Mixed-method evaluation of CARITAS: a hospital-to-community model of integrated care for dementia

ObjectivesThe capability and capacity of the primary and community care (PCC) sector for dementia in Singapore may be enhanced through better integration. Through a partnership involving a tertiary hospital and PCC providers, an integrated dementia care network (CARITAS: comprehensive, accessible, responsive, individualised, transdisciplinary, accountable and seamless) was implemented. The study evaluated the process and extent of integration within CARITAS.DesignTriangulation mixed-methods design and analyses were employed to understand factors underpinning network mechanisms.SettingThe study was conducted at a tertiary hospital in the northern region of Singapore.ParticipantsWe recruited participants who were involved in the conceptualisation, design, development and implementation of the CARITAS Programme from a tertiary hospital and PCC providers.InterventionWe used the Rainbow Model of Integrated Care-Measurement Tool (RMIC-MT) to assess integration from managerial perspectives. RMIC-MT comprises eight dimensions that play interconnected roles on a macro-level, meso-level and micro-level. We administered RMIC-MT to healthcare providers and conducted in-depth interviews with key CARITAS stakeholders.Primary and secondary outcome measuresWe assessed integration scores across eight dimensions of the RMIC-MT and factors underpinning network mechanisms.ResultsCompared with other dimensions, functional integration (mechanisms by which information and management modalities are linked) achieved the lowest mean score of 55. Other dimensions (eg, clinical, professional and organisational integration) scored about 70. Presence of inspiring clinical leaders and tacit interdependencies among partners strengthened the network. However, the lack of structured documentation and a shared information-technology platform hindered functional integration.ConclusionCARITAS has reached maturity in micro-levels and meso-levels of integration, while macro-integration needs further development. Integration can be enhanced by assessing service gaps, increasing engagement with stakeholders and providing a shared communication system.

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Exploring the psychometric properties of the Rainbow Model of Integrated Care measurement tool for care providers in Australia

BMJ Open ◽

10.1136/bmjopen-2018-027920 ◽

2019 ◽

Vol 9 (12) ◽

pp. e027920 ◽

Cited By ~ 2

Author(s):

Julian Fares ◽

Kon Shing Kenneth Chung ◽

Megan Passey ◽

Jo Longman ◽

Pim P Valentijn

Keyword(s):

Psychometric Properties ◽

Integrated Care ◽

Functional Integration ◽

Healthcare Providers ◽

Reliability And Validity ◽

Principal Component ◽

Measurement Tool ◽

Care Providers ◽

Validity And Reliability ◽

Four Dimensions

ObjectiveTo assess the reliability and validity of a shortened version of the Rainbow Model of Integrated Care (RMIC) measurement tool (MT). The original version of the measurement tool has been modified (shortened) for the Australian context.DesignValidation of the psychometric properties of the RMIC-MT.SettingHealthcare providers providing services to a geographically defined rural area in New South Wales (NSW), Australia.ParticipantsA sample of 56 healthcare providers providing mental and physical healthcare.Main outcome measuresThe psychometric properties of the tool were tested using principal component analysis for validity and Cronbach’s alpha for reliability.ResultsThe tool was shown to have good validity and reliability. The 35 items used in the shortened version of the tool were reduced to 29 items grouped into four dimensions: community-governance orientation, normative integration, functional integration and clinical-professional coordination.ConclusionsThe shortened version of the RMIC-MT is a valid and reliable tool that evaluates integrated care from a healthcare provider’s perspective in NSW, Australia. In order to assess the tool’s appropriateness in an international context, future studies should focus on validating the tool in other healthcare settings.

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Healthcare providers’ perception of the referral system in maternal care facilities in Aceh, Indonesia: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-031484 ◽

2019 ◽

Vol 9 (12) ◽

pp. e031484 ◽

Cited By ~ 4

Author(s):

Farah Diba ◽

Ichsan Ichsan ◽

Muhsin Muhsin ◽

Marthoenis Marthoenis ◽

Hizir Sofyan ◽

...

Keyword(s):

Healthcare Providers ◽

Cross Sectional Study ◽

Referral System ◽

Secondary Outcome ◽

Cross Sectional ◽

Healthcare Facilities ◽

Potential Barriers ◽

Lack Of Information ◽

Aceh Province ◽

Shared Information

ObjectivesOur study investigates the barriers perceived by staff in the referral systems in maternal healthcare facilities across Aceh province in Indonesia.DesignWith a cross-sectional approach, two sets of surveys were administered during September to October 2016 in 32 sampling units of our study. We also collected referral data in the form of the frequency of ingoing and outgoing referral cases per facility.SettingIn three districts, Aceh Besar, Banda Aceh and Bireuen, a total of 32 facilities including hospitals, community health centres, and private midwife clinics that met the criteria of providing at least basic emergency obstetric and neonatal care (BEonC) were covered.ParticipantsAcross the 32 healthcare centres, 149 members of staff (mainly midwives) agreed to participate in our surveys.Primary and secondary outcome measuresThe first survey consisted of 65 items focusing on organisational measures as well as case numbers for example, patient counts, mortality rate and complications. The second survey with 68 items asked healthcare providers about a range of factors including attitudes towards the referral process in their facility and potential barriers to a well-functioning system in their district.ResultsOverall, mothers’/families’ consent as well as the complex administration process were found to be the main barriers (36% and 12%, respectively). Healthcare providers noted that information about other facilities has the biggest room for improvement (37%) rather than transport, timely referral of mothers and babies, or the availability of referral facilities.ConclusionsThe largest barrier perceived by healthcare providers in our study was noted to be family consent and administrative burden. Moreover, lack of information about the referral system itself and other facilities seemed to be affecting healthcare providers and mothers/families alike and improvements perhaps through a shared information system is needed.

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Integrated care among healthcare providers in shared maternity care: what is the role of paper and electronic health records?

Australian Journal of Primary Health ◽

10.1071/py16081 ◽

2017 ◽

Vol 23 (4) ◽

pp. 397 ◽

Cited By ~ 1

Author(s):

Glenda Hawley ◽

Julie Hepworth ◽

Claire Jackson ◽

Shelley A. Wilkinson

Keyword(s):

Electronic Health Record ◽

Integrated Care ◽

Qualitative Content Analysis ◽

Healthcare Providers ◽

Tertiary Hospital ◽

Health Record ◽

Qualitative Research Design ◽

Electronic Health ◽

Two Phases

This study examines a paper hand-held record and a shared electronic health record in an Australian tertiary hospital healthcare maternity setting and the role that both types of records play in facilitating integrated care among healthcare providers. A qualitative research design was used where five focus groups were conducted in two phases with 69 hospital healthcare providers. In total, 32 interviews were also carried out with general practitioners. Transcripts were analysed using qualitative content analysis. Three key themes were identified: (1) selective use of records; (2) records as communication of care; and (3) negativity about the use of records. This study demonstrates that healthcare providers do not effectively share information using either a paper hand-held record or a shared electronic health record. Considering a national commitment to e-health innovation, a multi-professional input, organisational support and continuing education are identified as crucial to realising the potential of a maternity shared electronic health record to facilitate integrated care.

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Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?

BMJ Open ◽

10.1136/bmjopen-2020-038406 ◽

2020 ◽

Vol 10 (11) ◽

pp. e038406

Author(s):

Sayra Cristancho ◽

Emily Field

Keyword(s):

Internal Medicine ◽

Healthcare Providers ◽

Constructivist Grounded Theory ◽

Teaching Hospitals ◽

Secondary Outcome ◽

Qualitative Investigation ◽

Qualitative Nature ◽

Saving Face ◽

Critical Process ◽

Biological Literature

ObjectivesThis interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving ‘traces’ in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt. This paper brings awareness to its existence in the context of healthcare teamwork.DesignInterview-based study using Constructivist Grounded Theory methodology.SettingThis study was conducted in multiple team contexts at one of Canada’s largest acute-care teaching hospitals.Participants25 clinicians from across professions and disciplines. Specialties included surgery, anesthesiology, psychiatry, internal medicine, geriatrics, neonatology, paramedics, nursing, intensive care, neurology and emergency medicine.InterventionNot relevant due to the qualitative nature of the study.Primary and secondary outcomeNot relevant due to the qualitative nature of the study.ResultsThe dataset was analysed using the sensitising concept of ‘traces’ from Swarm Intelligence. This study brought to light novel and unique elements of trace-based communication in the context of healthcare teamwork including focused intentionality, successful versus failed traces and the contextually bounded nature of the responses to traces. While participants initially felt ambivalent about the idea of using traces in their daily teamwork, they provided a variety of examples. Through these examples, participants revealed the multifaceted nature of the purposes of trace-based communication, including promoting efficiency, preventing mistakes and saving face.ConclusionsThis study demonstrated that clinicians pervasively use trace-based communication despite differences in opinion as to its implications for teamwork and safety. Other disciplines have taken up traces to promote collective adaptation. This should serve as inspiration to at least start exploring this phenomenon in healthcare.

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139. Impact of Pharmacist Driven Outpatient Fluoroquinolone Stewardship Initiative in Community Based Setting

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.184 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S81-S81

Author(s):

Sarah Norman ◽

Sara Jones ◽

Cara Acklin ◽

Christian Cheatham

Keyword(s):

Antimicrobial Stewardship ◽

Healthcare Providers ◽

Hospital Setting ◽

Secondary Outcome ◽

Quality Improvement Initiative ◽

Oral Antibiotic ◽

Ambulatory Care Setting ◽

Community Based ◽

Before And After ◽

Physician Network

Abstract Background Antimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative. Methods This was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions. Results There was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year. Conclusion These findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

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Impact of blood group on survival following critical illness: a single-centre retrospective observational study

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2019-000426 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000426

Author(s):

Robert Slade ◽

Raza Alikhan ◽

Matt P Wise ◽

Lam Germain ◽

Simon Stanworth ◽

...

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Blood Group ◽

Outcome Measure ◽

Tertiary Hospital ◽

Current Data ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Transfusion Requirements ◽

Significant Difference

BackgroundPredicting patient outcomes following critical illness is challenging. Recent evidence has suggested that patients with blood group AB are more likely to survive following major cardiac surgery, and this is associated with a reduced number of blood transfusions. However, there are no current data to indicate whether a patient’s blood group affects general intensive care outcomes.ObjectiveThe objective of this study was to determine if ABO blood group affects survival in intensive care. The primary outcome measure was 90-day mortality with a secondary outcome measure of the percentage of patients receiving a blood transfusion.DesignRetrospective analysis of electronically collected intensive care data, blood group and transfusion data.SettingGeneral intensive care unit (ICU) of a major tertiary hospital with both medical and surgical patients.PatientsAll patients admitted to ICU between 2006 and 2016 who had blood group data available.InterventionNone.Measurements and main results7340 patients were included in the study, blood group AB accounted for 3% (221), A 41% (3008), B 10.6% (775) and O 45.4% (3336). These values are similar to UK averages. Baseline characteristics between the groups were similar. Blood group AB had the greatest survival benefit (blood group AB 90-day survival estimate 76.75, 95% CI 72.89 to 80.61 with the overall estimate 72.07, 95% CI 71.31 to 72.82) (log-rank χ2 16.128, p=0.001). Transfusion requirements were similar in all groups with no significant difference between the percentages of patients transfused (AB 23.1%, A 21.5%, B 18.7%, O 19.9%, Pearson χ2 5.060 p=0.167).ConclusionAlthough this is primarily a hypothesis generating study, intensive care patients with blood group AB appeared to have a higher 90-day survival compared with other blood groups. There was no correlation between blood group and percentage of patients receiving transfusion.

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Adherence to Beers Criteria in Geriatrics: A Retrospective Study in a Saudi Teaching Hospital

Geriatrics ◽

10.3390/geriatrics5040097 ◽

2020 ◽

Vol 5 (4) ◽

pp. 97

Author(s):

Samah Alshehri ◽

Mohannad Alshibani ◽

Ghaydaa Magboul ◽

Albandari Albandar ◽

Roaa Nasser ◽

...

Keyword(s):

Retrospective Study ◽

Older Patients ◽

Adverse Drug Events ◽

Healthcare Providers ◽

Tertiary Hospital ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Inflammatory Drugs ◽

The Mean ◽

Inappropriate Medications

Background: The aging process makes geriatric populations more prone to various chronic diseases. Such diseases require older patients to be on more medications than any other age group and make them more susceptible to adverse drug events related to potentially inappropriate medications (PIMs). Aim: To identify the prevalence of potentially inappropriate medications among older people and explore the most commonly prescribed PIMs in hospitalized patients. Design and Setting: A retrospective study conducted in a large tertiary hospital among patients hospitalized in a 4 year period from January 2015 to December 2018. Methods: The 2019 Beers Criteria were used to assess PIMs in all inpatient prescribed medications focusing on the first class (i.e., drug/drug class to be avoided in older adults). Results: The mean age was 75.17 ± 7.66 years. A total of 684 (80.6%) patients were prescribed at least one medication listed in the first-class category of the 2019 Beers Criteria. Top five drugs were proton pump inhibitors (40.3%), nonsteroidal anti-inflammatory drugs (10.2%), metoclopramide (9.3%), benzodiazepines (8.4%), and insulin (5.4%). Conclusions: The prevalence of PIMs is high among older patients admitted to the hospital. More efforts are needed to investigate the potential reasons and develop action plans to improve concordance to Beers Criteria among healthcare providers.

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Patient safety initiatives in obstetrics: a rapid review

BMJ Open ◽

10.1136/bmjopen-2017-020170 ◽

2018 ◽

Vol 8 (7) ◽

pp. e020170 ◽

Cited By ~ 5

Author(s):

Jesmin Antony ◽

Wasifa Zarin ◽

Ba’ Pham ◽

Vera Nincic ◽

Roberta Cardoso ◽

...

Keyword(s):

Patient Safety ◽

Healthcare Providers ◽

Audit And Feedback ◽

Rapid Review ◽

Secondary Outcome ◽

Provider Education ◽

Eligibility Criteria ◽

Clinician Education ◽

Study Selection ◽

Safety Outcomes

ObjectivesThis review was commissioned by WHO, South Africa-Country office because of an exponential increase in medical litigation claims related to patient safety in obstetrical care in the country. A rapid review was conducted to examine the effectiveness of quality improvement (QI) strategies on maternal and newborn patient safety outcomes, risk of litigation and burden of associated costs.DesignA rapid review of the literature was conducted to provide decision-makers with timely evidence. Medical and legal databases (eg, MEDLINE, Embase, LexisNexis Academic, etc) and reference lists of relevant studies were searched. Two reviewers independently performed study selection, abstracted data and appraised risk of bias. Results were summarised narratively.InterventionsWe included randomised clinical trials (RCTs) of QI strategies targeting health systems (eg, team changes) and healthcare providers (eg, clinician education) to improve the safety of women and their newborns. Eligible studies were limited to trials published in English between 2004 and 2015.Primary and secondary outcome measuresRCTs reporting on patient safety outcomes (eg, stillbirths, mortality and caesarean sections), litigation claims and associated costs were included.ResultsThe search yielded 4793 citations, of which 10 RCTs met our eligibility criteria and provided information on over 500 000 participants. The results are presented by QI strategy, which varied from one study to another. Studies including provider education alone (one RCT), provider education in combination with audit and feedback (two RCTs) or clinician reminders (one RCT), as well as provider education with patient education and audit and feedback (one RCT), reported some improvements to patient safety outcomes. None of the studies reported on litigation claims or the associated costs.ConclusionsOur results suggest that provider education and other QI strategy combinations targeting healthcare providers may improve the safety of women and their newborns during childbirth.

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PIT20 STUDY OF NEEDLE STICK INJURIES AMONG HEALTHCARE PROVIDERS: EVIDENCE FROM A TERTIARY HOSPITAL IN INDIA

Value in Health ◽

10.1016/j.jval.2019.04.992 ◽

2019 ◽

Vol 22 ◽

pp. S214

Author(s):

S. Sriram

Keyword(s):

Healthcare Providers ◽

Tertiary Hospital ◽

Needle Stick ◽

Needle Stick Injuries

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Identifying the effects of an upgraded ‘fever clinic’ on COVID-19 control and the workload of emergency department: retrospective study in a tertiary hospital in China

BMJ Open ◽

10.1136/bmjopen-2020-039177 ◽

2020 ◽

Vol 10 (8) ◽

pp. e039177

Author(s):

Jiangshan Wang ◽

Liang Zong ◽

Jinghong Zhang ◽

Han Sun ◽

Joseph Harold Walline ◽

...

Keyword(s):

Retrospective Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Disease Transmission ◽

Healthcare Providers ◽

Tertiary Hospital ◽

College Hospital ◽

Upper Respiratory Infection ◽

Number Of Patients ◽

Screening And Prevention

ObjectiveCOVID-19 started spreading widely in China in January 2020. Outpatient fever clinics (FCs), instituted during the SARS epidemic in 2003, were upgraded to serve for COVID-19 screening and prevention of disease transmission in large tertiary hospitals in China. FCs were hoped to relieve some of the healthcare burden from emergency departments (EDs). We aimed to evaluate the effect of upgrading the FC system on rates of nosocomial COVID-19 infection and ED patient attendance at Peking Union Medical College Hospital (PUMCH).DesignA retrospective cohort study.ParticipantsA total of 6365 patients were screened in the FC.MethodsThe FC of PUMCH was upgraded on 20 January 2020. We performed a retrospective study of patients presenting to the FC between 12 December 2019 and 29 February 2020. The date when COVID-19 was declared an outbreak in Beijing was 20 January 2020. Two groups of data were collected and subsequently compared with each other: the first group of data was collected within 40 days before 20 January 2020; the second group of data was collected within 40 days after 20 January 2020. All necessary data, including patient baseline information, diagnosis, follow-up conditions and the transfer records between the FC and ED, were collected and analysed.Results6365 patients were screened in the FC, among whom 2912 patients were screened before 21 January 2020, while 3453 were screened afterward. Screening results showed that upper respiratory infection was the major disease associated with fever. After the outbreak of COVID-19, the number of patients who were transferred from the FC to the ED decreased significantly (39.21% vs 15.75%, p<0.001), and patients generally spent more time in the FC (55 vs 203 min, p<0.001), compared with before the outbreak. For critically ill patients waiting for their screening results, the total length of stay in the FC was 22 min before the outbreak, compared with 442 min after the outbreak (p<0.001). The number of in-hospital deaths of critically ill patients in the FC was 9 out of 29 patients before the outbreak and 21 out of 38 after the outbreak (p<0.05). Nineteen cases of COVID-19 were confirmed in the FC during the period of this study. However, no other patients nor any healthcare providers were cross-infected.ConclusionThe workload of the FC increased significantly after the COVID-19 outbreak. New protocols regarding the use of FC likely helped prevent the spread of COVID-19 within the hospital. The upgraded FC also reduced the burden on the ED.

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