The comprehensive framework for integrated healthcare implementation: a realist evaluation of positive parenting in rural primary care in the US

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Deborah J. Moon ◽  
Adrian J. Ballard
Keyword(s):  
Primary Care ◽  
Service Delivery ◽  
Integrated Care ◽  
Realist Evaluation ◽  
Integrated Healthcare ◽  
Care Clinic ◽  
Content Type ◽  
Rural Primary Care ◽  
Routine Service ◽  
Comprehensive Framework

PurposeThis study aimed to develop a comprehensive framework that encompasses contextual determinants of integrated care implementation. The initial framework was developed based on literature and was refined based on contexts and mechanisms that facilitated or interfered with integrating a pilot parenting intervention, Behavior Checker (BC), into the routine service delivery in a rural primary care clinic in the USA.Design/methodology/approachThis study was a single organizational case study informed by the realist evaluation methodology. Data collection methods included key informant interviews, healthcare staff surveys, a focus group and direct observation of meetings. Data analysis focused on identifying the context-mechanism-outcome (CMO) frameworks, a heuristic used in a realist evaluation to map pathways of the interactions between program inputs and contextual conditions leading to intended and/or unintended outcomes.FindingsThe identified CMOs and antecedent contexts identified informed the process of revising the initial Comprehensive Framework for Integrated Healthcare Development and Implementation (CF-IHDI). The revised CF-IHDI contained six parent domains of outer setting, basic structures, people and value, intervention characteristics, organizational capabilities for change and key processes.Research limitations/implicationsThe CMOs and core characteristics of contextual conditions that activated facilitating mechanisms can inform future studies examining healthcare integration efforts.Practical implicationsThe CF-IHDI can guide primary care clinics in identifying factors and strategies to consider when integrating parenting or other psychosocial interventions into primary care routine service delivery.Originality/valueThe CF-IHDI developed in this study contributes to the knowledge of contexts and mechanisms that facilitate and interfere with integrated care implementation.

scholarly journals A GWEP COLLABORATION: IMPLEMENTING THE AWV IN A RURAL PRIMARY CARE CLINIC

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S393-S393
Author(s):  
Christine McKibbin
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Primary Care Clinic ◽  
Lessons Learned ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Rural Primary Care

Abstract This presentation will focus on the collaboration with the Dartmouth GWEP to implement the AWV in a rural primary care clinic. The challenges of practice transformation in busy primary care clinics will be discussed along with lessons learned on a successful GWEP partnership to achieve improved patient outcomes in primary care.

scholarly journals Realism and rhetoric in the evaluation of a new care model

2019 ◽  
Vol 27 (3) ◽  
pp. 204-214 ◽  
Author(s):  
Tom Grimwood
Keyword(s):  
Integrated Care ◽  
Large Scale ◽  
Realist Evaluation ◽  
Scale Transformation ◽  
Care Model ◽  
Content Type ◽  
Realist Approach ◽  
Dynamic Form ◽  
Multiple Audiences ◽  
Objective System

Purpose The purpose of this paper is to discuss the methodological challenges to evaluating one of the 50 vanguard sites of the new care model (NCM) programme for integrated care in England, and make the case for a modified realist approach to this kind of evaluation. Design/methodology/approach The paper considers three challenges to evaluating the NCM in this particular vanguard: complexity, strategy and rhetoric. It reflects on how the realist approach negotiates these philosophical challenges to delivering integrated care, in order to provide contextualised accounts of who a programme works for, in what context, and why. Findings The paper argues that, in the case of this particular vanguard site, the tangible benefit of the realist approach was not in providing a firm epistemological basis for evaluation, but rather in drawing out and articulating the ontological rhetoric of such large-scale transformation programmes. By understanding the work of the NCM less as an objective “system”, and more as a dynamic form of persuasion, aimed at securing the “adherence of minds” (Perelman and Olbrechts-Tyteca, 2008, p. 8) in multiple audiences, the paper suggests that realist evaluation can be used to address both the systematic issues and localised successes the NCMs encountered. Originality/value The paper identifies a number of aspects of new models of integrated care for evaluators to consider. It offers ways of negotiating the challenges to conventional outcome-focused evaluation, by drawing attention to the need for contextualised, time-situated and audience-sensitive value of NCMs.

Implementation of an integrated care model between general practitioner and cardiologist

2019 ◽  
Vol 27 (4) ◽  
pp. 305-315 ◽  
Author(s):  
Marijke Paula Margaretha Vester ◽  
Greetje Johanna de Grooth ◽  
Tobias Nicolaas Bonten ◽  
Bas Leendert van der Hoeven ◽  
Marieke Susanne de Doelder ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Integrated Care ◽  
Healthcare Delivery ◽  
Real Life ◽  
Cost Savings ◽  
Care Model ◽  
Potential Cost ◽  
Content Type ◽  
Program Costs

Purpose Integrated care models have shown to deliver efficient healthcare, but implementation has proven to be difficult. The Support Consultation is an integrated care model, which enables full integration by bundled payment, insurer involvement, predefined care pathways and strengthening of primary care. The purpose of this paper is to provide an indication of the improvements in healthcare delivery after implementation of this proposed model and to create a base for extension to similar interfaces between primary and secondary care. Design/methodology/approach A retrospective study was used to compare the effect on the number of referred patients with non-acute cardiac complaints and the cost effectiveness before and after implementation of the Support Consultation. Patients who previously would have been referred to the cardiologist were now discussed between general practitioner and cardiologist in a primary care setting. Findings The first consecutive 100 patients (age 55±16 years, male 48 percent), discussed in the Support Consultation, were analyzed. Implementation of the Support Consultation resulted in a net costs (program costs and referral costs) reduction of 61 percent compared with usual care. All involved parties were positive about the program. Research limitations/implications The Support Consultation has the ability to provide more effective healthcare delivery and to reduce net costs. The setting of the current study can be used as example for other specialties in countries with a similar healthcare system. Originality/value This study provides the potential cost savings after implementation of an integrated care model, based on real-life data.

An integrated care solution for the electrocardiogram monitoring

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Josephine S.F. Chow ◽  
Andrew Hopkins ◽  
Hany Dimitri ◽  
Hui Tie ◽  
Rachael Williams ◽  
...  
Keyword(s):  
Integrated Care ◽  
False Positive ◽  
New Technologies ◽  
False Positive Rate ◽  
Medical Officer ◽  
Wearable Technology ◽  
Time Saving ◽  
Integrated Healthcare ◽  
Content Type ◽  
Positive Rate

PurposeThis study has demonstrated how technology may contribute to integrated care solutions by comparing conventional ward telemetry (WT) to a wearable ECG monitor (S-Patch) to detect atrial fibrillation (AF) in patients with stroke.Design/methodology/approach51 patients admitted for stroke workup were recruited across two major tertiary centres to compare WT monitoring for two days versus S-Patch for four days in the detection of AF. The efficacy to detect AF using both technologies was assessed via data extractions and medical officer review. A matrix was used to measure nursing/patient satisfaction and setup/resource times were assessed.FindingsPatients (84–94%) and nursing staff (75–95%) preferred the S-Patch wearable technology. Non-parametric tests indicated significant time saving for removal of S-Patch versus WT [2.2 min vs 5.1 min (p = 0.00)]. Efficacy of S-Patch to detect AF following medical officer review was greater than WT, with seven patients identified with AF by S-Patch versus one using WT. The S-patch had a false positive rate of 78%.Research limitations/implicationsThe S-Patch is sensitive in the detection of AF; however, it showed a high false-positive rate with automated reporting. This study has provided insight into the details of delivery of integrated healthcare using wearable technology.Originality/valueThe technology and partnership were the first-in-kind in Australia. The S-Patch had a higher detection rate of AF compared to WT which allows patients to be anti-coagulated appropriately for the prevention of further stroke. The results of this study will be ideally placed to inform future policy in integrated healthcare using new technologies.

scholarly journals Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice

2016 ◽  
Vol 18 (02) ◽  
pp. 149-160 ◽  
Author(s):  
Feng Chang ◽  
Thivaher Paramsothy ◽  
Matthew Roche ◽  
Nishi S. Gupta
Keyword(s):  
Primary Care ◽  
Data Security ◽  
Family Health ◽  
Care Practice ◽  
Care Clinic ◽  
Clinic Staff ◽  
Environmental Scan ◽  
Rural Primary Care ◽  
Clinic Efficiency ◽  
Communications System

Aim To conduct an environmental scan of a rural primary care clinic to assess the feasibility of implementing an e-communications system between patients and clinic staff. Background Increasing demands on healthcare require greater efficiencies in communications and services, particularly in rural areas. E-communications may improve clinic efficiency and delivery of healthcare but raises concerns about patient privacy and data security. Methods We conducted an environmental scan at one family health team clinic, a high-volume interdisciplinary primary care practice in rural southwestern Ontario, Canada, to determine the feasibility of implementing an e-communications system between its patients and staff. A total of 28 qualitative interviews were conducted (with six physicians, four phone nurses, four physicians’ nurses, five receptionists, one business office attendant, five patients, and three pharmacists who provide care to the clinic’s patients) along with quantitative surveys of 131 clinic patients. Findings Patients reported using the internet regularly for multiple purposes. Patients indicated they would use email to communicate with their family doctor for prescription refills (65% of respondents), appointment booking (63%), obtaining lab results (60%), and education (50%). Clinic staff expressed concerns about patient confidentiality and data security, the timeliness, complexity and responsibility of responses, and increased workload. Conclusion Clinic staff members are willing to use an e-communications system but clear guidelines are needed for successful adoption and to maintain privacy of patient health data. E-communications might improve access to and quality of care in rural primary care practices.

Moving on: the BodyMind ApproachTM for medically unexplained symptoms

2017 ◽  
Vol 16 (2) ◽  
pp. 63-71 ◽  
Author(s):  
Helen Payne ◽  
Susan D.M. Brooks
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Medically Unexplained Symptoms ◽  
Symptom Distress ◽  
Depression Symptom ◽  
Care Clinic ◽  
Content Type ◽  
Cognitive Behaviour ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Purpose The purpose of this paper is to summarise practice-based evidence from an analysis of outcomes from a county-wide pilot study of a specialised primary care clinic employing an original approach for patients with medically unexplained symptoms (MUS). Conditions with persistent bodily symptoms for which tests and scans come back negative are termed MUS. Patients are generic, high health-utilising and for most there is no effective current treatment pathway. The solution is a proven service based on proof of concept, cost-effectiveness and market research studies together with practice-based evidence from early adopters. The research was transferred from a university into a real-world primary care clinical service which has been delivering in two clinical commissioning groups in a large county in England. Design/methodology/approach Clinical data calculated as reliable change from the various clinics were aggregated as practice-based evidence pre- and post-intervention via standardised measurements on anxiety, depression, symptom distress, functioning/activity, and wellbeing. It is not a research paper. Findings At post-course the following percentages of people report reliable improvement when compared to pre-course: reductions in symptom distress 63 per cent (39/62), anxiety 42 per cent (13/31) and depression 35 per cent (11/31); increases in activity levels 58 per cent (18/31) and wellbeing 55 per cent (17/31) and 70 per cent felt that they had enough help to go forward resulting in the self-management of their symptoms which decreases the need to visit the GP or hospital. Research limitations/implications Without a full clinical trial the outcomes must be interpreted with caution. There may be a possible Hawthorne or observer effect. Practical implications Despite the small numbers who received this intervention, preliminary observations suggest it might offer a feasible alternative for many patients with MUS who reject, or try and find unsatisfying, cognitive behaviour therapy. Social implications Many patients suffering MUS feel isolated and that they are the only one for whom their doctor cannot find an organic cause for their condition. The facilitated group has a beneficial effect on this problem, for example they feel a sense of belonging and sharing of their story. Originality/value The BodyMind Approach is an original intervention mirroring the new wave of research in neuroscience and philosophy which prides embodiment perspectives over solely cognitive ones preferred in the “talking” therapies. There is a sea change in thinking about processes and models for supporting people with mental ill-health where the need to include the lived body experience is paramount to transformation.

Vital Signs Screening for Alcohol Misuse in a Rural Primary Care Clinic: A Feasibility Study

2008 ◽  
Vol 24 (2) ◽  
pp. 133-135 ◽  
Author(s):  
J. Paul Seale ◽  
Monique R. Guyinn ◽  
Michael Matthews ◽  
Ike Okosun ◽  
M. Marie Dent
Keyword(s):  
Primary Care ◽  
Feasibility Study ◽  
Alcohol Misuse ◽  
Primary Care Clinic ◽  
Vital Signs ◽  
Care Clinic ◽  
Rural Primary Care

scholarly journals A scaling-up strategy supporting the expansion of integrated care: a study protocol

2019 ◽  
Vol 27 (3) ◽  
pp. 215-231 ◽  
Author(s):  
Liset Grooten ◽  
Cristina-Adriana Alexandru ◽  
Tamara Alhambra-Borrás ◽  
Stuart Anderson ◽  
Francesca Avolio ◽  
...  
Keyword(s):  
Integrated Care ◽  
Large Scale ◽  
Scale Up ◽  
Implementation Fidelity ◽  
Scaling Up ◽  
Realist Evaluation ◽  
Content Type ◽  
Project Outcomes ◽  
Care Systems ◽  
Funded Project

Purpose To ensure that more people will benefit from integrated care initiatives, scaling-up of successful initiatives is the way forward. However, new challenges present themselves as knowledge on how to achieve successful large-scale implementation is scarce. The EU-funded project SCIROCCO uses a step-based scaling-up strategy to explore what to scale-up, and how to scale-up integrated care initiatives by matching the complementary strengths and weaknesses of five European regions involved in integrated care. The purpose of this paper is to describe a multi-method evaluation protocol designed to understand what factors influence the implementation of the SCIROCCO strategy to support the scaling-up of integrated care. Design/methodology/approach The first part of the protocol focuses on the assessment of the implementation fidelity of the SCIROCCO step-based strategy. The objective is to gain insight in whether the step-based strategy is implemented as it was designed to explore what works and does not work when implementing the scaling-up strategy. The second part concerns a realist evaluation to examine what it is about the SCIROCCO’s strategy that works for whom, why, how and in which circumstances when scaling-up integrated care. Findings The intended study will provide valuable information on the implementation of the scaling-up strategy which will help to explain for what specific reasons the implementation succeeds and will facilitate further improvement of project outcomes. Originality/value The expected insights could be useful to guide the development, implementation and evaluation of future scaling-up strategies to advance the change towards more sustainable health and care systems.

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