scholarly journals Hospital-based chronic disease care model: protocol for an effectiveness and implementation evaluation

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037843
Author(s):  
Jennifer Sumner ◽  
Jason Phua ◽  
Yee Wei Lim
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Emergency Room ◽  
Clinical Outcomes ◽  
Qualitative Data ◽  
Emergency Room Visit ◽  
Type I ◽  
Care Model ◽  
Implementation Evaluation ◽  
Chronic Disease Patients

IntroductionNovel and efficient healthcare approaches are needed to better serve increasingly older chronic disease patients. Many effective integrated chronic disease management strategies have emerged from the primary care sector. However, in many Asian and developing countries, primary care is underdeveloped, and patients prefer secondary-based services. The Integrated Generalist-led Hospital (IGH) care model is a new approach, which may be better suited for chronic disease patients in the local context.Methods and analysisA hybrid type I study on the effectiveness and implementation of the IGH care model will be conducted. Implementation evaluation will be informed by the Consolidated Framework of Implementation Research (CFIR). Quantitative and qualitative data will be collected through in-depth interviews and focus group discussions with staff, a staff survey, patient interviews, clinical outcomes and cost data. Clinical outcomes include the length of stay, readmission, emergency room visit rate and mortality. Clinical outcomes will be summarised and compared with a propensity-matched ‘usual care’ group (derived from the general medicine ward(s) at a separate hospital). The Kaplan-Meier approach will be used to estimate time until death and time until first readmission (both within 30 days of discharge) and time until discharge. Multivariate regression models will be used to investigate the association between the care model and occurrence of readmission, emergency room visit and death, all within 30 days of discharge. Qualitative data will be analysed using a thematic analysis method. Qualitative and quantitative data will also be coded according to the five domains of the CFIR.Ethics and disseminationThis protocol was reviewed and approved by the National Healthcare Group Domain Specific Review Board (NHG DSRB 2019/00308). Results will be published in peer-reviewed scientific journals and conference presentations. Findings will also be discussed with key stakeholders through local dissemination events.

scholarly journals Effect of computerised, knowledge-based, clinical decision support systems on patient-reported and clinical outcomes of patients with chronic disease managed in primary care settings: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054659
Author(s):  
Marie line El Asmar ◽  
Kanika I Dharmayat ◽  
Antonio J Vallejo-Vaz ◽  
Ryan Irwin ◽  
Nikolaos Mastellos
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Support ◽  
Chronic Disease ◽  
Clinical Outcomes ◽  
Data Extraction ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Intervention Effect ◽  
Patient Reported

ObjectivesChronic diseases are the leading cause of disability globally. Most chronic disease management occurs in primary care with outcomes varying across primary care providers. Computerised clinical decision support systems (CDSS) have been shown to positively affect clinician behaviour by improving adherence to clinical guidelines. This study provides a summary of the available evidence on the effect of CDSS embedded in electronic health records on patient-reported and clinical outcomes of adult patients with chronic disease managed in primary care.Design and eligibility criteriaSystematic review, including randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, interrupted time series and controlled before-and-after studies, assessing the effect of CDSS (vs usual care) on patient-reported or clinical outcomes of adult patients with selected common chronic diseases (asthma, chronic obstructive pulmonary disease, heart failure, myocardial ischaemia, hypertension, diabetes mellitus, hyperlipidaemia, arthritis and osteoporosis) managed in primary care.Data sourcesMedline, Embase, CENTRAL, Scopus, Health Management Information Consortium and trial register clinicaltrials.gov were searched from inception to 24 June 2020.Data extraction and synthesisScreening, data extraction and quality assessment were performed by two reviewers independently. The Cochrane risk of bias tool was used for quality appraisal.ResultsFrom 5430 articles, 8 studies met the inclusion criteria. Studies were heterogeneous in population characteristics, intervention components and outcome measurements and focused on diabetes, asthma, hyperlipidaemia and hypertension. Most outcomes were clinical with one study reporting on patient-reported outcomes. Quality of the evidence was impacted by methodological biases of studies.ConclusionsThere is inconclusive evidence in support of CDSS. A firm inference on the intervention effect was not possible due to methodological biases and study heterogeneity. Further research is needed to provide evidence on the intervention effect and the interplay between healthcare setting features, CDSS characteristics and implementation processes.PROSPERO registration numberCRD42020218184.

scholarly journals Integrated Smoking Cessation for Smokers With Serious Mental Illness: Protocol for a Convergent Mixed Methods Implementation Evaluation Study

10.2196/25390 ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. e25390
Author(s):  
Kristina Schnitzer ◽  
Melissa Culhane Maravić ◽  
Diana Arntz ◽  
Nathaniel L Phillips ◽  
Gladys Pachas ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Smoking Cessation ◽  
Mixed Methods ◽  
Serious Mental Illness ◽  
Qualitative Data ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pragmatic Clinical Trial ◽  
Implementation Evaluation

Background Tobacco smoking is associated with significant morbidity and premature mortality in individuals with serious mental illness. A 2-year pragmatic clinical trial (PCORI PCS-1504-30472) that enrolled 1100 individuals with serious mental illness in the greater Boston area was conducted to test 2 interventions for tobacco cessation for individuals with serious mental illness: (1) academic detailing, which delivers education to primary care providers and highlights first-line pharmacotherapy for smoking cessation, and (2) provision of community health worker support to smoker participants. Implementing and scaling this intervention in other settings will require the systematic identification of barriers and facilitators, as well as the identification of relevant subgroups, effective and unique components, and setting-specific factors. Objective This protocol outlines the proposed mixed methods evaluation of the pragmatic clinical trial to (1) identify barriers and facilitators to effective implementation of the interventions, (2) examine group differences among primary care physicians, and (3) identify barriers that stakeholders such as clinical, payor, and policy leaders would anticipate to impact the implementation of effective components of the intervention. Methods Qualitative interviews will be conducted with all study community health workers and selected smoker participants, primary care providers, and other stakeholders. Measures of performance and engagement will guide purposive sampling. The Consolidated Framework for Implementation Research will guide qualitative data collection and analysis in accordance with the following framework approach: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation. Joint display analyses will be constructed to analyze and draw conclusions across the quantitative and qualitative data. Results The 3-year cluster-randomized trial has concluded, and the analysis of primary outcomes is underway. Results from the pragmatic trial and this mixed methods implementation evaluation will be used to help disseminate, scale, and expand a systems intervention. Conclusions The results of this mixed methods implementation evaluation will inform strategies for dissemination and solutions to potential barriers to the implementation of interventions from a smoking cessation trial for individuals with serious mental illness. International Registered Report Identifier (IRRID) DERR1-10.2196/25390

scholarly journals Do primary care physicians coordinate ambulatory care for chronic disease patients in Canada?

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Alan Katz ◽  
Patricia Martens ◽  
Dan Chateau ◽  
Bodgan Bogdanovic ◽  
Ina Koseva
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Ambulatory Care ◽  
Primary Care Physicians ◽  
Chronic Disease Patients

Practice strategies to improve primary care for chronic disease patients under a pay-for-value program

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Dori A. Cross ◽  
Paige Nong ◽  
Christy Harris-Lemak ◽  
Genna R. Cohen ◽  
Ariel Linden ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Chronic Disease Patients

scholarly journals Integrated Smoking Cessation for Smokers With Serious Mental Illness: Protocol for a Convergent Mixed Methods Implementation Evaluation Study (Preprint)

2020 ◽  
Author(s):  
Kristina Schnitzer ◽  
Melissa Culhane Maravić ◽  
Diana Arntz ◽  
Nathaniel L Phillips ◽  
Gladys Pachas ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Smoking Cessation ◽  
Mixed Methods ◽  
Serious Mental Illness ◽  
Qualitative Data ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pragmatic Clinical Trial ◽  
Implementation Evaluation

BACKGROUND Tobacco smoking is associated with significant morbidity and premature mortality in individuals with serious mental illness. A 2-year pragmatic clinical trial (PCORI PCS-1504-30472) that enrolled 1100 individuals with serious mental illness in the greater Boston area was conducted to test 2 interventions for tobacco cessation for individuals with serious mental illness: (1) academic detailing, which delivers education to primary care providers and highlights first-line pharmacotherapy for smoking cessation, and (2) provision of community health worker support to smoker participants. Implementing and scaling this intervention in other settings will require the systematic identification of barriers and facilitators, as well as the identification of relevant subgroups, effective and unique components, and setting-specific factors. OBJECTIVE This protocol outlines the proposed mixed methods evaluation of the pragmatic clinical trial to (1) identify barriers and facilitators to effective implementation of the interventions, (2) examine group differences among primary care physicians, and (3) identify barriers that stakeholders such as clinical, payor, and policy leaders would anticipate to impact the implementation of effective components of the intervention. METHODS Qualitative interviews will be conducted with all study community health workers and selected smoker participants, primary care providers, and other stakeholders. Measures of performance and engagement will guide purposive sampling. The Consolidated Framework for Implementation Research will guide qualitative data collection and analysis in accordance with the following framework approach: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation. Joint display analyses will be constructed to analyze and draw conclusions across the quantitative and qualitative data. RESULTS The 3-year cluster-randomized trial has concluded, and the analysis of primary outcomes is underway. Results from the pragmatic trial and this mixed methods implementation evaluation will be used to help disseminate, scale, and expand a systems intervention. CONCLUSIONS The results of this mixed methods implementation evaluation will inform strategies for dissemination and solutions to potential barriers to the implementation of interventions from a smoking cessation trial for individuals with serious mental illness. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/25390

scholarly journals GWEPS WORKING TO SUPPORT THE AGE-FRIENDLY HEALTHCARE SYSTEM MOVEMENT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S372-S372
Author(s):  
Tara A Cortes ◽  
Cinnamon St.John ◽  
Jeff Lucas
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Mental State ◽  
Qualitative Data ◽  
Chronic Disease Management ◽  
Healthy Behaviors ◽  
Community Volunteers ◽  
System Movement

Abstract Age friendly health systems aim to help people age and die with dignity. As this social movement progresses it is important to remember the community as a critical stakeholder. To ensure their engagement requires input from the community to understand their needs and education of the community to empower people to know what standard should be expected from an age friendly health system. The NYU GWEP has trained 140 community volunteers who have educated >4,500 older adults in the Bronx on healthy behaviors and chronic disease management. 85% responded that they have changed their behaviors as a result of the teaching. Qualitative data reveals that people feel they can now talk to their primary care provider in a meaningful way about what matters to them, the medications they take, their mental state, and mobility.

Enhancing the scalability of the collaborative care model for depression using mobile technology

2020 ◽  
Vol 10 (3) ◽  
pp. 573-579
Author(s):  
Kelly E Carleton ◽  
Urvashi B Patel ◽  
Dana Stein ◽  
David Mou ◽  
Alissa Mallow ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Clinical Outcomes ◽  
Collaborative Care ◽  
Depression Treatment ◽  
Care Model ◽  
Sample Mean ◽  
Collaborative Care Model ◽  
Contact Frequency

Abstract The collaborative care model (CoCM) has substantial support for improving behavioral health care in primary care. However, large-scale CoCM adoption relies on addressing operational and financial implementation challenges across health care settings with varying resources. An academic medical center serving socioeconomically and racially diverse patients implemented the CoCM in seven practices. A smartphone application was introduced to facilitate CoCM care management during depression treatment (app-augmented CoCM). App features included secure texting, goal/appointment reminders, symptom monitoring, and health education material. A nonrandomized convenience patient sample (N = 807) was enrolled in app-augmented CoCM and compared with patients in standard CoCM (N = 3,975). Data were collected on clinical contact frequency, engagement, and clinical outcomes. App-augmented CoCM patients received more health care team contacts (7.9 vs. 4.9, p < .001) and shorter time to follow up compared with the standard CoCM sample (mean = 11 vs. 19 days, p < .001). App-augmented CoCM patients had clinical outcomes similar to the standard CoCM group (47% vs. 46% with ≥50% depression improvement or score <10), despite app-augmented patients having more prior depression treatment episodes. Further, the app-augmented group with greater app engagement demonstrated increased behavioral health appointment compliance, including more completed appointments and fewer no shows, and greater depression symptom improvement than those with less app engagement. App-augmented CoCM may improve patient engagement in treatment and provide opportunities to implement key CoCM elements without overburdening practice resources. CoCM sustainability and scalability in primary care may be enhanced by using this technology.

Sign in / Sign up

Export Citation Format

Share Document