scholarly journals Facilitating co-production in public services: Empirical evidence from a co-design experience with family caregivers living in a remote and rural area

2020 ◽  
pp. 095148482097145
Author(s):  
Eleonora Gheduzzi ◽  
Niccolò Morelli ◽  
Guendalina Graffigna ◽  
Cristina Masella
Keyword(s):  
Home Care ◽  
Family Caregivers ◽  
Empirical Evidence ◽  
Rural Area ◽  
Public Service ◽  
Rural Areas ◽  
Crucial Role ◽  
Care Agency ◽  
Home Care Agency ◽  
Design Experience

The involvement of vulnerable actors in co-production activities is a debated topic in the current public service literature. While vulnerable actors should have the same opportunities to be involved as other actors, they may not have the needed competences, skills and attitudes to contribute to this process. This paper is part of a broader project on family caregivers’ engagement in remote and rural areas. In particular, it investigates how to facilitate co-production by looking at four co-design workshops with family caregivers, representatives of a local home care agency and researchers. The transcripts of the workshops were coded using NVivo, and the data were analysed based on the existing theory about co-production. Two main findings were identified from the analysis. First, the adoption of co-production by vulnerable actors may occur in conjunction with other forms of engagement. Second, the interactions among facilitators and providers play a crucial role in encouraging the adoption of co-production. We identified at least two strategies that may help facilitators and providers achieve that goal. However, there is a need for an in-depth understanding of how facilitators and providers should interact to enhance implementation of co-production.

Abstract TMP77: Development of a Collaborative Transition Coaching Program for Reduction of Post-stroke Hospitalizations

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ann M Leonhardt ◽  
Denise M Burgen ◽  
Jennifer Wolfe ◽  
Kelly Luther
Keyword(s):  
Ischemic Stroke ◽  
Home Care ◽  
Hospital Readmission ◽  
Fiscal Year ◽  
Pilot Program ◽  
Stroke Patients ◽  
Stroke Population ◽  
Essential Components ◽  
Care Agency ◽  
Home Care Agency

Issue: All-cause 30 day hospital readmission rate following discharge for ischemic stroke has been instituted by CMS as a quality measure. Successful readmission reduction planning is a hospital imperative. Purpose: We set out to establish a stroke-specific transitions coaching program with the intention of decreasing readmissions in our ischemic stroke population. Methods: Fiscal year 2013 stroke readmissions to our hospital were individually reviewed for factors leading to readmission. After determining 62.5% of avoidable readmissions were attributed to outpatient factors, a regional home care agency was contacted for collaboration. The agency has proven readmission reductions utilizing the Coleman Care Transitions Model. This model incorporates visits prior to discharge, by telephone, and at home by a trained transitions coach to ensure understanding of medications, follow up visits, and recognition of concerning symptoms. Cost estimates for expanding the program to stroke patients were made using the prior year’s volume based on primary payer, county, and discharge destination. A business plan was established and training and informational sessions planned. Results: Of the outpatient factors contributing to readmission the most common were medication issues, seeking emergency care prematurely, and need for education or support. Based on the data and prior successes of the home care agency a pilot program was developed. The estimated cost for patients not covered by their primary insurance is $52,000 annually. The estimated cost for one hospital readmission is $11,200. Preventing 5 readmissions per year would save $56,000. A successful collaborative was formed resulting in the ability to enroll a larger number of ischemic stroke patients in the transitions coaching program. Conclusions: Solving the problem of readmissions after ischemic stroke is complex and requires extensive planning and collaboration. Identifying our issues and establishing a pilot program took nearly a year. Key stakeholders and a committed team are essential components of establishing a collaborative process of this magnitude. The pilot program will be evaluated by comparting readmission rates in the ischemic stroke population pre and post initiation.

Abstract 23: Reducing Stroke Readmissions Utilizing a Home Care Based Transitions Coaching Program

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ann M Leonhardt Caprio ◽  
Denise M Burgen ◽  
Curtis G Benesch
Keyword(s):  
Ischemic Stroke ◽  
Home Care ◽  
Hospital Readmissions ◽  
Care Transitions ◽  
Hospital Inpatient ◽  
Pilot Program ◽  
Readmission Rates ◽  
Specific Patient ◽  
Care Agency ◽  
Home Care Agency

Background: The Center for Medicare and Medicaid Services (CMS) has instituted utilization of all-cause, unplanned 30 day hospital readmissions following discharge for ischemic stroke as part of the Hospital Inpatient Quality Reporting Program. While readmission reduction following stroke is a hospital imperative, there is minimal evidence on stroke-specific readmission reduction programs. Purpose: We sought to reduce 30 day readmissions following ischemic stroke through utilization of an established care transitions program in collaboration with our institution’s affiliated home care agency. Methods: Our institution’s home care agency has reduced readmission rates in the general medical population utilizing the Coleman Care Transitions Model © . This model incorporates motivational interviewing in visits prior to hospital discharge, with a home visit 24 to 48 hours after discharge, and by telephone at least weekly by a trained transitions coach. The coach ensures understanding of medications, follow up visits, and recognition of red flag symptoms. A one year pilot program for stroke patients utilizing this established program was initiated in October 2015. Basic stroke training was provided for all coaching staff. Quarterly readmission rates for 1 year prior to the intervention and 6 months following were analyzed. Results: During the first 6 months of the pilot program 18.2% of patients discharged with a diagnosis of ischemic stroke qualified for and completed the coaching program. Of those in the program 3.3% were readmitted. Overall, there were 15 readmissions in 13 patients, 85% of whom did not receive transitions coaching services. The readmission rate in the year prior to intervention was 7.8%, in the 6 months following 4.5%. These findings represent a 42.7% overall reduction in readmissions (p = 0.06) and a treatment effect of 1.7. Conclusions: Utilizing the Coleman Care Transitions Model © led to a meaningful reduction of hospital readmissions for patients with ischemic stroke in this pilot program. In an area in which readmission reduction has proven challenging, expanding the availability of a home care based program for specific patient populations may be an effective strategy.

scholarly journals An etnographic study of elementary education in the rural area of Dompu county, the province of West Nusa Tenggara

2016 ◽  
Vol 2 (1) ◽  
pp. 79 ◽  
Author(s):  
Nurrahmah Nurrahmah ◽  
Zamroni Zamroni ◽  
Sumarno Sumarno
Keyword(s):  
Elementary Education ◽  
Rural Area ◽  
Public Service ◽  
Rural Areas ◽  
Rice Fields ◽  
The Other ◽  
Educational Service ◽  
The People ◽  
Self Actualization ◽  
Upper Level

The study aims to describe: (1) public service for elementary education in rural areas; (2) the meaning of education and the implementation of elementary education in the people of rural areas; and (3) the life and meaning of poverty for people of rural areas. The study was etnographic research. The subjects were the providers and users of educational service. The research concludes that: (1) educational service in rural areas has not been coordinated and integrated both vertically and horizontally, so that the service elements have not been maximum in providing educational service; (2) the implementation of education is influenced by the surrounding environments (policy, community, and nature) so that its condition or the problems emerging in the lower level is a reflection of that in the upper level. People in rural areas regard education as a symbol of profession and self-actualization within the children’s selves in order that the children would show respect to their parents, would not destroy the nature, have noble characteristics and be smart persons for their own sake in the future; (3) physically people in rural areas might be described as a community that lacks facilities including transportation, highway systems, water, electricity, and market for trading the harvest. On the other hand, mentally, people in rural areas might be described as a community that is fond of having aids, enjoys the final products, is lazy and dependent on the nature. People in rural areas regard their poverty based on physical indicators (the possession of luxurious goods, rice fields, livestock, income, and housings) and non-physical indicators (the dependency on the nature and absence of education).

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