scholarly journals Collaborative chronic care model implementation within outpatient behavioral health care teams: qualitative results from a multisite trial using implementation facilitation

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Jennifer L. Sullivan ◽  
Bo Kim ◽  
Christopher J. Miller ◽  
A. Rani Elwy ◽  
Karen L. Drummond ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Support ◽  
Information Systems ◽  
Clinical Information ◽  
Self Management ◽  
Clinical Information Systems ◽  
Work Role ◽  
Community Resources ◽  
Management Support ◽  
Outpatient Mental Health

Abstract Background This paper reports on a qualitative evaluation of a hybrid type II stepped-wedge, cluster randomized trial using implementation facilitation to implement team-based care in the form of the collaborative chronic care model (CCM) in interdisciplinary outpatient mental health teams. The objective of this analysis is to compare the alignment of sites’ clinical processes with the CCM elements at baseline (time 1) and after 12 months of implementation facilitation (time 2) from the perspective of providers. Methods We conducted semi-structured interviews to assess the extent to which six CCM elements were in place: work role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and organizational/leadership support. Interviews were transcribed and a priori CCM elements were coded using a directed content analysis approach at times 1 and 2. We sought consensus on, and compared, the extent to which each CCM element was in place at times 1 and 2. Results We conducted 27 and 31 telephone interviews at times 1 and 2, respectively, with outpatient mental health providers at nine participating sites. At time 1 and time 2, three CCM elements were most frequently present across the sites: work role redesign, patient self-management support, and provider decision support. The CCM elements with increased implementation from time 1 to time 2 were work role redesign, patient self-management support, and clinical information systems. For two CCM elements, linkages to community resources and organizational/leadership support, some sites had increased implementation at time 2 compared to time 1, while others had reductions. For the provider decision support element, we saw little change in the extent of its implementation. Conclusions Sites increased the extent of implementation on several CCM elements. The most progress was made in the CCM elements where sites had CCM-aligned processes in place at time 1. Teams made progress on elements they could more easily control, such as work role redesign. Our results suggest that maximizing the benefits of CCM-based outpatient mental health care may require targeting resources and training toward specific CCM elements—especially in the use of clinical information systems and linking with community resources. Trial registration Clinical Trials NCT02543840.

scholarly journals Collaborative Chronic Care Model Implementation within Outpatient Behavioral Health Care Teams: Qualitative Results from a Multisite Trial using Implementation Facilitation

2020 ◽  
Author(s):  
Jennifer L Sullivan ◽  
Bo Kim ◽  
Christopher Miller ◽  
A. Rani Elwy ◽  
Karen Drummond ◽  
...  
Keyword(s):  
Mental Health ◽  
Information Systems ◽  
Clinical Information ◽  
Self Management ◽  
Clinical Information Systems ◽  
Work Role ◽  
Community Resources ◽  
Management Support ◽  
Outpatient Mental Health ◽  
Leadership Support

Abstract Background: This paper reports on a qualitative evaluation of a hybrid II stepped-wedge trial using implementation facilitation to implement team-based care in the form of the Collaborative Chronic Care Model (CCM) in interdisciplinary outpatient mental health teams. The objective of this study was to compare the alignment of sites’ clinical processes with the CCM elements at baseline (Time 1) and after 12 months of implementation facilitation (Time 2) from the perspective of providers.Methods: We conducted semi-structured interviews to assess the extent to which six CCM elements were in place: work role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and organizational/leadership support. Interviews were transcribed and a priori CCM elements were coded using a directed content analysis approach at Time 1 and 2. We sought consensus on, and compared, the extent to which each CCM element was in place at Times 1 and 2.Results: We conducted 27 and 31 telephone interviews at Times 1 and 2, respectively, with outpatient mental health providers at nine participating sites. At Time 1 and Time 2, three CCM elements were most frequently present across the sites: work role redesign, patient self-management support, and provider decision support. The CCM elements with increased implementation from Time 1 to Time 2 were: work role redesign, patient self-management support, and clinical information systems. For two CCM elements, linkages to community resources and organizational/leadership support, some sites had increased implementation at Time 2 compared to Time 1, while others had reductions.Conclusions: Sites increased the extent of implementation on several CCM elements. The most progress was made in the CCM elements where sites had CCM-aligned processes already in place at Time 1. Teams made progress on elements they could more easily control, such as work role redesign. Our results suggest that maximizing the benefits of CCM-based outpatient mental health care may require targeting resources and training toward specific CCM elements—especially in the use of clinical information systems and linking with community resources. Trial Registration: Clinical Trials NCT02543840Registered 7 September 2015.

Organizational Factors Associated With Self-management Behaviors in Diabetes Primary Care Clinics

2009 ◽  
Vol 35 (5) ◽  
pp. 843-850 ◽  
Author(s):  
Amer A. Kaissi ◽  
Michael Parchman
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Medication Adherence ◽  
Support System ◽  
Clinical Information ◽  
Organizational Characteristics ◽  
Self Management ◽  
Management Support ◽  
Primary Care Clinics ◽  
Management Behaviors

Purpose The purpose of this article is to examine the relationship between organizational characteristics as measured by the Chronic Care Model (CCM) and patient self-management behaviors among patients with type 2 diabetes. Methods The study design was cross-sectional. The study setting included 20 primary care clinics from South Texas. The sample included approximately 30 consecutive patients that were enrolled from each clinic for a sample of 617 patients. For the data collection procedures, the CCM survey was completed by caregivers in the clinic. Self-management behaviors were obtained from patient exit surveys. For measures, the CCM consisted of 6 structural dimensions: (1) organization support, (2) community linkages, (3) self-management support, (4) decision support system, (5) delivery system design, and (6) clinical information systems. Patient self-management behavior included whether the patient reported always doing all 4 of the following behaviors as they were instructed: (1) checking blood sugars, (2) following diabetes diet, (3) exercising, and (4) taking medications. For data analyses, to account for clustering of patients within clinics, hierarchical logistic regression models were used. Results Self-management support was positively associated with medication adherence, while decision support system was positively associated with exercise and all 4 self-management behaviors. Surprisingly, community linkages were negatively associated with medication adherence, while clinical information system was negatively associated with diet and all 4 behaviors. A total score, including all dimensions, was positively associated with only exercise. Conclusions Health care providers and diabetes educators in primary care clinics should consider how organizational characteristics of the clinic might influence self-management behaviors of patients. The focus should be on better access to evidence-based information at the point of care and self-management needs and activities.

scholarly journals THE USAGE OF MEDICAL INFORMATICS IN CRITICAL CARE MEDICINE

2017 ◽  
Vol 1 (4) ◽  
pp. 100-101
Author(s):  
Marsa Gholamzadeh ◽  
Hamidreza Abtahi
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Decision Support ◽  
Information Systems ◽  
Medical Informatics ◽  
Clinical Information ◽  
Clinical Information Systems ◽  
Quality Of Patient Care ◽  
The World

Introduction: The intensive care unit can be defined as a complex system that composed of clinical informations, tasks and knowledge. It is also one of the most stressful and most vital parts of healthcare centers which involve a huge amount of information and clinical data daily. These informations should be analyzed and managed in the best way as soon as possible to restore patients to normal by health professionals. Accurate and timely diagnosis, the best treatment and to avoid any possible error in this section can be equivalent to achieve the best possible result and reducing the length of hospitalization and mortality. As a result, due to the complex nature of the critical care and the mass of clinical data; using a combination of medical knowledge with the latest technologies and use of medical informatics capabilities can be the best way to reduce the workload of the sector and improve the quality of patient care. Methods: A systematic search was conducted on the PubMed/MEDLINE, web of science, BMJ, ScienceDirect, and Scopus database for finding studies that have related to critical care and usage of informatics or medical informatics. The collected data and results are summarized by researchers and the results analyzed based on similarities and differences. Results: With increased development of medical informatics and electronic systems has led to substantial progress in the field of critical care since 1980 till now around the world. Several articles, research projects has published. From 1981 to 2016 almost 600 scientific papers were found which included reports, posters and thesis written in context of critical care medical informatics. More than 65 percent of these studies is about designing CDSS in this field. Today, many of these systems are used in medical centers around the world and lead to improving the quality of patient care and reduce medical errors in intensive care units. Among these 600 papers, 230 articles related to our issue in fields of the design of electronic records, clinical information systems, decision support systems, data mining, telemedicine, smart analysis of clinical information and knowledge extraction techniques were selected as the main source of this study. Conclusion: According to results of our study, it seems that critical care is potentially a valuable resource for medical informatics researches. The applied of medical informatics in the different fields of the diagnosis, interpretation, and treatment in different countries have improved the quality of care for patients in critical care field. We can mention some common fields which used such as infection control and early detection in intensive care units, clinical information systems, and CPOE and decision support systems such as APACHE system for grading the severity of illness of patients who hospitalized and even telemedicine. Since this area of research has not been a field of interest in Iran yet, it seems that this study with the aim of review the application of medical informatics in different countries could lead to practical researches in this field.

scholarly journals Integrating evidence into clinical information systems for nursing decision support

2008 ◽  
Vol 77 (6) ◽  
pp. 413-420 ◽  
Author(s):  
Suzanne Bakken ◽  
Leanne M. Currie ◽  
Nam-Ju Lee ◽  
W. Dan Roberts ◽  
Sarah A. Collins ◽  
...  
Keyword(s):  
Decision Support ◽  
Information Systems ◽  
Clinical Information ◽  
Clinical Information Systems

Effectivness of Health Information System Applications: Clinical Information and Diagnosis-Treatment Systems in Turkey

2017 ◽  
Vol 5 (1) ◽  
pp. 122
Author(s):  
Assist. Prof. Dr. Demokaan DEMİREL
Keyword(s):  
Decision Making ◽  
Information System ◽  
Information Systems ◽  
Management Information System ◽  
Health Sector ◽  
Health Information System ◽  
Clinical Information ◽  
Clinical Decision ◽  
Clinical Information Systems ◽  
Management Information

The distinctive quality of the new social structure is that information becomes the only factor of production. In today's organizations, public administrators are directly responsible for applying information to administrative processes. In addition to his managerial responsibilities, a knowledge based organization requires every employee to take responsibility for achieving efficiency. This has increased the importance of information systems in the decision-making process. Information systems consist of computer and communication technology, data base management and model management and include activity processing system, management information system, decision support systems, senior management information system, expert systems and office automation systems. Information systems in the health sector aim at the management and provision of preventive and curative health services. The use of information systems in healthcare has the benefits of increasing service quality, shortening treatment processes, maximizing efficiency of the time, labour and medical devices. The use of information systems for clinical decision making and reducing medical errors in the healthcare industry dates back to the 1960s. Clinical information systems involve processing, storing and re-accessing information that supports patient care in a hospital. Clinical information systems are systems that are directly or indirectly related to patient care. These systems include electronic health/patient records, clinical decision support systems, nurse information systems, patient tracking systems, tele-medicine, case mix and smart card applications. Diagnosis-treatment systems are information-based systems used in the diagnosis and treatment of diseases. It consists of laboratory information systems, picture archiving and communication system, pharmacy information system, radiology information system, nuclear medicine information system. This study aims to evaluate the effectiveness of health information system applications in Turkey. The first part of the study focuses on the concept of information systems and the types of information systems in organization structures. In the second part, clinical information systems and applications for diagnosis-treatment systems in Turkey are examined. Finally, the study evaluates applications in the health sector qualitatively from the new organizational structure, which is formed by information systems.

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