Care coordination challenges between a high-volume center and rural physicians treating patients with pancreatic cancer.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 58-58
Author(s):  
Matthew DePuccio ◽  
Natasha Kurien ◽  
Angela Sarna ◽  
Ann Scheck McAlearney ◽  
Aslam Ejaz
Keyword(s):  
Pancreatic Cancer ◽  
Care Coordination ◽  
High Volume ◽  
Data Systems ◽  
Structured Interviews ◽  
Care Coordinator ◽  
Rural Physicians ◽  
Treatment Plans ◽  
Team Based Care ◽  
Rural Patients

58 Background: Pancreatic cancer (PC) patients treated at high-volume centers (HVCs) benefit from specialty services that may not be accessible to rural patients: complex treatment planning, advanced surgical and chemo-radiation options, and multidisciplinary team-based care. As a result, rural PC patients often seek treatment at multiple locations for different episodes of care (i.e., chemotherapy and surgery). The facilitators and barriers to coordinating care between rural physicians and HVCs for rural PC patients treated by both types of providers are not well-understood. Methods: We conducted semi-structured interviews with PC specialists (medical, surgical, and radiation oncologists, n = 9) at a HVC (The Ohio State University) actively treating and co-managing rural PC patients with rural physicians. Using rigorous qualitative methods, two co-authors independently coded the interview transcripts to develop a thematic account of HVC-rural physician care coordination barriers and facilitators. Results: Initial interactions between PC specialists and rural PC patients often require duplication of diagnostic testing (i.e., imaging) due to inadequate transfer of medical records at the time of consultation. This is partly due to inefficient phone communication between HVCs and rural physicians. Such inefficiencies often discourage two-way communication between HVCs and rural physicians, and this can hinder development of a shared understanding of patients’ treatment plans. Specialists suggested a dual-approach may help to improve care coordination in this context: (a) developing better personal relationships with rural physicians to facilitate information-sharing and “closing-the-loop” on patients’ treatment plans; and (b) implementing data systems that permit physicians to share patients’ records across organizations. Several specialists acknowledged the benefit of having a dedicated care coordinator who could help patients connect with specialists, navigate the different healthcare systems, and relay information between providers. Conclusions: Given the challenges that can complicate the PC treatment process for rural patients, it is important to consider opportunities to address these issues. Taking steps to improve efficiency in communication may help facilitate the development of cohesive treatment plans and promote team-based care. Further studies are needed to examine the effects of care coordination interventions, like the use of care coordinators, on improving care for rural PC patients.

Multidisciplinary care for rural pancreatic cancer patients: Providers’ perspectives about patients’ challenges navigating between rural healthcare settings and high-volume centers.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 116-116
Author(s):  
Natasha Kurien ◽  
Matthew DePuccio ◽  
Angela Sarna ◽  
Ann Scheck McAlearney ◽  
Aslam Ejaz
Keyword(s):  
Pancreatic Cancer ◽  
Support Groups ◽  
Treatment Plan ◽  
Multidisciplinary Care ◽  
High Volume ◽  
Additional Stress ◽  
Structured Interviews ◽  
Rural Healthcare ◽  
Major Barrier ◽  
Healthcare Settings

116 Background: Multidisciplinary care from high-volume centers (HVCs) improves outcomes for patients with pancreatic cancer (PC). However, rural PC patients lack access to high-volume PC specialists, resulting in the need for them to travel to distant HVCs for specialized treatment. The barriers and challenges rural PC patients face when seeking care at distant HVCs is poorly understood. Methods: We conducted semi-structured interviews with PC specialists (medical, surgical, and radiation oncologists, n = 9) at a HVC (The Ohio State University) actively treating and co-managing rural PC patients with rural physicians. Using rigorous qualitative methods, two coders independently coded the interview transcripts to develop a thematic account of challenges rural PC patients encounter when receiving care at distant HVCs. Results: PC specialists commonly identified transportation as a major barrier they believed their rural PC patients experienced, and noted both the distance these patients needed to travel and difficulties patients reported in navigating major cities to receive care at HVCs. Similarly, providers commented that rural PC patients and their families reported having difficulty finding affordable lodging near HVCs sometimes resulting in the need for frequent and inconvenient back-and-forth travel between the HVC and the patient’s home. One interviewee stressed the importance of health literacy and the need for providers to improve physician-patient communication as well as provide resources to help rural PC patients better understand their condition and recommended treatment plan. PC specialists also indicated that some rural PC patients had expressed discomfort about contacting physicians outside their in-person clinic visits. They also reported that the possible duplication of services such as diagnostic imaging that could occur may result in increased financial stress for their patients. Conclusions: PC specialists noted several challenges they perceived their rural PC patients may face when navigating care between rural healthcare settings and HVCs. Notably, these challenges may both impact the delivery of high-quality multidisciplinary care and cause additional stress for rural PC patients. Future studies should examine how interventions (e.g., patient navigators, support groups, educational resources) aimed specifically at addressing barriers to multidisciplinary PC care for rural PC patients can be designed and implemented.

scholarly journals Involving Patients with Multimorbidity in Service Planning: Perspectives on Continuity and Care Coordination

2016 ◽  
Vol 6 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Michaela L. Schiøtz ◽  
Dorte Høst ◽  
Anne Frølich
Keyword(s):  
Care Coordination ◽  
Patient Preferences ◽  
Planning Process ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Development Project ◽  
Service Planning ◽  
University Hospital ◽  
Structured Interviews ◽  
Care Coordinator

Background The prevalence of multiple comorbid chronic conditions, or multimorbidity, is increasing. Care provided to people with multimorbidity is often fragmented, incomplete, inefficient, and ineffective. As part of a research and development project focusing on improving care, we sought to involve patients with multimorbidity in the planning process. Objective To identify opportunities for improving care by understanding how patients from a Danish University Hospital experience care coordination. Design Qualitative semi-structured interviews with 14 patients with multimorbidity. Results Patients with multimorbidity described important concerns about care that included: (1) disease-centered, rather than patient-centered, care; (2) lack of attention to comorbidities and patient preferences and needs; and (3) involvement of numerous healthcare providers with limited care coordination. Poor continuity of care resulted in lack of treatment for complex problems, such as pain and mental health issues, medication errors, adverse events, and a feeling of being lost in the system. Receiving care from generalists (e.g. general practitioners and healthcare professionals at prevention centers) and having a care coordinator seemed to improve patients’ experience of continuity and coordination of care. Suggestions for service improvements when providing care for people with multimorbidity included using care coordinators, longer consultation times, consultations specifically addressing follow-up on prescribed medications, and shifting the focus of care from disease states to patients’ overall health status. Conclusions A need exists for a reorganization of care delivery for people with multimorbidity that focuses on improved care coordination and puts patient preferences at the center of care.

scholarly journals Effects of COVID-19 Pandemic on the Treatment of Pancreatic Cancer: A Perspective from Central Europe

2021 ◽  
Vol 38 (2) ◽  
pp. 158-165
Author(s):  
Ilaria Pergolini ◽  
I. Ekin Demir ◽  
Christian Stöss ◽  
Klaus Emmanuel ◽  
Robert Rosenberg ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Central Europe ◽  
Pancreatic Surgery ◽  
Online Survey ◽  
Viral Infections ◽  
High Volume ◽  
Tumor Board ◽  
Standards Of Care ◽  
The Impact

Background: This survey aimed to register changes determined by the COVID-19 pandemic on pancreatic surgery in a specific geographic area (Germany, Austria, and Switzerland) to evaluate the impact of the pandemic and obtain interesting cues for the future. Methods: An online survey was designed using Google Forms focusing on the local impact of the pandemic on pancreatic surgery. The survey was conducted at 2 different time points, during and after the lockdown. Results: Twenty-five respondents (25/56) completed the survey. Many aspects of oncological care have been affected with restrictions and delays: staging, tumor board, treatment selection, postoperative course, adjuvant treatments, outpatient care, and follow-up. Overall, 60% of respondents have prioritized pancreatic cancer patients according to stage, age, and comorbidities, and 40% opted not to operate high-risk patients. However, for 96% of participants, the standards of care were guaranteed. Discussion/Conclusions: The first wave of the COVID-19 pandemic had an important impact on pancreatic cancer surgery in central Europe. Guidelines for prompt interventions and prevention of the spread of viral infections in the surgical environment are needed to avoid a deterioration of care in cancer patients in the event of a second wave or a new pandemic. High-volume centers for pancreatic surgery should be preferred and their activity maintained. Virtual conferences have proven to be efficient during this pandemic and should be implemented in the near future.

scholarly journals How are patients with rare diseases and their carers in the UK impacted by the way care is coordinated? An exploratory qualitative interview study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Amy Simpson ◽  
Lara Bloom ◽  
Naomi J. Fulop ◽  
Emma Hudson ◽  
Kerry Leeson-Beevers ◽  
...  
Keyword(s):  
Care Coordination ◽  
Structured Interviews ◽  
School Work ◽  
Travel Costs ◽  
Care Plans ◽  
Use Of Technology ◽  
Number Of Factors ◽  
Qualitative Interview Study ◽  
The Uk ◽  
The Impact

Abstract Background Care coordination is considered important for patients with rare conditions, yet research addressing the impact of care coordination is limited. This study aimed to explore how care coordination (or lack of) impacts on patients and carers. Semi-structured interviews were conducted with 15 patients and carers/parents in the UK, representing a range of rare conditions (including undiagnosed conditions). Transcripts were analysed thematically in an iterative process. Results Participants described a range of experiences and views in relation to care coordination. Reports of uncoordinated care emerged: appointments were uncoordinated, communication between key stakeholders was ineffective, patients and carers were required to coordinate their own care, and care was not coordinated to meet the changing needs of patients in different scenarios. As a result, participants experienced an additional burden and barriers/delays to accessing care. The impacts described by patients and carers, either attributed to or exacerbated by uncoordinated care, included: impact on physical health (including fatigue), financial impact (including loss of earnings and travel costs), and psychosocial impact (including disruption to school, work and emotional burden). Overall data highlight the importance of flexible care, which meets individual needs throughout patients’/carers’ journeys. Specifically, study participants suggested that the impacts may be addressed by: having support from a professional to coordinate care, changing the approach of clinics and appointments (where they take place, which professionals/services are available and how they are scheduled), and improving communication through the use of technology, care plans, accessible points of contact and multi-disciplinary team working. Conclusion This study provides further evidence of impacts of uncoordinated care; these may be complex and influenced by a number of factors. Approaches to coordination which improve access to care and lessen the time and burden placed on patients and carers may be particularly beneficial. Findings should influence future service developments (and the evaluation of such developments). This will be achieved, in the first instance, by informing the CONCORD Study in the UK.

An investigation of the mass-market fashion design process

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Prabod Dharshana Munasinghe ◽  
D.G.K. Dissanayake ◽  
Angela Druckman
Keyword(s):  
Design Process ◽  
Market Design ◽  
High Volume ◽  
Design Stage ◽  
Fashion Design ◽  
Structured Interviews ◽  
Mass Market ◽  
Content Type ◽  
Responsible Consumption ◽  
The Impact

Purpose The process of fashion design varies between market segments, yet these variations have not yet been properly explored. This study aims to examine the fashion design process as practised at the mass-market level, as this is the most vibrant and the largest market segment in terms of production volumes and sales. Design/methodology/approach It is observed that 15 semi-structured interviews were conducted with mass-market fashion designers. Key activities of the mass-market design process were identified and a comparative analysis was conducted with the general design process. Findings The mass-market design process is found to prioritise profits rather than aesthetic aspects, with the buyer exercising more power than the designer. This hinders creativity, which, in turn, may impede a move towards more environmentally benign designs. Originality/value The clothing industry is responsible for high environmental impacts and many of these impacts arise through decisions made in the design stage. In particular, the mass-market for clothing because of its high volume of sales and fast throughput, accounts for a great deal of the impact. However, little is understood about the design process that is practised in the mass-fashion market. This paper fills the gap by developing a framework that describes the mass-market design process. Understanding the design process will enable progress to be made towards achieving the United Nations Sustainable Development Goal 12: Responsible Consumption and Production.

Staff Perceptions of Implementation of a Team-Based Model of Patient-Centered Primary Care

2015 ◽  
Vol 4 (4) ◽  
pp. 244-250
Author(s):  
Sherri L LaVela ◽  
Jennifer N Hill
Keyword(s):  
Primary Care ◽  
Team Building ◽  
Organizational Factors ◽  
Care Staff ◽  
Health Care Staff ◽  
Structured Interviews ◽  
Implementation Barriers ◽  
Patient Centered ◽  
Optimal Care ◽  
Team Based Care

Objectives. Patient-Aligned Care Teams (PACTs) aim to reorganize primary care by putting the patient at the center of the care team that includes family and health care staff; embodying patient-centered care (PCC). Team members share information, and work together in a synergistic, supportive way to provide optimal care based on mutually negotiated goals to meet patient needs. Our objective was to evaluate the process, barriers, and facilitators to implementing PACT as part of a VA quality improvement effort.Study Design/Methods. Semi-structured interviews were conducted, transcribed verbatim and analyzed with constant comparative techniques using constructs from implementation and organizational frameworks. Respondent demographic and position-level data were also collected. Data were collected in 2013.Results. A purposive sample of 35 key leaders and staff involved in implementing and/or participating in PACT at VA facilities participated. Implementation barriers included: failure to gain staff buy-in for PACT early on and to alleviate existing concerns about time and resources, incongruent performance measurement, and lack of defined role/responsibilities. Implementation facilitators included: training and engaging staff in PCC delivery and support for team-building.Conclusions. Team-based approaches to care have strong literature support; less is known about implementation. This study provides insight into the implementation of team-based care. Implementation of a team-based care model should include staff preparation and support (awareness, education, and encouragement) in advance. Once implemented, continued attention to team-building efforts and staff engagement are needed for sustainability. Healthcare organizations must understand and address multiple organizational factors to successfully implement team-based care that leads to systemic and sustainable PCC delivery.

scholarly journals Care coordination guidelines for the care of people with spina bifida

2020 ◽  
Vol 13 (4) ◽  
pp. 499-511
Author(s):  
Alexander Van Speybroeck ◽  
Patricia Beierwaltes ◽  
Betsy Hopson ◽  
Suzanne McKee ◽  
Lisa Raman ◽  
...  
Keyword(s):  
Health Care ◽  
Spina Bifida ◽  
Patient Care ◽  
Care Coordination ◽  
Health Care Services ◽  
Treatment Plan ◽  
Age Groups ◽  
Multidisciplinary Care ◽  
Shared Responsibility ◽  
Care Coordinator

Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a person’s care to facilitate the appropriate delivery of health care services. Organizing care involves the marshalling of personnel and other resources needed to carry out all required patient care activities. It is often managed by the exchange of information among participants responsible for different aspects of care [1]. With an estimated 85% of individuals with Spina Bifida (SB) surviving to adulthood, SB specific care coordination guidelines are warranted. Care coordination (also described as case management services) is a process that links them to services and resources in a coordinated effort to maximize their potential by providing optimal health care. However, care can be complicated due to the medical complexities of the condition and the need for multidisciplinary care, as well as economic and sociocultural barriers. It is often a shared responsibility by the multidisciplinary Spina Bifida team [2]. For this reason, the Spina Bifida Care Coordinator has the primary responsibility for overseeing the overall treatment plan for the individual with Spina Bifida[3]. Care coordination includes communication with the primary care provider in a patient’s medical home. This article discusses the Spina Bifida Care Coordination Guideline from the 2018 Spina Bifida Association’s Fourth Edition of the Guidelines for the Care of People with Spina Bifida and explores care coordination goals for different age groups as well as further research topics in SB care coordination.

Formal Service Practitioners' Views of Family Caregivers' Responsibilities and Difficulties

2006 ◽  
Vol 25 (1) ◽  
pp. 43-53 ◽  
Author(s):  
Nancy Guberman ◽  
Jean-Pierre Lavoie ◽  
Jacinthe Pepin ◽  
Sylvie Lauzon ◽  
Maria-Elisa Montejo
Keyword(s):  
Family Relations ◽  
Structured Interviews ◽  
Apparent Contradiction ◽  
High Expectations ◽  
Formal Service ◽  
The Family ◽  
Treatment Plans ◽  
Multiple Case ◽  
Negative Impacts ◽  
Case Design

ABSTRACTThis article identifies home care practitioners' perceptions of the responsibilities, difficulties, and needs for support of caregivers. It is based on a study undertaken in Quebec with 55 practitioners and 10 administrators from 10 CLSCs located in rural, urban, and metropolitan areas. The study had a qualitative, multiple-case design and used logs recording all contact with caregivers in the space of a week, followed by semi-structured interviews. Analysis reveals that practitioners tend to perceive the work of caregivers as mainly instrumental and clinical, ignoring the family relations that tie them to their relative. Although aware of the difficulties facing caregivers and the negative impacts of caregiving, a majority of practitioners have high expectations of caregiver participation in treatment plans, albeit as quasi-nurse's aides. Our analysis offers an explanation for this apparent contradiction by examining practitioners' values with regard to family responsibility for care.

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