Decentralizing healthcare in Norway to improve patient-centered outpatient clinic management of rheumatoid arthritis – a conceptual model

AbstractA growing population of older adults and improved effective treatments for inflammatory rheumatic diseases will increase the demand for more healthcare resources that already struggle with staggering outpatient clinic waiting times. Transformative delivery care models that provide sustainable healthcare services are urgently needed to meet these challenges. In this mini-review article, a proposed Lifelong Treatment Model for a decentralized follow-up of outpatient clinic patients living with rheumatoid arthritis is presented and discussed.Our conceptual model follows four steps for a transformative care delivery model supported by an Integrated Practice Unit; (1) Diagnosis, (2) Treatment, (3) Patient Empowered Disease Management, and (4) Telehealth. Through an Integrated Practice Unit, a multidisciplinary team could collaborate with patients with rheumatoid arthritis to facilitate high-value care that addresses most important outcomes of the patients; (1) Early Remission, (2) Decentralization, (3) Improved Quality of Life, and (4) Lifelong Sustain Remission.The article also addresses the growing challenges for the healthcare delivery system today for patients with rheumatoid arthritis and proposes how to reduce outpatient clinic visits without compromising quality and safety.

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Active and Healthy Aging

Health Literacy ◽

10.4018/978-1-5225-1928-7.ch018 ◽

2017 ◽

pp. 369-391

Author(s):

Emine Özmete

Keyword(s):

Qualitative Research ◽

Delivery System ◽

Healthy Aging ◽

Healthcare Delivery ◽

Healthcare Services ◽

Capital City ◽

Elderly Persons ◽

Healthcare Delivery System ◽

Care And Support ◽

Depth Interviews

This study aims to investigate the difficulties experienced by elderly persons in accessing healthcare services and their satisfaction with issues as regards the healthcare system. In this study, qualitative research was carried out to assess the difficulties regarding the healthcare delivery system and satisfaction with the healthcare services. This qualitative research was performed through in-depth interviews with 6 men and 4 women aged 65+ years, in Ankara, the capital city of Turkey. It was discovered that elderly persons required the support of others to access a doctor, a health institution or hospital and the care and support of others for the regular intake of their drugs with increasing age. They were satisfied with the current family physician program. The most significant challenges experienced by elderly persons regarding the healthcare delivery system included crowded hospitals, difficulty walking, the unavailability of wheel chairs, and inadequate assistance from support staff.

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Simulation Modeling of Healthcare Delivery

Management Engineering for Effective Healthcare Delivery ◽

10.4018/978-1-60960-872-9.ch003 ◽

2011 ◽

pp. 69-89

Author(s):

Ian W. Gibson

Keyword(s):

Simulation Modeling ◽

Healthcare Delivery ◽

Healthcare Services ◽

Healthcare Delivery System ◽

Scarce Resources ◽

Power Simulation ◽

Modeling Analysis ◽

Management Techniques ◽

The Cost ◽

Delivery Models

Healthcare has delivered incredible improvements in diagnosis and treatment of diseases but faces challenges to improve the delivery of services. Healthcare is a complex system using expensive and scarce resources. Benchmarking, experience, and lean management techniques currently provide the basis for developing service delivery models and facility planning. Simulation modeling can supplement these methods to enable a better understanding of the complex systems involved. This provides the basis for developing and evaluating options to provide improved healthcare delivery. Simulation modeling enables a better understanding of the processes and the resources used in delivering healthcare services and improving healthcare delivery systems. Options to improve the cost effectiveness can be evaluated without experimenting with patients. This chapter reviews the current challenges and methods including the use of simulation modeling. Analysis of emergency patient flows through a major hospital shows the capability of simulation modeling to enable improvement of the healthcare delivery system. This chapter enables healthcare managers to understand the power simulation modeling brings to the improvement of healthcare delivery.

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The Heart Failure Readmission Intervention by Variable Early Follow-up (THRIVE) Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.120.006553 ◽

2020 ◽

Vol 13 (10) ◽

Cited By ~ 1

Author(s):

Keane K. Lee ◽

Rachel C. Thomas ◽

Thida C. Tan ◽

Thomas K. Leong ◽

Anthony Steimle ◽

...

Keyword(s):

Heart Failure ◽

Primary Care Physicians ◽

Care Delivery ◽

Healthcare Delivery ◽

Clinic Visit ◽

Heart Failure Hospitalization ◽

Healthcare Delivery System ◽

Unique Identifier ◽

Clinic Visits

Background: In-person clinic follow-up within 7 days after discharge from a heart failure hospitalization is associated with lower 30-day readmission. However, health systems and patients may find it difficult to complete an early postdischarge clinic visit, especially during the current pandemic. We evaluated the effect on 30-day readmission and death of follow-up within 7 days postdischarge guided by an initial structured nonphysician telephone visit compared with follow-up guided by an initial clinic visit with a physician. Methods and Results: We conducted a pragmatic randomized trial in a large integrated healthcare delivery system. Adults being discharged home after hospitalization for heart failure were randomly assigned to either an initial telephone visit with a nurse or pharmacist to guide follow-up or an initial in-person clinic appointment with primary care physicians providing usual care within the first 7 days postdischarge. Telephone appointments included a structured protocol enabling medication titration, laboratory ordering, and booking urgent clinic visits as needed under physician supervision. Outcomes included 30-day readmissions and death and frequency and type of completed follow-up within 7 days of discharge. Among 2091 participants (mean age 78 years, 44% women), there were no significant differences in 30-day heart failure readmission (8.6% telephone, 10.6% clinic, P =0.11), all-cause readmission (18.8% telephone, 20.6% clinic, P =0.30), and all-cause death (4.0% telephone, 4.6% clinic, P =0.49). Completed 7-day follow-up was higher in 1027 patients randomized to telephone follow-up (92%) compared with 1064 patients assigned to physician clinic follow-up (79%, P <0.001). Overall frequency of clinic visits during the first 7 days postdischarge was lower in participants assigned to nonphysician telephone guided follow-up (48%) compared with physician clinic-guided follow-up (77%, P <0.001). Conclusions: Early, structured telephone follow-up after hospitalization for heart failure can increase 7-day follow-up and reduce in-person visits with comparable 30-day clinical outcomes within an integrated care delivery framework. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03524534.

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Towards a Shariah Compliance Model for Healthcare Centres with reference to Spiritual Healers: Issues and Challenges

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v17i1.1039 ◽

2018 ◽

Vol 17 (1) ◽

Author(s):

Ramizah Wan Muhammad

Keyword(s):

Public Health ◽

Tertiary Care ◽

Healthcare Delivery ◽

Healthcare Services ◽

Healthcare Delivery System ◽

Factors Affecting ◽

Healthcare Centre ◽

The Public ◽

The People ◽

Spiritual Healers

Generally, a good healthcare centre comprises of qualified manpower, right policies and right procedures in providing primary care, secondary care and tertiary care for the patients as well as in public health. Other than manpower, healthcare centres must also look at social, religious and cultural factors affecting the recipients of the healthcare services given by the healthcare centres. In this paper, the author will look at some pertinent issues such as the need to have spiritual healers in any healthcare centre to help the patients in dealing with fatal illness. The spiritual healer is to help the patient and give him motivation so that he could have a positive mind throughout his journey in battling with his illness. Sometimes we have patients who refused to listen to the doctor's advice. Thus, the role of the spiritual healer would be important in assisting the healthcare centres and its management to convince him. Another issue is the privacy, respect and trust between patients and doctors as well as with the management of the healthcare centres. One of the duties of the healthcare centres’ management and doctors is, to respect the patient's religion and his faith. These three issues are amongst the important issues which every healthcare centre must look upon. Definitely there are a lot of challenges in addressing the above mentioned issues such as the procedures, methods on how to execute these issues and most importantly the perception of the public. In Islam, health care is one of the five important elements in which the Prophet SAW has mentioned in one hadith to be taken care of. A study has shown that a nation-building efforts has no meaningwithout the best public health and healthcare delivery system to the people.

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Investigating Perceptions of Patients on Healthcare Pricing Within The Private Healthcare Sector In Sri Lanka

Asia Pacific Journal of Health Management ◽

10.24083/apjhm.v16i3.631 ◽

2021 ◽

Vol 16 (3) ◽

pp. 235-242

Author(s):

Kanchana Sajeeva Narangoda ◽

Estie Kruger ◽

Marc Tennant

Keyword(s):

Sri Lanka ◽

Private Sector ◽

Healthcare Delivery ◽

Target Population ◽

Healthcare Services ◽

Healthcare Sector ◽

Sufficient Evidence ◽

Healthcare Delivery System ◽

Private Hospitals ◽

Private Healthcare

Demand for private sector healthcare services in Sri Lanka is on the rise. This is very evident from the increase in the number of registered private healthcare institutions from 1990 to 2017. [1,2] With the increasing utilization of private sector healthcare services, various qualitative factors, and service-related issues associated with the healthcare delivery system have become common debates. A major concern, patients have expressed, is about the fees charged by doctors and hospitals. Principle aim of this study was to investigate the perceptions of patients on healthcare pricing within the private healthcare sector in Sri Lanka. The target population of the study was defined as Sri Lankans who have been inpatients in private hospitals within the past year. The focus districts were Colombo, Kandy, and Galle. These 3 districts represented nearly 60% of the total private sector bed capacity. From each district, three main private hospitals were selected. Over 700 patients were invited to participate, 246 surveys were completed, and 215 were retained as 31 had excessive missing and/or unclear data. In all 3 districts the majority of patients were either dissatisfied with or remained neutral (69%) on the hospital fees,(66%) on doctor’s fees,(74%) on the overall price they ended up paying,(76%) on whether they think the healthcare services they received are value for money. This study did not investigate the reasons or the factors that may affect the satisfaction or dissatisfaction of patients towards the fees they paid Multiple factors can affect patient’s perception on the fees they paid. With negative perception on the above it can be concluded that there is sufficient evidence to challenge private sector healthcare satisfaction level vs price/fees equilibrium in Sri Lanka.

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1107. The MAAGE Study: Health Care Utilization for the Treatment of Medically Attended Acute Gastroenteritis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.941 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S331-S332

Author(s):

Claire P Mattison ◽

Holly Groom ◽

Judy Donald ◽

S Bianca Salas ◽

Zachary Marsh ◽

...

Keyword(s):

Healthcare Utilization ◽

Acute Gastroenteritis ◽

Healthcare Delivery ◽

Healthcare Services ◽

Care Utilization ◽

Comorbid Condition ◽

Inpatient Setting ◽

Healthcare Delivery System ◽

Kaiser Permanente ◽

Demographic Patterns

Abstract Background Acute gastroenteritis (AGE) exacts a substantial disease burden across the age spectrum, although healthcare utilization for AGE is not well characterized. Through active surveillance of medically attended acute gastroenteritis (MAAGE) encounters within a large, integrated healthcare delivery system, we analyzed demographic patterns of healthcare utilization among AGE patients. Methods From April 1, 2014 to September 30, 2016, we collected information on all MAAGE encounters in Kaiser Permanente Northwest (KPNW) patients through daily abstraction from electronic health records using ICD-9/-10 codes. For each patient, a MAAGE episode was defined as all MAAGE encounters <30 days apart. Results There were 109,493 MAAGE encounters among 39,451 patients. Patients were 60.4% female and 39.6% male; 10.3% were <5 years old, 9.7% were 5–17, 31.1% were 18–44, 25.4% were 45–64, and 23.5% were ≥65. Among those with known race, 87.2% were white; 4.1% were Asian, 3.6% were black, and 5.1% were other or multiple races. Prevalence of any chronic comorbid condition was 52.9%. Of 52,107 MAAGE episodes, 81.0% first presented as outpatients; this was most common in those aged <5 (92.1%) and decreased with age to 75.0% in those ≥65. First presenting remotely (email or telephone) ranged from 4.0% in those aged <5 to 19.3% in those ≥65; 52.7% of episodes first presenting remotely had no subsequent visits. Few episodes first presented to an emergency department (3.8% in <5 year olds to 6.6% in 18–44 year olds) or inpatient setting (0.1% in <5 year olds to 1.7% in ≥65 year olds). Most MAAGE episodes comprised of one encounter (median: 1.0, mean: 2.1). The number of encounters per episode was lowest in those <5 years old (median: 1.0, mean: 1.5) and highest in those ≥65 (median: 2.0, mean: 2.5). Most deaths within 30 days from the start of an episode (131/161) were in those ≥65; there were none in those <5, 1 in those 5–17, 5 in those 18–44, and 24 in those 45–64. Conclusion We found that the number of encounters per MAAGE episode increased with age and that outpatient and remote encounters are important settings for the initial clinical management of MAAGE in all ages. These data can help to better quantify the economic burden of AGE and guide appropriate delivery of healthcare services. Disclosures All authors: No reported disclosures.

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A Multidisciplinary Remote Healthcare Delivery System to Increase Health Care Access, Pathology Screening, and Treatment in Developing Countries

Healthcare Policy and Reform ◽

10.4018/978-1-5225-6915-2.ch063 ◽

2019 ◽

pp. 1376-1409

Author(s):

Thierry Oscar Edoh ◽

Pravin Amrut Pawar ◽

Bernd Brügge ◽

Gunnar Teege

Keyword(s):

Health Care ◽

Delivery System ◽

Health Care Access ◽

Care Delivery ◽

Healthcare Delivery ◽

Access To Healthcare ◽

Healthcare Delivery System ◽

Care Access ◽

Traditional Practitioners ◽

Remote Care

In this paper, the authors describe a case study of the poor access to healthcare in developing world, case of Benin, a West African developing country. The authors identify problems and the existing obstacles for applying standard Telemedicine and eHealth solutions. The authors particularly describe an adapted multidisciplinary remote care delivery system approach for improving and increasing the use of existing health services as well as the access to healthcare by overcoming some cultural, social, financial, and at least linguistic barriers. The multidisciplinary remote care delivery system integrates traditional practitioners, because most people are more confident with the traditional medicine. The authors further present a practical test which has shown that their approach has the potential to improve the quality and effectiveness of health care in rural and other concerned regions and also increase the accessibility to health care system.

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Active and Healthy Aging

Handbook of Research on Healthcare Administration and Management - Advances in Healthcare Information Systems and Administration ◽

10.4018/978-1-5225-0920-2.ch022 ◽

2017 ◽

pp. 384-406

Author(s):

Emine Özmete

Keyword(s):

Qualitative Research ◽

Delivery System ◽

Healthy Aging ◽

Healthcare Delivery ◽

Healthcare Services ◽

Capital City ◽

Elderly Persons ◽

Healthcare Delivery System ◽

Care And Support ◽

Depth Interviews

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A Context-Aware Authorization Model for Process-Oriented Personal Health Record Systems

Certification and Security in Health-Related Web Applications ◽

10.4018/978-1-61692-895-7.ch003 ◽

2011 ◽

pp. 46-65

Author(s):

Eleni Mytilinaiou ◽

Vassiliki Koufi ◽

Flora Matamateniou ◽

George Vassilacopoulos

Keyword(s):

Care Delivery ◽

Personal Health Record ◽

Healthcare Delivery ◽

Healthcare Providers ◽

Healthcare Services ◽

Information Support ◽

Personal Health ◽

Health Record ◽

Healthcare Organizations ◽

Process Oriented

Healthcare delivery is a highly complex process involving a broad range of healthcare services, typically performed by a number of geographically distributed and organizationally disparate healthcare providers requiring increased collaboration and coordination of their activities in order to provide shared and integrated care. Under an IT-enabled, patient-centric model, health systems can integrate care delivery across the continuum of services, from prevention to follow-up, and also coordinate care across all settings. In particular, much potential can be realized if cooperation among disparate healthcare organizations is expressed in terms of cross-organizational healthcare processes, where information support is provided by means of Personal Health Record (PHR) systems. This chapter assumes a process-oriented PHR system and presents a security framework that addresses the authorization and access control issues arisen in these systems. The proposed framework ensures provision of tight, just-in-time permissions so that authorized users get access to specific objects according to the current context. These permissions are subject to continuous adjustments triggered by the changing context. Thus, the risk of compromising information integrity during task executions is reduced.

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New Payment Models and Big Data Analytics

Encyclopedia of Business Analytics and Optimization ◽

10.4018/978-1-4666-5202-6.ch145 ◽

2014 ◽

pp. 1622-1636

Author(s):

Avnish Rastogi

Keyword(s):

Care Delivery ◽

Healthcare Delivery ◽

Big Data Analytics ◽

National Research Council ◽

International Perspective ◽

Institute Of Medicine ◽

Healthcare Delivery System ◽

Quality Outcomes ◽

Younger Age ◽

Government Mandates

It has been fascinating to watch how American healthcare delivery system is going through a paradigm shift to meet new government mandates and bend the care delivery cost curve. For years, US health care system has been fragmented and falling short on quality, outcomes, costs, and lacking framework to support care continuum. According to the study conducted by National Research Council and the Institute of Medicine, for many years, US population has been dying at the younger age than population with similar characteristics in other countries such as Canada, Australia and Japan. When compared with the peer countries, US Population did worse in health areas such as drug related deaths, obesity, chronic diseases, disability, etc. (Institute of Medicine of the National Academics. 2013 in, U.S Health in International Perspective Shorter Lives, Poorer Health.)

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