Health system characteristics of quality care delivery: A comparative case study examination of palliative care for cancer patients in four regions in Ontario, Canada

2011 ◽  
Vol 26 (4) ◽  
pp. 322-335 ◽  
Author(s):  
Jonathan Sussman ◽  
Lisa Barbera ◽  
Daryl Bainbridge ◽  
Doris Howell ◽  
Jinghao Yang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Health System ◽  
Acute Care ◽  
Pattern Analysis ◽  
Care Delivery ◽  
Quality Care ◽  
Structural Features ◽  
Comparative Case Study ◽  
Care Utilization

Background: A number of palliative care delivery models have been proposed to address the structural and process gaps in this care. However, the specific elements required to form competent systems are often vaguely described. Aim: The purpose of this study was to explore whether a set of modifiable health system factors could be identified that are associated with population palliative care outcomes, including less acute care use and more home deaths. Design: A comparative case study evaluation was conducted of ‘palliative care’ in four health regions in Ontario, Canada. Regions were selected as exemplars of high and low acute care utilization patterns, representing both urban and rural settings. A theory-based approach to data collection was taken using the System Competency Model, comprised of structural features known to be essential indicators of palliative care system performance. Key informants in each region completed study instruments. Data were summarized using qualitative techniques and an exploratory factor pattern analysis was completed. Results: 43 participants (10+ from each region) were recruited, representing clinical and administrative perspectives. Pattern analysis revealed six factors that discriminated between regions: overall palliative care planning and needs assessment; a common chart; standardized patient assessments; 24/7 palliative care team access; advanced practice nursing presence; and designated roles for the provision of palliative care services. Conclusions: The four palliative care regional ‘systems’ examined using our model were found to be in different stages of development. This research further informs health system planners on important features to incorporate into evolving palliative care systems.

scholarly journals Lessons learnt: examining the use of case study methodology for nursing research in the context of palliative care

2019 ◽  
Vol 24 (6) ◽  
pp. 446-459
Author(s):  
Paula Brogan ◽  
Felicity Hasson ◽  
Sonja McIlfatrick
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Case Study Research ◽  
Lessons Learned ◽  
Research Approach ◽  
Nursing Research ◽  
Case Study Methodology ◽  
Study Research ◽  
Study Methodology

Background An empirical social research approach, facilitating in-depth exploration of complex, contemporary contextualised phenomena, case study research has been used internationally in healthcare studies across clinical settings, to explore systems and processes of care delivery. In the United Kingdom, case study methods have been championed by nurse researchers, particularly in the context of community nursing and palliative care provision, where its applicability is well established. Yet, dogged by conceptual confusion, case study remains largely underutilised as a research approach. Method Drawing on examples from nursing and palliative care studies, this paper clarifies case study research, identifies key concepts and considers lessons learned about its potential for nursing research within the unique and complex palliative and end of life context. Conclusion A case study approach offers nurse researchers the opportunity for in-depth, contextualised understanding of the systems and processes which influence their role in palliative care delivery across settings. However, philosophical and conceptual understandings are needed and further training in case study methodology is required to enable researchers to articulate and conduct case study.

Integrating Concurrent Palliative Care into Cancer Care Delivery Settings

2018 ◽  
Author(s):  
Meagan Whisenant ◽  
Kathi Mooney
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Care Delivery ◽  
Scale Up ◽  
Fee For Service ◽  
National Guidelines ◽  
Reimbursement Mechanisms ◽  
Early Integration ◽  
Home Based

This case study reviews the evidence for adoption of concurrent palliative care (CPC) during treatment for advanced cancer. Increasing research evidence and expert panel consensus has resulted in national guidelines and professional society endorsement of early integration of palliative care into oncology care. However, there is variable uptake of these guidelines and penetration of CPC into practice. Barriers to implementation include the need to increase awareness of existing evidence and guidelines, stigma, adequacy of a workforce for scale-up, lack of models for integration and delivery, and restrictive reimbursement mechanisms. Changing health care models that emphasize value-based care over fee-for-service can accelerate adoption. Use of technology can also overcome barriers related to scalability and resource use. The case study concludes with the recommendation that implementation science methodologies be used to guide successful integration of CPC in outpatient and home-based settings for patients with advanced cancer and their family caregivers.

scholarly journals Tracking the evolution of hospice palliative care in Canada: A comparative case study analysis of seven provinces

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Allison M Williams ◽  
Valorie A Crooks ◽  
Kyle Whitfield ◽  
Mary-Lou Kelley ◽  
Judy-Lynn Richards ◽  
...  
Keyword(s):  
Palliative Care ◽  
Comparative Case Study ◽  
Study Analysis ◽  
Case Study Analysis ◽  
Hospice Palliative Care

scholarly journals A Comparative Case Study of Prescribing and Non-Prescribing Physiotherapists and Podiatrists

2020 ◽  
Author(s):  
Nicola Carey ◽  
Judith Edwards ◽  
Simon Otter ◽  
Heather Gage ◽  
Peter Williams ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Health Professionals ◽  
Care Delivery ◽  
Comparative Case Study ◽  
Allied Health Professionals ◽  
Future Developments ◽  
The World

Abstract BackgroundIncreasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists.Aim: to compare outcomes of Physiotherapist and Podiatrist Independent Prescriber (PP- IP) patients with those of Physiotherapist and Podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications.Design: a mixed method comparative case studyMethods: Using mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016).Results: 488 patients were recruited: n=243 IP sites, and n=245 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p>0.05) and patient satisfaction (p≤0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than NP-PP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 minutes). ConclusionThis study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.

scholarly journals A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists

2020 ◽  
Author(s):  
Nicola Carey ◽  
Judith Edwards ◽  
Simon Otter ◽  
Heather Gage ◽  
Peter Williams ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Health Professionals ◽  
Care Delivery ◽  
Comparative Case Study ◽  
Allied Health Professionals ◽  
Future Developments ◽  
The World

Abstract BackgroundIncreasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists.Aim: to compare outcomes of physiotherapist and podiatrist Independent Prescriber (PP- IP) patients with those of physiotherapist and podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications.Design: a mixed method comparative case study Methods: Using mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016). Results: 489 patients were recruited: n=243 IP sites, and n=246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p>0.05) and patient satisfaction (p≤0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than PP-NP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 minutes). ConclusionThis study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.

scholarly journals Exploring Challenges of Hospital Chaplains in Transdisciplinary Teams

2020 ◽  
Vol 5 ◽  
Author(s):  
Stephen A. Spates ◽  
Catherine Y. Kingsley Westerman ◽  
Leslie A. Laam ◽  
Ryan Goke
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Health Outcomes ◽  
Quality Care ◽  
Ability To Work ◽  
Hospital Chaplains ◽  
Communication Challenges ◽  
Medical Health

Hospital chaplains experience obstacles in contributing to team objectives when a part of transdisciplinary teams. This case study explores the communication challenges of membership on transdisciplinary teams for hospital chaplains, using a fictional account based on data from a previous study. Chaplain David Howard is one of three chaplains at Grace Hospital and is assigned to the newly formed palliative care transdisciplinary team. The purpose of this team is to work towards providing quality care to patients in the upcoming integrative medicine wing. Although the team is tasked with improving the quality of life for patients, David notices that his concerns of quality care often clash with his medical colleagues' concerns about improved medical health outcomes. As the team's differing perspectives are revealed, it is evident that their communication is crucial to their ability to work together successfully.

scholarly journals Palliative care for cancer patients near end of life in acute-care hospitals across Canada: a look at the inpatient palliative care code

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
J. Tung ◽  
J. Chadder ◽  
D. Dudgeon ◽  
C. Louzado ◽  
J. Niu ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Acute Care ◽  
Care Delivery ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Administrative Databases ◽  
Care Hospital ◽  
Care Needs ◽  
Patients With Cancer

Hospitals play an important role in the care of patients with advanced cancer: nearly half of all cancer deaths occur in acute-care settings. The need for increasing access to palliative care and related support services for patients with cancer in acute-care hospitals is therefore growing. Here, we examine how often and how early in their illness patients with cancer might be receiving palliative care services in the 2 years before their death in an acute-care hospital in Canada. The palliative care code from inpatient administrative databases was used as a proxy for receiving, or being referred for, palliative care. Currently, the palliative care code is the only data element routinely collected from patient charts that allows for the tracking of palliative care activity at a pan-Canadian level.     Our findings suggest that most patients with cancer who die in an acute-care hospital receive a palliative designation; however, many of those patients are identified as palliative only in their final admission before death. Of the patients who received a palliative designation before their final admission, nearly half were identified as palliative less than 2 months before death. Findings signal that delivery of services within and between jurisdictions is not consistent, that the palliative care needs of some patients are being missed by physicians, and that palliative care is still largely seen as end-of-life care and is not recognized as an integral component of cancer care.     Measuring the provision of system-wide palliative care remains a challenge because comprehensive national data about palliative care are not currently reported from all sectors. To advance measurement and reporting of palliative care in Canada, attention should be focused on collecting comparable data from regional and provincial palliative care programs that individually capture data about palliative care delivery in all health care sectors.

scholarly journals A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists

2020 ◽  
Author(s):  
Nicola Carey ◽  
Judith Edwards ◽  
Simon Otter ◽  
Heather Gage ◽  
Peter Williams ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Health Professionals ◽  
Care Delivery ◽  
Comparative Case Study ◽  
Allied Health Professionals ◽  
Future Developments ◽  
The World

Abstract Background: Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists.Aim: to compare outcomes of physiotherapist and podiatrist Independent Prescriber (PP- IP) patients with those of physiotherapist and podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications.Design: a mixed method comparative case study Methods: Using mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016). Results: 489 patients were recruited: n=243 IP sites, and n=246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p>0.05) and patient satisfaction (p≤0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than PP-NP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 minutes). Conclusion: This study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.

scholarly journals A COMBINED MULTI-OBJECTIVE SIMULATION-OPTIMIZATION AND AHP APPROACH: A HEALTHCARE CASE STUDY

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohammad Dehghanimohammadabadi ◽  
Nihan Kabadayi
Keyword(s):  
Quality Of Care ◽  
Care Delivery ◽  
Simulation Optimization ◽  
Quality Care ◽  
Health Providers ◽  
Patients Satisfaction ◽  
Combined Simulation ◽  
The Impact

Quality of care is crucial for patients' satisfaction and safety in healthcare centers. The majority of hospitals attempt to implement facility-wide improvements to ensure high-quality care delivery. This study aims to propose a combined Simulation-Optimization and MCDM approach to accurately assess the impact of quality improvement initiatives on different facets of healthcare systems. In this framework, first, the importance (weights) of the different healthcare criteria is determined by health providers’ using an AHP approach. Then, the weights provided by AHP are applied in a simulation-optimization environment to determine the most efficient action with the most desirable quality of care. Simulation provides a platform to examine the effectiveness of different improvement efforts and calculate their impact on the system performance measures.

Sign in / Sign up

Export Citation Format

Share Document