽

Martina Furegato ◽

Emma Harding-Esch ◽

S Tariq Sadiq ◽

...

Keyword(s):

Health System ◽

Point Of Care ◽

Point Of Care Tests

Download Full-text

Training a system-literate care coordination workforce

Australian Health Review ◽

10.1071/ah15014 ◽

2016 ◽

Vol 40 (2) ◽

pp. 210 ◽

Cited By ~ 6

Author(s):

Lucio Naccarella ◽

Richard H. Osborne ◽

Peter M. Brooks

Keyword(s):

Health Literacy ◽

Health System ◽

Care Coordination ◽

Health Workforce ◽

Quality Standards ◽

Models Of Care ◽

Care Coordinator ◽

Allied Health Professionals ◽

Professional Quality ◽

Care Coordinators

People with chronic complex conditions continue to experience increasing health system fragmentation and poor coordination. To reverse these trends, one solution has been an investment in effective models of care coordination that use a care coordinator workforce. Care coordinators are not a homogenous workforce – but an applied professional role, providing direct and indirect care, and is often undertaken by nurses, allied health professionals, social workers or general practitioners. In Australia, there is no training curriculum nor courses, nor nationally recognised professional quality standards for the care coordinator workforce. With the growing complexity and fragmentation of the health care system, health system literacy – shared understanding of the roles and contributions of the different workforce professions, organisations and systems, among patients and indeed the health workforce is required. Efforts to improve health system literacy among the health workforce are increasing at a policy, practice and research level. However, insufficient evidence exists about what are the health system literacy needs of care coordinators, and what is required for them to be most effective. Key areas to build a health system literate care coordination workforce are presented. Care coordination is more than an optional extra, but one of the only ways we are going to be able to provide equitable health services for people with chronic complex conditions. People with low health literacy require more support with the coordination of their care, therefore we need to build a high performing care coordinator workforce that upholds professional quality standards, and is health literacy responsive.

Download Full-text

The Impact of Technology-Enabled Care Coordination in a Complex Mental Health System: A Local System Dynamics Model (Preprint)

10.2196/preprints.25331 ◽

2020 ◽

Author(s):

Frank Iorfino ◽

Jo-An Occhipinti ◽

Adam Skinner ◽

Tracey Davenport ◽

Shelley Rowe ◽

...

Keyword(s):

Mental Health ◽

Growth Rate ◽

Psychological Distress ◽

Health System ◽

Care Coordination ◽

Mental Health System ◽

Service Capacity ◽

Health Related ◽

Care Systems ◽

The Impact

BACKGROUND Prior to the COVID-19 pandemic, major shortcomings in the way mental health care systems were organized were impairing the delivery of effective care. The mental health impacts of the pandemic, the recession, and the resulting social dislocation will depend on the extent to which care systems will become overwhelmed and on the strategic investments made across the system to effectively respond. OBJECTIVE This study aimed to explore the impact of strengthening the mental health system through technology-enabled care coordination on mental health and suicide outcomes. METHODS A system dynamics model for the regional population catchment of North Coast New South Wales, Australia, was developed that incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and suicidal behavior. The model reproduced historic time series data across a range of outcomes and was used to evaluate the relative impact of a set of scenarios on attempted suicide (ie, self-harm hospitalizations), suicide deaths, mental health–related emergency department (ED) presentations, and psychological distress over the period from 2021 to 2030. These scenarios include (1) business as usual, (2) increase in service capacity growth rate by 20%, (3) standard telehealth, and (4) technology-enabled care coordination. Each scenario was tested using both pre– and post–COVID-19 social and economic conditions. RESULTS Technology-enabled care coordination was forecast to deliver a reduction in self-harm hospitalizations and suicide deaths by 6.71% (95% interval 5.63%-7.87%), mental health–related ED presentations by 10.33% (95% interval 8.58%-12.19%), and the prevalence of high psychological distress by 1.76 percentage points (95% interval 1.35-2.32 percentage points). Scenario testing demonstrated that increasing service capacity growth rate by 20% or standard telehealth had substantially lower impacts. This pattern of results was replicated under post–COVID-19 conditions with technology-enabled care coordination being the only tested scenario, which was forecast to reduce the negative impact of the pandemic on mental health and suicide. CONCLUSIONS The use of technology-enabled care coordination is likely to improve mental health and suicide outcomes. The substantially lower effectiveness of targeting individual components of the mental health system (ie, increasing service capacity growth rate by 20% or standard telehealth) reiterates that strengthening the whole system has the greatest impact on patient outcomes. Investments into more of the same types of programs and services alone will not be enough to improve outcomes; instead, new models of care and the digital infrastructure to support them and their integration are needed.

Download Full-text

Development of a hub and spoke model for quality improvement in rural and urban healthcare settings in India: a pilot study

BMJ Open Quality ◽

10.1136/bmjoq-2019-000908 ◽

2020 ◽

Vol 9 (3) ◽

pp. e000908

Author(s):

Sushil Srivastava ◽

Vikram Datta ◽

Rahul Garde ◽

Mahtab Singh ◽

Ankur Sooden ◽

...

Keyword(s):

Quality Improvement ◽

Health System ◽

Point Of Care ◽

Critical Factor ◽

Care Quality ◽

Hub And Spoke ◽

Healthcare Settings ◽

Rural And Urban ◽

Key Resources ◽

Medical Colleges

ObjectiveHub and spoke model has been used across industries to augment peripheral services by centralising key resources. This exercise evaluated the feasibility of whether such a model can be developed and implemented for quality improvement across rural and urban settings in India with support from a network for quality improvement.MethodsThis model was implemented using support from the state and district administration. Medical colleges were designated as hubs and the secondary and primary care facilities as spokes. Training in quality improvement (QI) was done using WHO’s point of care quality improvement methodology. Identified personnel from hubs were also trained as mentors. Both network mentors (from QI network) and hub-mentors (from medical colleges) undertook mentoring visits to their allotted facilities. Each of the participating facility completed their QI projects with support from mentors.ResultsTwo QI training workshops and two experience sharing sessions were conducted for implementing the model. A total of 34 mentoring visits were undertaken by network mentors instead of planned 14 visits and rural hub-mentors could undertake only four visits against planned 18 visits. Ten QI projects were successfully completed by teams, 80% of these projects started during the initial intensive phase of mentoring. The projects ranged from 3 to 10 months with median duration being 5 months.DiscussionVarious components of a health system must work in synergy to sustain improvements in quality of care. Quality networks and collaboratives can play a significant role in creating this synergy. Active participation of district and state administration is a critical factor to produce a culture of quality in the health system.

Download Full-text

Status Update on Data Required to Build a Learning Health System

Journal of Clinical Oncology ◽

10.1200/jco.19.03094 ◽

2020 ◽

Vol 38 (14) ◽

pp. 1602-1607 ◽

Cited By ~ 2

Author(s):

Monica M. Bertagnolli ◽

Brian Anderson ◽

Kelly Norsworthy ◽

Steven Piantadosi ◽

Andre Quina ◽

...

Keyword(s):

Health Care ◽

Health System ◽

Large Scale ◽

Point Of Care ◽

Health Care Systems ◽

Clinical Care ◽

Real World Data ◽

Learning Health System ◽

Care Systems ◽

Data Elements

Wide adoption of electronic health records (EHRs) has raised the expectation that data obtained during routine clinical care, termed “real-world” data, will be accumulated across health care systems and analyzed on a large scale to produce improvements in patient outcomes and the use of health care resources. To facilitate a learning health system, EHRs must contain clinically meaningful structured data elements that can be readily exchanged, and the data must be of adequate quality to draw valid inferences. At the present time, the majority of EHR content is unstructured and locked into proprietary systems that pose significant challenges to conducting accurate analyses of many clinical outcomes. This article details the current state of data obtained at the point of care and describes the changes necessary to use the EHR to build a learning health system.

Download Full-text